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Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity.
This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity.
The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication.
A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating.
Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.
Tobacco use, poor nutrition, risky alcohol consumption, physical inactivity, and obesity are the leading modifiable health risks that can cause noncommunicable diseases, including cardiovascular disease, chronic respiratory disease, cancer, stroke, and diabetes [
Real-time video communication, also known as videoconferencing, telehealth, or telecare [
Individual counseling is used by service providers to deliver support for smoking cessation [
The capability, opportunity, motivation, and behavior (COM-B) model by Michie et al [
One systematic review has examined the effectiveness of various technology-based interventions on smoking cessation, including real-time video counseling; however, the review only included studies of participants with low socioeconomic status or disadvantaged populations [
This systematic review aimed to examine the effectiveness of individual real-time video counseling on health risks for smoking, nutrition, alcohol, physical inactivity, and obesity relative to (1) a no-intervention control group or (2) other modes of intervention delivery.
This narrative review follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [
The electronic databases Cochrane Register of Controlled Trials (via Cochrane Library), MEDLINE (Medical Literature Analysis and Retrieval System Online; from 1946), EMBASE (Excerpta Medica dataBASE; from 1947), PsycINFO (from 1806), and Scopus were searched from inception to retrieve studies published up to November 21, 2019, that described a real-time video counseling intervention (eg, video conferencing or video consultation or telehealth or telemedicine) for modifying health risks for smoking, nutrition, alcohol consumption, physical activity, and obesity. The reference lists of included trials were also manually searched to retrieve any other relevant studies.
The database search consisted of focused text word searches and medical subject heading searches. The search terms were divided into 3 groups: (1) smoking, nutrition, alcohol, physical activity, and obesity behavior (ie, tobacco use, nutrition, alcohol drinking, physical activity, obesity, healthy lifestyle, lifestyle), (2) video communication intervention (ie, telemedicine, videoconferencing, remote consultation, Skype, Viber, webcam, Talky Core, WhatsApp, FaceTime, Messenger, Google Hangouts), and (3) study design (ie, randomized controlled trial, cluster randomized trial).
Nicotine/
Tobacco/
exp “Tobacco Use Cessation”/
exp “Tobacco Use”/
(Cigar* or smok* or tobacco or nicotine).tw.
1 or 2 or 3 or 4 or 5
exp Healthy Lifestyle/
exp Life Style/
(lifestyle* or life style*).tw.
nutrition*.mp.
exp Fruit/
exp Vegetables/
(fruit* or vegetable*).tw.
7 or 8 or 9 or 10 or 11 or 12 or 13
exp Alcohol Drinking/
exp Alcoholism/ or exp Drinking Behavior/
exp Alcoholic Intoxication/
(Alcohol* or drinking).tw.
15 or 16 or 17 or 18
exp Exercise/
physical activity.mp.
exp Sedentary Lifestyle/
(physical activit* or physical inactivit*).tw.
(exercise* or Sport*).tw.
20 or 21 or 22 or 23 or 24
exp Overweight/
Obes*.tw.
26 or 27
exp Telemedicine/
exp Videoconferencing/
Remote Consultation/
(skype or viber or webcam or talky core or whatsapp or facetime or messenger or google* hangouts).mp. (mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms)
((real time or realtime) adj3 (counsel* or support* or therap* or conference or consult*)).tw.
(remote adj3 (communicat* or consult*)).tw.
29 or 30 or 31 or 32 or 33 or 34
6 or 14 or 19 or 25 or 28
35 and 36
exp Randomized Controlled Trial/
exp Randomized Controlled Trials as Topic/
exp Clinical Trial/
exp Clinical Trials as Topic/
exp Random Allocation/
Random*.tw.
Trial.tw.
38 or 39 or 40 or 41 or 42 or 43 or 44
37 and 45
Studies were included in this review if they met the following criteria:
Study design: randomized trials or cluster randomized trials. Randomized trials and cluster randomized trials were included because these designs are considered the gold standard for measuring effectiveness [
Study participants: any population (ie, general population, patients).
Setting: any setting, including community and health care settings.
Intervention: video communication was used as the mode to deliver individual, one-on-one support (ie, Skype, FaceTime, Facebook Messenger, WhatsApp, or any preferred individual real-time video communication platform).
Comparators: the comparators included a no-intervention control group or any other form of support to address the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity, such as written materials, telephone counseling, web-based support, and face-to-face interventions.
Language: studies published in English.
