Information technology and lifestyle: a systematic evaluation of Internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use
Novel interventions are needed to improve lifestyle and prevent NCDs, the leading cause of death and disability globally. This study aimed to systematically review, synthesize, and grade scientific evidence on the effectiveness of novel information and communication technology to reduce NCDs risk.
Methods and results
The researchers systematically searched PubMed for studies evaluating the effect of Internet, mobile phone, personal sensors, or standalone computer software on diet, physical activity, adiposity, tobacco, or alcohol use. They included all interventional and prospective observational studies conducted among generally healthy adults published between January 1990 and November 2013. American Heart Association criteria were used to evaluate and grade the strength of evidence. From 8,654 abstracts, 224 relevant reports were identified. Evidence limitations included relatively brief durations (generally <6 months, nearly always <1 year), heterogeneity in intervention content and intensity, and limited representation from middle/low‐income countries.
Evidence limitations included relatively brief durations, heterogeneity in intervention content and intensity, and limited representation from middle- and low‐income countries.
Excessive Alcohol Use
Of 1015 abstracts screened, 41 RCTs and 6 quasi‐experimental studies met inclusion criteria. All studies were conducted in high‐income Western countries including the United States (N=21), The Netherlands (n=7), United Kingdom (n=5), Canada (n=3), New Zealand (n=3), Sweden (n=2), Germany (n=2), Australia, Switzerland, Finland, and Denmark.
More than half (n=27) were carried out in universities, colleges, or schools; and the remaining in primary care, workplace, or other community settings. The study population mostly included adults with unhealthy patterns of alcohol use. Most studies evaluated the effect of a single session intervention consisting of assessment and personalized feedback over a follow‐up period of 1 week to 2 years.
Of 47 studies evaluating Internet interventions, 39 (34%) reported a significant decrease in alcohol use. Of 41 RCTs, 34 (83%) reported statistically significant benefits. The only trial that compared Internet versus conventional intervention reported significant within‐group improvement in heavy alcohol use days at 3 and 6 months, but no significant between‐group differences.
The type and magnitude of effect sizes varied across the studies reporting reductions in alcohol use. Examples included reductions of
- 63% in weekly alcohol use after a 3‐month intervention;
- 50% in heavy alcohol use days at 6‐month follow‐up among veterans screening positive for alcohol misuse;
- 7 drinks in mean weekly alcohol consumption at 3‐month follow‐up among risky alcohol users;
- 16% in heavy episodic alcohol use at 1‐month follow‐up relative to controls; and
- 10 units (100 mL ethanol) in weekly alcohol use at 7‐week follow‐up.
Discussion
The researchers systematically investigated, synthesized, and graded scientific evidence for the effectiveness of information and communication technology to improve lifestyle. Their results support the effectiveness of Internet interventions to improve diet, physical activity, adiposity, tobacco, and excess alcohol.
Mobile interventions were also found to be effective for improving physical activity and adiposity. The study’s comprehensive review also identified several important research gaps and potential directions for future research.
Conclusions
Internet and mobile interventions improve important lifestyle behaviors up to one year. This systematic review supports the need for long‐term interventions to evaluate sustainability.