Alkhaldi Ghadah, Hamilton Fiona L, Lau Rosa, Webster Rosie, Michie Susan, Murray Elizabeth
eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
J Med Internet Res. 2016 Jan 8;18(1):e6. doi: 10.2196/jmir.4790.
Digital interventions have been effective in improving numerous health outcomes and health behaviors; furthermore, they are increasingly being used in different health care areas, including self-management of long-term conditions, mental health, and health promotion. The full potential of digital interventions is hindered by a lack of user engagement. There is an urgent need to develop effective strategies that can promote users' engagement with digital interventions. One potential method is the use of technology-based reminders or prompts.
To evaluate the effectiveness of technology-based strategies for promoting engagement with digital interventions.
Cochrane Collaboration guidelines on systematic review methodology were followed. The search strategy was executed across 7 electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, the Education Resources Information Center (ERIC), PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Databases were searched from inception to September 13, 2013, with no language or publication type restrictions, using three concepts: randomized controlled trials, digital interventions, and engagement. Gray literature and reference lists of included studies were also searched. Titles and abstracts were independently screened by 2 authors, then the full texts of potentially eligible papers were obtained and double-screened. Data from eligible papers were extracted by one author and checked for accuracy by another author. Bias was assessed using the Cochrane risk of bias assessment tool. Narrative synthesis was performed on all included studies and, where appropriate, data were pooled using meta-analysis. All findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A total of 14 studies were included in the review with 8774 participants. Of the 14 studies, 9 had sufficient data to be included in the meta-analyses. The meta-analyses suggested that technology-based strategies can potentially promote engagement compared to no strategy for dichotomous outcomes (relative risk [RR] 1.27, 95% CI 1.01-1.60, I(2)=71%), but due to considerable heterogeneity and the small sample sizes in most studies, this result should be treated with caution. No studies reported adverse or economic outcomes. Only one study with a small sample size compared different characteristics; the study found that strategies promoting new digital intervention content and those sent to users shortly after they started using the digital intervention were more likely to engage users.
Overall, studies reported borderline positive effects of technology-based strategies on engagement compared to no strategy. However, the results have to be interpreted with caution. More research is needed to replicate findings and understand which characteristics of the strategies are effective in promoting engagement and how cost-effective they are.
数字干预在改善众多健康结果和健康行为方面已证明是有效的；此外，它们越来越多地应用于不同的医疗保健领域，包括长期疾病的自我管理、心理健康和健康促进。用户参与度的缺乏阻碍了数字干预的全部潜力。迫切需要制定有效的策略来促进用户对数字干预的参与。一种潜在的方法是使用基于技术的提醒或提示。
评估基于技术的策略在促进对数字干预的参与方面的有效性。
遵循Cochrane协作网关于系统评价方法的指南。检索策略在7个电子数据库中执行：Cochrane对照试验中心注册库（CENTRAL）、医学索引数据库（MEDLINE）、荷兰医学文摘数据库（Embase）、科学引文索引数据库（Web of Science）、教育资源信息中心（ERIC）、心理学文摘数据库（PsycINFO）以及护理学与健康相关文献累积索引数据库（CINAHL）。对数据库从创建到2013年9月13日进行检索，无语言或出版类型限制，使用三个关键词：随机对照试验、数字干预和参与度。还检索了灰色文献和纳入研究的参考文献列表。由2位作者独立筛选标题和摘要，然后获取潜在合格论文的全文并进行二次筛选。由一位作者提取合格论文的数据，并由另一位作者检查其准确性。使用Cochrane偏倚风险评估工具评估偏倚。对所有纳入研究进行叙述性综合分析，并在适当情况下使用荟萃分析合并数据。所有结果均按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告。
该评价共纳入14项研究，8774名参与者。在这14项研究中，9项有足够的数据可纳入荟萃分析。荟萃分析表明，与无策略相比，基于技术的策略在二分结局方面可能促进参与度（相对风险[RR]1.27，95%置信区间1.01 - 1.60，I² = 71%），但由于相当大的异质性以及大多数研究中的样本量较小，该结果应谨慎对待。没有研究报告不良或经济结局。只有一项小样本研究比较了不同特征；该研究发现，促进新数字干预内容的策略以及在用户开始使用数字干预后不久发送给用户的策略更有可能促使用户参与。
总体而言，与无策略相比，研究报告基于技术的策略对参与度有临界的积极影响。然而，结果必须谨慎解释。需要更多研究来重复这些发现，并了解策略的哪些特征在促进参与度方面有效以及它们的成本效益如何。
