评估电子健康干预措施在管理老年人多种生活方式风险行为方面的有效性：系统评价和荟萃分析。

Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis.

机构信息

School of Physical Education, Shandong University, Jinan, China.

School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.

出版信息

J Med Internet Res. 2024 Jul 31;26:e58174. doi: 10.2196/58174.

DOI:10.2196/58174

PMID:39083787

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11325121/

Abstract

BACKGROUND

Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors.

OBJECTIVE

The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years.

METHODS

The literature search was conducted in 6 electronic databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus-from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep.

RESULTS

A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD -0.23, 95% CI -0.33 to -0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework.

CONCLUSIONS

eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult-oriented research is needed to develop eHealth interventions that can change multiple behaviors.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418.

摘要

背景

养成不良生活方式会增加罹患多种与年龄相关的慢性疾病的风险，包括心血管疾病、肥胖和阿尔茨海默病。关于基于电子健康的多种健康行为改变（MHBC）干预措施在管理生活方式风险行为方面的有效性，证据有限。

目的

本系统评价的目的是评估针对≥50 岁人群的≥2 种主要生活方式风险行为的基于电子健康的 MHBC 干预措施的有效性。

方法

从 2024 年 5 月 1 日起，我们在 6 个电子数据库（PubMed、Embase、Web of Science、Scopus、Cochrane 图书馆和 SPORTDiscus）中进行了文献检索。符合条件的研究是针对 6 种感兴趣行为中的≥2 种行为的电子健康干预措施的随机对照试验：饮酒、吸烟、饮食、身体活动（PA）、久坐行为和睡眠。

结果

共纳入 34 篇文章，涉及 35 项研究。基于电子健康的 MHBC 干预措施显著提高了戒烟率（比值比 2.09，95%置信区间 1.62-2.70；P<.001）、水果摄入量（标准化均数差[SMD]0.18，95%置信区间 0.04-0.32；P=.01）、蔬菜摄入量（SMD 0.17，95%置信区间 0.05-0.28；P=.003）、自我报告的总 PA（SMD 0.22，95%置信区间 0.02-0.43；P=.03）和客观测量的中等至剧烈 PA（SMD 0.25，95%置信区间 0.09-0.41；P=.002）；此外，干预措施还降低了脂肪摄入量（SMD -0.23，95%置信区间 -0.33 至 -0.13；P<.001）。未观察到饮酒、久坐行为或睡眠方面的影响。进行了敏感性分析以测试汇总结果的稳健性。此外，使用 GRADE（评估、制定和评估推荐的分级）框架评估证据的确定性。