A new systematic review published in the Journal of the American Heart Association finds that internet and mobile interventions for diet, exercise, smoking, and alcohol overuse are, on the whole, effective -- but there are troubling gaps in the growing evidence base for these tools. First and foremost, researchers noticed a dearth of long-term studies; few lasted longer than a year. Second, they found studies were less likely to target at risk populations and used such a broad panel of outcome measures it was hard to compare one with another.
"We found that evidence on effectiveness of information and communication technologies mainly came from short‐term (< 6 months) experimental studies, with far less data on long‐term effectiveness or sustainability," researchers wrote. "Additionally, most studies were in high‐income countries and largely included volunteers who were generally more motivated and more educated than the general public. This could limit generalizability of findings, highlighting the need for more evidence from studies with longer duration of follow‐up ( > 1 year), from population subgroups (e.g., less educated, elderly) and from developing countries."
The seven authors, affiliated with all different universities inside and outside the United States, looked through more than 8,600 abstracts to identify 224 studies that fit their inclusion criteria. They looked for studies that dealt with internet and mobile lifestyle interventions for noncommunicable diseases, excluding studies lasting less than a week or having less than 50 participants.
The results that researchers were able to glean were encouraging. For studies of diet and adiposity, 69 percent of internet interventions, two out of three mobile interventions, and 81 percent of combined internet/mobile interventions showed significant improvements. For physical activity, 88 percent of internet interventions and 79 percent of personal sensor (pedometer or wearable) interventions had significant positive effects.
Results were less consistent for smoking cessation and alcohol overuse. Just 2 out of 7 mobile smoking interventions and 34 percent of internet drinking interventions had positive results.
The study also looked for lessons to be learned from which studies showed positive results and which didn't. They did identify a few best practices in different areas.
"We found that using evidence‐based behavioral change strategies could increase the effectiveness of internet and mobile interventions," researchers wrote. "For example, in studies of the diet and adiposity, interventions were more effective if adopting multiple modes of communication, using tailored messages, and integrating goal‐setting and self‐monitoring...We also found that interaction with providers could increase the success rate of the intervention. For example, in studies of smoking cessation, the interventions tended to be more effective if they included a direct interaction between smoker and healthcare provider. These findings could inform development of novel Internet and mobile interventions that are more effective and have a greater adherence rate."
