Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews
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Abstract
Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. Objective: This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. Methods: We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. Results: We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. Conclusions: Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074.
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Randomized controlled trials evaluating mHealth for promoting smoking cessation, physical activity, dietary improvement, alcohol reduction, and weight loss have had inconclusive findings.
“Despite numerous randomized controlled trials evaluating the effectiveness of mHealth for promoting smoking cessation, physical activity, dietary improvement, alcohol consumption reduction, and weight loss, the findings have been inconclusive.”
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- Authors
- Gold, N., Yau, A., Rigby, B., Dyke, C., Remfry, E. A., & Chadborn, T.
- Affiliations
- Public Health England (GB)
- University of Cambridge (GB)
- Durham University (GB)
- University of Copenhagen (DK)
- Corresponding author
- Gold, Natalie
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2021-05-14
- Volume
- 23
- Issue
- 5
- Pages
- e19688
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC8164125
- OpenAlex
- W3161759293
- Cited by
- 56
- References
- 115
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 11 · 2023: 14 · 2022: 6 · 2021: 2
- FWCI
- 1.70
- 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)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- Durham Research Online (Durham University) (acceptedVersion, other-oa)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion, cc-by)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- Public Health England
- Centre for Diet and Activity Research
- Medical Research Council
- Economic and Social Research Council (2084476)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- digital health interventions, cardiovascular disease prevention, behavioral risk factors, physical activity, smoking cessation, alcohol consumption, diet, mobile health, online intervention, intervention delivery mode, medication adherence, attrition, effect size, non-compliance
- MeSH terms
- Systematic Reviews as Topic, Adult, Cardiovascular Diseases, Diet, Humans, Exercise, Cell Phone
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