Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
BMC Public Health. 2020 Oct 23;20(1):1605. doi: 10.1186/s12889-020-09700-7.
Electronic (eHealth) and mobile (mHealth) health interventions can provide a large coverage, and are promising tools to change health behavior (i.e. physical activity, sedentary behavior and healthy eating). However, the determinants of intervention effectiveness in primary prevention has not been explored yet. Therefore, the objectives of this umbrella review were to evaluate intervention effectiveness, to explore the impact of pre-defined determinants of effectiveness (i.e. theoretical foundations, behavior change techniques, social contexts or just-in-time adaptive interventions), and to provide recommendations for future research and practice in the field of primary prevention delivered via e/mHealth technology.
PubMed, Scopus, Web of Science and the Cochrane Library were searched for systematic reviews and meta-analyses (reviews) published between January 1990 and May 2020. Reviews reporting on e/mHealth behavior change interventions in physical activity, sedentary behavior and/or healthy eating for healthy subjects (i.e. subjects without physical or physiological morbidities which would influence the realization of behaviors targeted by the respective interventions) were included if they also investigated respective theoretical foundations, behavior change techniques, social contexts or just-in-time adaptive interventions. Included studies were ranked concerning their methodological quality and qualitatively synthesized.
The systematic search revealed 11 systematic reviews and meta-analyses of moderate quality. The majority of original research studies within the reviews found e/mHealth interventions to be effective, but the results showed a high heterogeneity concerning assessment methods and outcomes, making them difficult to compare. Whereas theoretical foundation and behavior change techniques were suggested to be potential positive determinants of effective interventions, the impact of social context remains unclear. None of the reviews included just-in-time adaptive interventions.
Findings of this umbrella review support the use of e/mHealth to enhance physical activity and healthy eating and reduce sedentary behavior. The general lack of precise reporting and comparison of confounding variables in reviews and original research studies as well as the limited number of reviews for each health behavior constrains the generalization and interpretation of results. Further research is needed on study-level to investigate effects of versatile determinants of e/mHealth efficiency, using a theoretical foundation and additionally explore the impact of social contexts and more sophisticated approaches like just-in-time adaptive interventions.
The protocol for this umbrella review was a priori registered with PROSPERO: CRD42020147902 .
电子（eHealth）和移动（mHealth）健康干预措施可以提供广泛的覆盖范围，并且是改变健康行为（即身体活动、久坐行为和健康饮食）的有前途的工具。然而，初级预防中干预效果的决定因素尚未得到探索。因此，本伞式综述的目的是评估干预效果，探讨预定义效果决定因素（即理论基础、行为改变技术、社会背景或即时自适应干预）的影响，并为初级预防领域通过电子/移动健康技术提供未来研究和实践的建议。
在 1990 年 1 月至 2020 年 5 月期间，检索了 PubMed、Scopus、Web of Science 和 Cochrane Library 中的系统评价和荟萃分析（综述）。如果综述报告了针对健康受试者的电子/移动健康行为改变干预措施，这些干预措施涉及身体活动、久坐行为和/或健康饮食，并且还调查了相应的理论基础、行为改变技术、社会背景或即时自适应干预措施，则将其纳入研究范围。纳入的研究根据其方法学质量进行了排名，并进行了定性综合。
系统搜索共发现了 11 篇质量中等的系统评价和荟萃分析。综述中大多数原始研究发现电子/移动健康干预措施是有效的，但结果表明评估方法和结果存在高度异质性，使得结果难以比较。虽然理论基础和行为改变技术被认为是有效干预措施的潜在积极决定因素，但社会背景的影响尚不清楚。综述中没有一项包括即时自适应干预措施。
本伞式综述的结果支持使用电子/移动健康来增强身体活动和健康饮食，减少久坐行为。综述和原始研究中普遍存在对混杂变量的报告和比较不精确，以及每种健康行为的综述数量有限，这限制了结果的推广和解释。需要进一步在研究层面上研究电子/移动健康效率的各种决定因素的影响，使用理论基础，并进一步探索社会背景的影响以及即时自适应干预等更复杂的方法。
本伞式综述的方案已预先在 PROSPERO 上注册：CRD42020147902 。
