Currently submitted to: Journal of Medical Internet Research
Date Submitted: Oct 23, 2019
Open Peer Review Period: Oct 23, 2019 - Dec 18, 2019
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Digital platforms for the self-management of noncommunicable disease: A systematic review
Digital interventions are effective for health behavior change as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform, which would host a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. For this review, a digital platform has been defined as: a web-based host for numerous discrete, evidence-based digital health interventions, which are effective in supporting NCD self-management. Offers tool for guidance towards the interventions that are most suited to the user’s needs and preferences.
This review aims to identify digital platforms and examine their potential for supporting NCD self-management and health behavior change.
A literature search was conducted in August 2018 using EBSCOhost, PubMed, Scopus, and Embase.com. No digital platforms were identified, so criteria were broadened to include platform-like digital health interventions. Eligible interventions offered several health behavior change features to optimize NCD self-management in an adult population and provided digitally-supported guidance for the user towards the features best suited to them. Data collected on interventions was guided by the CONSORT-EHEALTH checklist. Evaluation data were collected on effectiveness and process outcomes.
Six interventions were included for review. Targeted NCDs included cardiovascular diseases (n=2), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). All six used behavior change theories and frameworks to guide conceptualization. Development approaches were similar, with five of six implementing user-centered, iterative processes to optimize intervention relevance. Physical activity was the most targeted health behavior, addressed in all six interventions. Self-report measures and existing medical records were the main sources of data collection during evaluation. Four of the six interventions assessed changes in behavior. Just one demonstrated significant improvements in overall physical activity compared to the control group at 3-months (+4297 MET-minutes/week, P=.02). Significant improvements in diabetes-specific self-care behavior were observed for two of the six interventions at 1-month and 9-months. Older age, female, and lower baseline self-efficacy were associated with greater changes in self-care. One of the six studies reported significant improvements in disease-related quality of life of users at 9-months compared to non-users of the intervention. Adherence was based on the number of follow-up respondents and ranged from 27% to 83% across the six interventions (mean 65 ± SD 25). Initial log-in rates were high (84% ± 17%) and an average of 4 log-ins per user per month (± SD 2.5) was recorded for half of the interventions. User satisfaction was high and platform-like interventions were considered useful, especially the personal relevance to the user and the authoritative nature of the evidence-based components.
This review suggests that, with guidance and support, a digital platform could effectively address the individual needs of users to affect positive behavior change. Drawing several evidence-based interventions together has the potential to engage a diverse user group and optimize engagement with existing interventions. This review highlights the need for comprehensive user-centered development and iterative evaluation of a digital platform for NCD self-management. Clinical Trial: PROSPERO 2018 CRD 420 1810 2095
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