School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia.
J Med Internet Res. 2021 Dec 21;23(12):e23513. doi: 10.2196/23513.
Smoking tobacco, poor nutrition, risky alcohol use, and physical inactivity (SNAP) behaviors tend to cluster together. Health benefits may be maximized if interventions targeted multiple health risk behaviors together rather than addressing single behaviors. The internet has wide reach and is a sustainable mode for delivery of interventions for multiple health behaviors. However, no systematic reviews have examined the long-term effectiveness of internet-based interventions on any combination of or all SNAP behaviors in adults aged 18 years or older.
This systematic review examined, among adults (aged ≥18 years), the effectiveness of internet-based interventions on SNAP behaviors collectively in the long term compared with a control condition.
The electronic databases Medline, PsycINFO, Embase, CINAHL, and Scopus were searched to retrieve studies describing the effectiveness of internet-based interventions on ≥2 SNAP behaviors published by November 18, 2019. The reference lists of retrieved articles were also checked to identify eligible publications. The inclusion criteria were randomized controlled trials or cluster randomized controlled trials with adults examining an internet-based intervention measuring the effect on ≥2 SNAP behaviors at least 6 months postrecruitment and published in English in a peer-reviewed journal. Two reviewers independently extracted data from included studies and assessed methodological quality using the Quality Assessment Tool for Quantitative Studies. A robust variance estimation meta-analysis was performed to examine the long-term effectiveness of internet-based interventions on all 4 SNAP risk behavior outcomes. All SNAP outcomes were coded so they were in the same direction, with higher scores equating to worse health risk behaviors.
The inclusion criteria were met by 11 studies: 7 studies measured the effect of an internet-based intervention on nutrition and physical activity; 1 study measured the effect on smoking, nutrition, and physical activity; and 3 studies measured the effect on all SNAP behaviors. Compared with the control group, internet-based interventions achieved an overall significant improvement across all SNAP behaviors in the long term (standardized mean difference -0.12 [improvement as higher scores = worse health risk outcomes], 95% CI -0.19 to -0.05; I=1.5%, P=.01). The global methodological quality rating was "moderate" for 1 study, while the remaining 10 studies were rated as "weak."
Internet-based interventions were found to produce an overall significant improvement across all SNAP behaviors collectively in the long term. Internet-based interventions targeting multiple SNAP behaviors have the potential to maximize long-term improvements to preventive health outcomes.
吸烟、不良营养、危险饮酒和缺乏身体活动（SNAP）行为往往会集中出现。如果干预措施同时针对多种健康风险行为，而不是针对单一行为，则可能最大限度地提高健康益处。互联网覆盖面广，是提供多种健康行为干预措施的可持续模式。然而，尚无系统评价检查过针对 18 岁或以上成年人的任何 SNAP 行为组合或所有 SNAP 行为的基于互联网的干预措施的长期效果。
本系统评价旨在检查成年人（年龄≥18 岁）中，基于互联网的干预措施在长期内对 SNAP 行为的总体效果，与对照组相比。
检索 Medline、PsycINFO、Embase、CINAHL 和 Scopus 电子数据库，以检索描述 2019 年 11 月 18 日之前发表的基于互联网的干预措施对≥2 种 SNAP 行为的有效性的研究。还检查了检索文章的参考文献列表，以确定合格的出版物。纳入标准为随机对照试验或群组随机对照试验，对象为成年人，检查了至少在招募后 6 个月测量基于互联网的干预措施对≥2 种 SNAP 行为影响的研究，并以同行评审的期刊发表的英文出版物。两名审查员独立提取纳入研究的数据，并使用定量研究质量评估工具评估方法学质量。采用稳健方差估计荟萃分析来检验基于互联网的干预措施对所有 4 种 SNAP 风险行为结果的长期效果。所有 SNAP 结果均进行了编码，以便它们朝着相同的方向，得分越高表示健康风险行为越差。
纳入标准符合 11 项研究：7 项研究测量了基于互联网的干预措施对营养和身体活动的影响；1 项研究测量了对吸烟、营养和身体活动的影响；3 项研究测量了对所有 SNAP 行为的影响。与对照组相比，基于互联网的干预措施在长期内整体上显著改善了所有 SNAP 行为（标准化均数差-0.12[改善为得分越高表示健康风险越高]，95%CI-0.19 至-0.05；I=1.5%，P=.01）。全球方法学质量评分为 1 项研究为“中等”，其余 10 项研究为“弱”。
发现基于互联网的干预措施在长期内总体上显著改善了所有 SNAP 行为。针对多种 SNAP 行为的基于互联网的干预措施有可能最大限度地提高预防健康结果的长期改善。
