UMR 6051, ARENES, EHESP, Paris, France.
EA 4360, APEMAC, Université de Lorraine, Nancy, France.
Public Health. 2019 Oct;175:8-18. doi: 10.1016/j.puhe.2019.06.011. Epub 2019 Jul 30.
The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness.
A scoping review according to PRIMSA-ScR checklist.
We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies.
Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps.
To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.
本综述的目的是分析研究移动健康应用程序（MHApps）有效性的研究人员如何评估这种有效性的条件。
根据 PRIMSA-ScR 清单进行范围综述。
我们对评估 MHApps 改变身体活动行为和饮食习惯的有效性的高内部有效性研究中的疗效/有效性条件进行了范围综述。我们使用了 PubMed、Web of Science、SPORTDiscus 和 PsycINFO 数据库，并根据 O'Malley 和 PRISMA-ScR 建议对综述进行了处理。我们选择了具有高内部有效性方法（随机对照试验、准实验研究、系统评价和荟萃分析）的研究，涉及饮食和/或身体活动行为；涵盖初级、二级或三级预防和涉及行为改变（摄入、维持）。我们排除了与高水平运动和远程医疗相关的 MHApps 文章。研究选择过程遵循了一个由两名独立评估研究的作者共同制定的方案。
最终选择并分析了 22 篇文章。我们注意到，支持行为改变的机制和技术的报告和研究很差。没有解释这些 MHApps 是如何工作的，以及它们如何可以转移或不转移。事实上，作者报告的主要疗效条件是指工具的实际方面。此外，社会不平等问题基本上被简化为对技术的获取（缩小获取差距），而且文化程度研究不足，尽管它是数字预防的一个重要考虑因素。总的来说，即使它们涉及行为，评估也侧重于工具而不是干预，并且不允许对 MHApps 进行全面评估。
为了了解 MHApps 在支持行为改变方面的附加值，似乎有必要借鉴与健康技术评估相关的范式，同时考虑技术的特点，以及借鉴与复杂干预措施相关的范式，同时考虑预防的特点。这种综合方法可以帮助澄清这些以患者为中心的 MHApps 是如何工作的，也是改善 MHApps 有效性、可转移性和可扩展性评估的一个条件。
