Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review
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Abstract
Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents.
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Digital health interventions enable the scale up of personalized and behavioral interventions at low cost.
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- Authors
- Brigden, A., Anderson, E., Linney, C., Morris, R., Parslow, R., Serafimova, T., Smith, L., Briggs, E., Loades, M., & Crawley, E.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Brigden, Amberly
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-07-31
- Volume
- 22
- Issue
- 7
- Pages
- e16924
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7428934
- OpenAlex
- W3026675645
- Cited by
- 63
- References
- 87
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 9 · 2023: 8 · 2022: 16 · 2021: 9 · 2020: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute for Health and Care Research (DRF-2017-10-169, DRF-2016-09-021, SRF-2013-06-013)
- Department of Health and Social Care
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Keywords
- digital interventions, behaviour change interventions, children with chronic illness, childhood obesity, childhood overweight, childhood anxiety, exergames, social media interventions, internet-based cognitive behavioral therapy, behaviour change techniques, parental involvement, therapist support, child-centered design, user experience, intervention development and evaluation, monitoring and feedback
- MeSH terms
- Internet-Based Intervention, Behavior Therapy, Child, Child, Preschool, Chronic Disease, Female, Humans, Male, Prospective Studies, Prevalence
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