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WHAT ARE WE MEASURING WHEN WE EVALUATE DIGITAL INTERVENTIONS FOR IMPROVING LIFESTYLE? A SCOPING META-REVIEW
Digital health interventions
Lifestyle
Physical activity
Sleep
Social relationship
Stress management
Substance use
Author
Affilliation
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Instituto de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
McMaster University. Department of Psychiatry and Behavioural Neurosciences. Hamilton, ON, Canada.
McMaster University. Department of Psychiatry and Behavioural Neurosciences. Hamilton, ON, Canada / Hospital de Clínicas de Porto Alegre. Instituto Nacional de Ciência e Tecnologia Translacional em Medicina. Laboratory of Molecular Psychiatry. Bipolar Disorder Program. Porto Alegre, RS, Brazil / Universidade Federal do Rio Grande do Sul. Department of Psychiatry. Porto Alegre, RS, Brazil.
University of Valencia. Department of Medicine. Teaching Unit of Psychiatry and Psychological Medicine. Valencia, Spain.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
McMaster University. Department of Psychiatry and Behavioural Neurosciences. Hamilton, ON, Canada.
McMaster University. Department of Psychiatry and Behavioural Neurosciences. Hamilton, ON, Canada / Hospital de Clínicas de Porto Alegre. Instituto Nacional de Ciência e Tecnologia Translacional em Medicina. Laboratory of Molecular Psychiatry. Bipolar Disorder Program. Porto Alegre, RS, Brazil / Universidade Federal do Rio Grande do Sul. Department of Psychiatry. Porto Alegre, RS, Brazil.
University of Valencia. Department of Medicine. Teaching Unit of Psychiatry and Psychological Medicine. Valencia, Spain.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Abstract
Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.
Keywords
DietDigital health interventions
Lifestyle
Physical activity
Sleep
Social relationship
Stress management
Substance use
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