Outcome measures: any measure of an individual’s smoking (eg, smoking cessation, quit attempts), nutrition (eg, serves of fruit and/or vegetables, calories), alcohol (eg, number of standard drinks of alcohol), physical activity (eg, number of minutes of moderate or vigorous physical activity or metabolic equivalent [MET] minutes), or obesity (eg, BMI, waist circumference).
After removing duplicate records, 2 authors (JB and FT, PA, or MM) independently screened the titles and abstracts of all records using either EndNote or Covidence. Papers that did not meet the eligibility criteria were excluded. Two reviewers independently examined the full text of the papers that were deemed eligible or whose eligibility was uncertain based on the title and abstract screening. Two reviewers met and discussed any discrepancies until a consensus was reached. The reasons for exclusion were recorded for all full text papers assessed that were ineligible.
Two authors (JB and AB or EB) independently extracted the following data from eligible studies: authors and country, years data collected, study design, sample characteristics, recruitment method, eligibility criteria, participation rate, treatment conditions, the video intervention received, retention at follow-up, outcome measures, the comparators, and costs. All discrepancies were resolved between the 2 reviewers through discussion, and a third reviewer (FT) was consulted when necessary.
The quality assessment of each included study was assessed independently by 2 reviewers (JB and FT). The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project was used to assess methodological quality [
After removing duplicates, a total of 7991 records were screened. Of these, 7894 records were excluded at the title and abstract screening stage, and 97 full text records were assessed for eligibility (
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram of the screening and selection process. SNAPO: smoking, nutrition, alcohol consumption, physical activity, and obesity.
Four studies focused on individual video counseling for smoking cessation [
Three randomized trials that examined the effectiveness of real-time video counseling compared with telephone counseling for smoking cessation were conducted in the United States [
One trial delivered the intervention through 4 individually tailored sessions at the clinic [
Three studies reported prolonged abstinence, 1 at 3 months [
In 1 study, participants received up to 5 sessions with the therapist via videoconference and were followed-up at 3 months [
Alcohol consumption was measured at 3, 6, and 12 months in 1 study [
Three trials examined the effectiveness of individual video counseling to increase physical activity. The trials were conducted in Australia [
One trial assessed physical activity in minutes per week at week 9 and 6 months [
The video counseling intervention was compared with either individualized documented reports (individualized written reports at 3 time points addressing lifestyle modifications) [
In the nonclinical populations [
In a study conducted with women living with HIV, a clinical population, the video counseling group was significantly more likely than the telephone counseling group to achieve biochemically verified point prevalence abstinence at 3 months (video 33.3%; telephone 4.8%) and 6 months postquitting (video 38.1%; telephone 4.8%) [
Two studies were conducted in a nonclinical population [
Only a single study was conducted in a clinical population (alcohol dependent) [
One study for physical activity was conducted among a nonclinical population [
Two of the physical activity studies were conducted among a clinical population [
In the study by Weinstock et al [
All studies examining the effectiveness of real-time video counseling on obesity were conducted with clinical populations [
Two studies [
Of the 3 [
One study on physical activity in a nonclinical population [
All 3 studies conducted with clinical populations [
Methodological quality assessment of eligible studies.
Study | Selection bias | Study design | Confounders | Blinding | Data collection methods | Withdrawals and dropouts | Global rating | ||||||||
|
|||||||||||||||
|
Kim et al [ |
Weak | Strong | Weak | Weak | Strong | Moderate | Weak | |||||||
|
Kim et al [ |
Weak | Strong | Weak | Weak | Strong | Weak | Weak | |||||||
|
Nomura et al [ |
Weak | Strong | Strong | Weak | Strong | Strong | Weak | |||||||
|
Richter et al [ |
Weak | Strong | Strong | Weak | Strong | Strong | Weak | |||||||
|
|||||||||||||||
|
King et al [ |
Weak | Strong | Moderate | Weak | Strong | Weak | Weak | |||||||
|
Staton-Tindall et al [ |
Moderate | Strong | Weak | Weak | Weak | Strong | Weak | |||||||
|
Tarp et al [ |
Weak | Strong | Strong | Weak | Strong | Moderate | Weak | |||||||
|
|||||||||||||||
|
Alley et al [ |
Weak | Strong | Weak | Weak | Strong | Weak | Weak | |||||||
|
Chemtob et al [ |
Weak | Strong | Weak | Moderate | Strong | Strong | Weak | |||||||
|
Weinstock et al [ |
Weak | Strong | Strong | Moderate | Moderate | Strong | Moderate | |||||||
|
|||||||||||||||
|
Hansen et al [ |
Weak | Strong | Strong | Weak | Strong | Strong | Weak | |||||||
|
Homma et al [ |
Weak | Strong | Weak | Weak | Strong | Strong | Weak | |||||||
|
Johnson et al [ |
Weak | Strong | Strong | Weak | Strong | Strong | Weak |
Most studies (n=12) were rated as weak for selection bias because the participation rate was <60% or unclear [
