Swindle Taren, Poosala Anwesh B, Zeng Nan, Børsheim Elisabet, Andres Aline, Bellows Laura L
Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States.
Griffin Hospital, Derby, CT, United States.
J Med Internet Res. 2022 Jan 11;24(1):e28230. doi: 10.2196/28230.
Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children.
The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions.
This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes.
In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies.
The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children.
数字干预措施越来越多地用于改善健康行为。相较于面对面干预，其获取途径更便捷且成本更低，使得这类干预颇具吸引力。具体而言，数字平台可能是增加幼儿身体活动（PA）的一种有前景的方法。
本系统评价的目标有三个方面：（1）确定使用数字PA干预策略针对学龄前儿童（即3至5岁）的研究质量；（2）评估旨在改善学龄前儿童PA的数字干预措施和方法的有效性；（3）研究当前数字PA干预方法的理论应用和实施效果。
本评价识别并总结了关于数字支持干预措施促进学龄前儿童PA的研究。我们生成了3组相关搜索词，包括与技术相关的术语、与PA相关的术语以及与体重相关的术语。搜索范围包括Ovid MEDLINE（R）及印刷版之前的Epub、在研及其他未编入索引的文献以及每日更新文献、Ovid EMBASE、Ovid Cochrane对照试验中心注册库、Ovid Cochrane系统评价数据库和Scopus。研究筛选由一位作者主导并由另一位作者核实；同样这两位作者使用标准化工具评估研究质量，三位作者完成关于PA结果、理论应用和实施效果的数据提取。
总共识别出601项研究；8项符合纳入标准。就研究质量而言，只有2项研究获得总体高质量且偏倚风险低的评级。除1项研究外，所有研究的样本量都较小（<100）。仅有2项总体质量较弱的研究报告了儿童PA结果有积极且显著的变化，这两项研究均采用以儿童为导向的方法。总共5项研究在设计干预措施时应用了行为理论；基于理论应用未发现有效性模式。最后，没有研究报告采用、成本、渗透率或可持续性等实施效果；1项研究未评估任何实施效果，且没有一项研究报告超过2项实施效果。研究最常测量的实施效果是可接受性（n = 4），3项研究中研究人员评估了保真度（干预措施的执行与设计的符合程度）。
对PA有显著影响的干预措施采用了以儿童为中心的活动；仅由家长主导的数字干预措施对改善PA无效。未来进行严谨设计、监测实施效果以及测试数字组件贡献的研究，将增进对数字干预措施增加儿童PA有效性的理解。
