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手机干预在改善健康结果方面的比较效果:荟萃分析评价。

The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review.

机构信息

Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University, Fort Worth, TX, United States.

Department of Communication and Media, University of Missouri-St. Louis, St. Louis, MO, United States.

出版信息

JMIR Mhealth Uhealth. 2019 Apr 3;7(4):e11244. doi: 10.2196/11244.


DOI:10.2196/11244
PMID:30942695
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6468337/
Abstract

BACKGROUND: As mobile technology continues expanding, researchers have been using mobile phones to conduct health interventions (mobile health-mHealth-interventions). The multiple features of mobile phones offer great opportunities to disseminate large-scale, cost-efficient, and tailored messages to participants. However, the interventions to date have shown mixed results, with a large variance of effect sizes (Cohen d=-0.62 to 1.65). OBJECTIVE: The study aimed to generate cumulative knowledge that informs mHealth intervention research. The aims were twofold: (1) to calculate an overall effect magnitude for mHealth interventions compared with alternative interventions or conditions, and (2) to analyze potential moderators of mHealth interventions' comparative efficacy. METHODS: Comprehensive searches of the Communication & Mass Media Complete, PsycINFO, Web of Knowledge, Academic Search Premier, PubMed and MEDLINE databases were conducted to identify potentially eligible studies in peer-reviewed journals, conference proceedings, and dissertations and theses. Search queries were formulated using a combination of search terms: "intervention" (Title or Abstract) AND "health" (Title or Abstract) AND "phone" OR "black-berr*" (OR mHealth OR "application*" OR app* OR mobile OR cellular OR "short messag*" OR palm* OR iPhone* OR MP3* OR MP4* OR iPod*) (Title or Abstract). Cohen d was computed as the basic unit of analysis, and the variance-weighted analysis was implemented to compute the overall effect size under a random-effects model. Analysis of variance-like and meta-regression models were conducted to analyze categorical and continuous moderators, respectively. RESULTS: The search resulted in 3424 potential studies, the abstracts (and full text, as necessary) of which were reviewed for relevance. Studies were screened in multiple stages using explicit inclusion and exclusion criteria, and citations were evaluated for inclusion of qualified studies. A total of 64 studies were included in the current meta-analysis. Results showed that mHealth interventions are relatively more effective than comparison interventions or conditions, with a small but significant overall weighted effect size (Cohen d=0.31). In addition, the effects of interventions are moderated by theoretical paradigm, 3 engagement types (ie, changing personal environment, reinforcement tracking, social presentation), mobile use type, intervention channel, and length of follow-up. CONCLUSIONS: To the best of our knowledge, this is the most comprehensive meta-analysis to date that examined the overall effectiveness of mHealth interventions across health topics and is the first study that statistically tested moderators. Our findings not only shed light on intervention design using mobile phones, but also provide new directions for research in health communication and promotion using new media. Future research scholarship is needed to examine the effectiveness of mHealth interventions across various health issues, especially those that have not yet been investigated (eg, substance use, sexual health), engaging participants using social features on mobile phones, and designing tailored mHealth interventions for diverse subpopulations to maximize effects.

摘要

背景:随着移动技术的不断发展,研究人员一直在利用手机开展健康干预(移动医疗-mHealth 干预)。手机的多种功能为向参与者大规模、高效且定制化地传播信息提供了绝佳机会。然而,迄今为止的干预措施效果不一,效应量的差异很大(Cohen d=-0.62 至 1.65)。

目的:本研究旨在为移动医疗干预研究提供累积知识。目的有两个:(1)计算移动医疗干预与其他干预或条件相比的总体效果大小;(2)分析移动医疗干预比较疗效的潜在调节因素。

方法:全面检索同行评议期刊、会议录、论文和论文中的潜在合格研究,检索数据库包括 Communication & Mass Media Complete、PsycINFO、Web of Knowledge、Academic Search Premier、PubMed 和 MEDLINE。使用术语组合制定查询词:“干预”(标题或摘要)和“健康”(标题或摘要)和“phone”或“black-berr*”(或 mHealth 或“application*”或 app或 mobile 或 cellular 或“short messag”或 palm或 iPhone或 MP3或 MP4或 iPod*)(标题或摘要)。Cohen d 被计算为基本分析单位,采用随机效应模型对方差加权分析进行计算,以计算总体效应大小。分别使用方差分析似然和元回归模型分析类别和连续调节因素。

结果:搜索结果产生了 3424 项潜在研究,对其摘要(如有必要,还有全文)进行了相关性审查。研究分多个阶段使用明确的纳入和排除标准进行筛选,并对引文进行评估以纳入合格研究。目前的荟萃分析共纳入 64 项研究。结果表明,移动医疗干预比对照干预或条件更有效,具有较小但显著的总体加权效应大小(Cohen d=0.31)。此外,干预效果还受到理论范式、3 种参与类型(即改变个人环境、强化跟踪、社交展示)、移动使用类型、干预渠道和随访时间的调节。

结论:据我们所知,这是迄今为止最全面的荟萃分析,考察了移动医疗干预在各种健康主题上的总体效果,也是第一个统计检验调节因素的研究。我们的研究结果不仅为利用手机进行干预设计提供了启示,还为使用新媒体进行健康传播和促进研究提供了新的方向。未来的研究需要检验移动医疗干预在各种健康问题上的效果,特别是那些尚未得到研究的问题(例如,药物使用、性健康),利用手机上的社交功能吸引参与者,并为不同的亚人群设计定制的移动医疗干预措施,以最大限度地提高效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb60/6468337/201d6f855c8d/mhealth_v7i4e11244_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb60/6468337/546defaa5c71/mhealth_v7i4e11244_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb60/6468337/201d6f855c8d/mhealth_v7i4e11244_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb60/6468337/546defaa5c71/mhealth_v7i4e11244_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb60/6468337/201d6f855c8d/mhealth_v7i4e11244_fig2.jpg

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本文引用的文献

[1]
The Impact of mHealth Interventions: Systematic Review of Systematic Reviews.

JMIR Mhealth Uhealth. 2018-1-17

[2]
Mobile Health Interventions for Improving Health Outcomes in Youth: A Meta-analysis.

JAMA Pediatr. 2017-5-1

[3]
Are Social Networking Sites Making Health Behavior Change Interventions More Effective? A Meta-Analytic Review.

J Health Commun. 2017-3

[4]
A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa.

BMC Med. 2017-2-6

[5]
Influence of a community-based stretching intervention on the health outcomes among Korean-Chinese female migrant workers in South Korea: A randomized prospective trial.

Jpn J Nurs Sci. 2017-10

[6]
A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial.

JMIR Mhealth Uhealth. 2016-6-22

[7]
A Theory-Based Exercise App to Enhance Exercise Adherence: A Pilot Study.

JMIR Mhealth Uhealth. 2016-6-15

[8]
Effectiveness of an App for Reducing Preoperative Anxiety in Children: A Randomized Clinical Trial.

JAMA Pediatr. 2016-8-1

[9]
The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults.

Int J Behav Nutr Phys Act. 2016-4-21

[10]
Telehealth to improve asthma control in pregnancy: A randomized controlled trial.

Respirology. 2016-3-31

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