Cited by 219Digital Mental Health InterventionsMobile Health and mHealth ApplicationsHealth Literacy and Information Accessibility

The DOI matches its Crossref record; 117 of the 117 references it cites were found in a registry or an index; none of the 120 sources its claims cite is checked for support yet.

Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress

Open access
Murray, Elizabeth·2012·Medicine 2.0

Abstract

The potential advantages of using the Internet to deliver self-care and behavior-change programs are well recognized. An aging population combined with the increasing prevalence of long-term conditions and more effective medical interventions place financial strain on all health care systems. Web-based interventions have the potential to combine the tailored approach of face-to-face interventions with the scalability of public health interventions that have low marginal costs per additional user. From a patient perspective, Web-based interventions can be highly attractive because they are convenient, easily accessible, and can maintain anonymity/privacy. Recognition of this potential has led to research in developing and evaluating Web-based interventions for self-management of long-term conditions and behavior change. Numerous systematic reviews have confirmed the effectiveness of some Web-based interventions, but a number of unanswered questions still remain. This paper reviews the progress made in developing and evaluating Web-based interventions and considers three challenging areas: equity, effectiveness, and implementation. The impact of Web-based interventions on health inequalities remains unclear. Although some have argued that such interventions can increase access to underserved communities, there is evidence to suggest that reliance on Web-based interventions may exacerbate health inequalities by excluding those on the "wrong" side of the digital divide. Although most systematic reviews have found a positive effect on outcomes of interest, effect sizes tend to be small and not all interventions are successful. Further work is needed to determine why some interventions work and others do not. This includes considering the "active ingredients" or mechanism of action of these complex interventions and the context in which they are used. Are there certain demographic, psychological, or clinical factors that promote or inhibit success? Are some behaviors or some clinical problems more amenable to change by computer-based interventions? Equally problematic is the issue of implementation and integration of such programs into routine clinical practice. Many eHealth projects end when the research is concluded and fail to become part of mainstream clinical care. One way of addressing these challenges is to apply the Medical Research Council framework for developing, evaluating, and implementing complex interventions. This includes having a strong theoretical foundation, developing a proposed mechanism or pathway of action, ensuring that the evaluation adequately reflects this proposed pathway, and considering implementation from the beginning of the development process.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review examines the potential, pitfalls, and progress of Web-based interventions for behavior change and self-management, focusing on three unresolved challenges: equity, effectiveness, and implementation. It argues that applying the Medical Research Council framework for complex interventions, together with greater use of theory, could help realize the field's potential.

Key findings

  • Web-based interventions have potential advantages in reach, accessibility, tailoring, and low marginal cost per user, but effect sizes in systematic reviews "tend to be small and not all interventions are successful."
  • Equity is unresolved: Internet penetration in 2011 was 11% in Africa, 24% in Asia, and 36% in Latin America/Caribbean; within the UK, access was 99% among households earning ≥£40,000 versus 43% at ≤£12,500, 95% among university graduates versus 31% among those who left school without graduating, <40% among those aged 65+, and 41% among those with work-limiting health problems or disabilities.
  • Effectiveness varies by outcome: reviews support effects for smoking cessation, alcohol reduction, safer sex, and physical activity, but a UK HTA review found little or no impact of adaptive e-learning on dietary behaviors and no impact on weight loss or BMI; CCBT is effective across mild-to-moderate depression, anxiety, OCD, and phobias, whereas non-CCBT emotional interventions (social networks, personal stories) lack robust evidence of benefit or harm.
  • A meta-analysis of ~85 studies covering >45,000 participants found that more extensive use of theory (particularly the Theory of Planned Behavior) and certain behavior-change techniques (eg, stress management, goal setting, action planning) were associated with larger effect sizes.

Methods

  • Design: narrative review/commentary, not a systematic review; no search strategy, inclusion criteria, or formal synthesis method is reported.
  • Scope: synthesizes existing systematic reviews, meta-analyses, and trials across self-management of long-term conditions, health promotion, and mental health, plus policy and implementation literature.
  • Analysis: thematic discussion organized around equity, effectiveness (cognitive, behavioral, emotional outcomes, mechanism of action, cost-effectiveness), and implementation, with recommendations framed by the MRC complex interventions framework and normalization process theory.

Limitations

  • The paper states that a number of unanswered questions remain, including why some interventions work and others do not, what the "active ingredients" and effective dose are, and which demographic, psychological, or clinical factors promote or inhibit success; data on user characteristics and adherence are described as "confusing and contradictory."
  • The paper states there is a paucity of data on actual cost-effectiveness of Internet interventions and a paucity of comparative data on online peer-support services.
  • Evident from the text (not framed as a limitation by the author): this is a single-author narrative review without a documented systematic search or quality appraisal, so selection of cited evidence may be non-exhaustive and subject to author perspective.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/med20.1741

Cites

117 of 117 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 120 cited sources checked · 0 supported · 0 flagged

Show all 44 claims

  • It may state two separate claims as one. 38
  • Probably not a substantial claim. 36
  • The quote only partly states this claim. 1
62 of 62
  • The paper relies on this without support.

    Normalization is important for sustainability.

    “Normalization is important for sustainability.”
1 of 1

Claims other papers make about this one

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Citations

Cites

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Show all 117 references

Research works printed but not linked: 5

  1. Corbin, JM, 1998, Unending Work and Care: Managing Chronic Illness at Home (Jossey Bass Social and Behavioral Science Series)
  2. Wangberg, SC, 2008, Patient Prefer Adherence, 2, 57
  3. 10.1267/meth03040366 · DOI
  4. 10.1267/meth03040297 · DOI
  5. Rasu, RS, 2010, Am J Manag Care, 16, e98

Cited by

Sorted by citations

Items 101–200 of 219

Metadata

Authors
Murray, E.
Affiliations
University College London (GB)
Corresponding author
Murray, Elizabeth
Venue
Medicine 2.0
Published
2012-08-14
Volume
1
Issue
2
Pages
e3
ISSN
1923-2195 (ISSN-L)
OpenAlex
W1990682749
Cited by
219
References
117
Citations by year
2026: 9 · 2025: 9 · 2024: 7 · 2023: 15 · 2022: 16 · 2021: 20 · 2020: 13 · 2019: 15 · 2018: 13 · 2017: 33 · 2016: 25 · 2015: 25 · 2014: 12 · 2013: 6 · 2012: 1
FWCI
19.86
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Medicine 2 0 (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
Keywords
online intervention, e-health, behavior change, self-management, chronic disease, self-care, digital divide, health disparities, implementation, complex interventions, MRC framework, mechanism of action, scalability, health care costs

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