This is the first review to examine the effectiveness of individual real-time video counseling on smoking, nutrition, alcohol consumption, physical activity, and obesity. This review focused on real-time video communication technology, an emerging intervention delivery mode. The overall results suggest that video counseling is neither more nor less effective in modifying smoking and alcohol consumption but may have particular benefits for addressing physical inactivity and obesity. Given that the effectiveness of video counseling was similar to conventional methods used to treat smoking and alcohol consumption and that many individuals with nicotine dependence or alcohol dependence may not join and complete conventional treatment [
Of the 4 studies that examined the effectiveness of video counseling on smoking cessation [
The evidence in 3 studies indicated that there was no significant difference between real-time video counseling and face-to-face counseling (usual care) for reducing alcohol consumption [
Real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 [
Two studies that focused on obesity reported a significant change in BMI from preintervention to 3 months between the video counseling intervention and the individualized monthly document reports group [
It is worth noting that 7 studies [
Four studies (1 smoking [
Satisfaction with video counseling was compared with a comparator group in 2 smoking trials [
Although a comprehensive search strategy was conducted, the studies included were disproportionate across smoking, nutrition, alcohol consumption, physical activity, and obesity outcomes. Namely, there was no intervention targeting nutrition and only 4 studies targeting smoking, 3 studies targeting alcohol consumption, 3 studies targeting physical activity, and 3 studies targeting obesity. The lack of studies limits the conclusions that can be made and highlights the need for more trials assessing the effectiveness of individual, real-time video counseling that target these behaviors. Additionally, some studies that were not published in a peer-reviewed journal or not written in English were excluded, and some studies may have been missed through limitations in the searched databases [
This review highlights the need for more research trials examining the effectiveness of video counseling for health risks for smoking, nutrition, alcohol consumption, physical activity, and obesity. Future research should assess the effectiveness of video counseling for each health risk behavior in various populations (eg, general population, high-risk groups, and minority groups), settings (eg, health care settings, community settings, rural and remote locations), countries (eg, low- and middle-income), and cultures (eg, culturally and linguistically diverse groups, indigenous) to build upon the evidence-base and improve the generalizability of the findings. Studies examining the effectiveness of real-time video counseling for health factors of smoking, nutrition, alcohol consumption, physical activity, and obesity should consider having a larger sample size to increase the power to detect differences between groups, include populations with diverse socioeconomic and cultural backgrounds, and reduce selection bias through random selection and blind assessors and participants where possible. Future research could also examine the effectiveness of real-time video counseling for other behaviors such as sleep, health care seeking behaviors, adherence to treatments, and mental health.
Such evidence is important for informing the practices of public health prevention programs and health practitioners. Real-time video consultations have been successfully used by health practitioners for various patient-clinician consultations of long-term conditions such as heart failure, depression, schizophrenia, stroke, asthma, spinal cord injury, and chronic pain [
This review focused on effectiveness, costs, and satisfaction, factors that contribute to decision making regarding the mode by which care is delivered to clients. Policy makers and service providers also take into account other factors when making a decision about whether to integrate an intervention into their routine practices, such as feasibility, each from a provider and a client perspective. Further research is required to determine the relative benefits of video counseling in terms of these other policy and practice decision-making factors.
Characteristics of studies examining the effectiveness of video counseling on smoking cessation .
Characteristics of studies examining the effectiveness of video counseling on alcohol consumption.
Characteristics of studies examining the effectiveness of video counseling on physical activity.
Characteristics of studies examining the effectiveness of video counseling on obesity.
capability, opportunity, motivation, and behavior
disability-adjusted life year
leisure time physical activity
metabolic equivalent
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Prospective Register of Systematic Reviews
Rutgers Alcohol Problem Index
spinal cord injury
The School of Medicine and Public Health at the University of Newcastle, Hunter New England Population Health, and Hunter Medical Research Institute provided infrastructure support. FT was supported by a Cancer Institute New South Wales Early Career Fellowship (15/ECF/1-44) followed by a National Health & Medical Research Council Career Development Fellowship (APP1143269). The sponsors had no role in the study design; in the collection, analyses, and interpretation of data; in the writing of the manuscript; and in the decision to submit the paper for publication.
None declared.