Selection biases in technology-based intervention research: patients' technology use relates to both demographic and health-related inequities.

Objective: Researchers conduct studies with selection biases, which may limit generalizability and outcomes of intervention research. In this methodological reflection, we examined demographic and health characteristics of implantable cardioverter defibrillator patients who were excluded from an informatics intervention due to lack of access to a computer and/or the internet. Materials and Methods: Using information gathered from surveys and electronic health records, we compared the intervention group to excluded patients on demographic factors, computer skills, patient activation, and medical history. Results: Excluded patients were older, less educated, less engaged and activated in their health, and had worse health (ie, more medical comorbidities) than nonexcluded patients. Discussion: Although excluded from the intervention based solely on lack of access to a computer and/or internet, excluded patients may have needed the intervention more because they were sicker with more comorbidities. Conclusion: Researchers must be mindful of enrollment biases and demographic and health-related inequities that may exist during recruitment for technology-based interventions.