Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review

Abstract

Background Digital health interventions are efficacious in health-promoting behaviors (eg, healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is unclear. Objective This systematic review aimed to evaluate studies on behavior change techniques (BCTs) and mechanisms of change in digital health interventions aimed at promoting health-enhancing behaviors in midlife women (aged 40-65 years). Methods A systematic literature search of the electronic databases PubMed, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials in the Cochrane Library was conducted. In total, 2 independent reviewers selected the studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the behavior change wheel framework. Reporting of psychological theory use within these interventions was explored using the Theory Coding Scheme. Mode of delivery, psychological theory, and BCTs were presented as descriptive statistics. Results In total, 13 interventions (including 1315 women) reviewed used 13 (SD 4.30, range 6-21) BCTs per intervention on average. The “Shaping knowledge” and “Repetition and substitution” behavior change categories were used most frequently, with 92% (12/13) of the interventions implementing at least one of the BCTs from these 2 categories. Only 13.98% (169/1209) of the 93 available BCTs were used, with “Instructions on behaviour” most frequently used (12/13, 92%). The behavior change wheel mapping suggests that half of the intervention content aimed to increase “Capability” (49/98, 50% of the intervention strategies), “Motivation” (41/98, 42%), and “Opportunity” (8/98, 8%). “Behavioural Regulation” was the most frequently used mechanism of action (15/98, 15%), followed by increasing “Knowledge” (13/98, 13%) and “Cognitive and Interpersonal skills” (10/98, 10%). A total of 78% (7/9) of the intervention functions were used in the studies to change behavior, primarily through “Enablement” (60/169, 35.5%), whereas no study used “Restriction” or “Modelling” functions. Although 69% (9/13) of the interventions mentioned a psychological theory or model, most (10/13, 77%) stated or suggested rather than demonstrated the use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (9/13, 69%) modes of delivery, followed by phone or SMS text message (8/13, 62%) and wearables (7/13, 54%). Conclusions The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support the assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions for women in midlife. Trial Registration PROSPERO CRD42021259246; https://tinyurl.com/4ph74a9u

Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature

“…“Self-monitoring,” “biofeedback,” and “goal setting of PA behaviour” were the most frequently used BCTs across the included studies. These findings concur with previous literature on digital behavior change interventions targeting PA, which also highlighted the role of “social support” in adults [ 103 - 105 ] and older adults [ 106 ]. In this review, “social support” was used in 67% (6/9) of the studies targeting both healthy [ 56 , 76 , 79 , 85 ] and clinical (ie, survivors of breast cancer) [ 81 , 83 ] midlife women.…”

“…Reporting of interventions and mode of delivery in the included studies was insufficient; accordingly, we could not comment on the link between the described BCTs and mechanisms of action, a problem highlighted in similar reviews. Sediva et al [ 103 ] highlighted the relevant real concern of low treatment fidelity on the delivery of content as planned across the 13 included complex interventions, including PA apps. By contrast, without adequate information reported on measurements of fidelity or ensuring that the underpinning theory is reflected in the design and implementation process, implementation failure can potentially occur and, thus, the real-world effectiveness of such interventions must be considered with caution [ 109 , 110 ].…”

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“…AlSwayied et al [65] found early evidence that mobile-based physical activity programs are helpful for enhancing moderate to vigorous physical activities among midlife women. Another systematic review by Sediva et al [66] on 13 digital health interventions found that most interventions for midlife women targeted weight loss, lifestyles, and menopausal symptom management and primarily relied on the provision of instructions on healthy behaviors, fostering capability, and motivation. Although the heterogeneity of the studies and their outcomes forbids a conclusion about the general effectiveness of these digital health interventions, it is hoped that these contents may build confidence and familiarity in women with their health care providers, thus connecting women in need to more specialized support.…”

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