Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Med Internet Res. 2020 Oct 28;22(10):e16774. doi: 10.2196/16774.
Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change.
This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change.
A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool.
A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score.
Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
数字干预措施对于健康行为改变是有效的，因为它们能够实现慢性非传染性疾病（NCD）的自我管理。然而，它们往往不能满足个人的具体或当前需求和偏好。一种替代方法是使用数字平台，该平台可以容纳一系列离散的、已有的数字健康干预措施。平台架构将允许用户随着时间的推移探索一系列基于证据的解决方案，以优化他们的自我管理和健康行为改变。
本综述旨在确定类似数字平台的干预措施，并研究它们在支持 NCD 自我管理和健康行为改变方面的潜力。
2020 年 1 月，使用 EBSCOhost、PubMed、Scopus 和 EMBASE 进行了文献检索。未发现数字平台，因此放宽了标准，包括类似数字平台的干预措施。合格的类似平台干预措施提供了一系列离散的、基于证据的健康行为改变功能，以优化成年人 NCD 的自我管理，并为用户提供数字化支持，引导他们使用最适合其需求和偏好的功能。干预措施的数据收集以 CONSORT-EHEALTH（电子和移动健康应用程序和在线远程医疗的报告试验的综合标准）清单为指导，包括有效性和过程结果的评估数据。使用混合方法评估工具评估纳入文献的质量。
共有 7 项研究被纳入综述。目标 NCD 包括心血管疾病（CVD；n=3）、糖尿病（n=3）和慢性阻塞性肺疾病（n=1）。基于随访响应者数量的平均依从率为 69%（SD 20%）。在 7 项研究中，4 项具有最高依从率（80%）的研究还遵循行为改变理论，并采用迭代的、以用户为中心的方法进行开发，优化干预措施的相关性。所有 7 项干预措施都提供了算法支持的用户指导工具，包括电子决策支持、与使用模式交互的智能功能以及行为改变阶段匹配工具。在 7 项研究中，有 6 项评估了行为的变化。报告了中高强度体力活动方面的显著效果，但对其他特定健康行为没有显著效果。然而，在专注于综合行为改变措施的研究中观察到了积极的行为改变，例如自我护理和自我管理，每个措施都涉及几个关键的生活方式风险因素（例如，药物依从性）。未发现心理社会结局（例如，生活质量）的显著差异。临床结局的显著变化主要与特定于疾病的多方面措施相关，例如临床疾病控制和心血管风险评分。
通过现有的基于证据的数字干预措施，迭代的、以用户为中心的数字平台结构的开发可以优化用户对自我管理支持的参与度。提供具有适当指导程度的一系列干预措施有可能促进特定疾病的健康行为改变和众多用户、病情或护理阶段的有效自我管理。
