Digital technology to support lifestyle and health behaviour changes in surgical patients: systematic review

Abstract

Background Digital technologies (such as smartphone applications, activity trackers, and e-learning platforms) have supported patients with long-term conditions to change their lifestyle health behaviours. The aim of this study was to examine the effectiveness of digital technologies in supporting patients undergoing elective surgery to change their health behaviours. Methods A systematic review was conducted of articles reporting a digital intervention supporting behaviour change in adult patients who underwent elective bariatric, oncological or orthopaedic surgery. MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Scopus were searched from inception to March 2019 for quantitative intervention studies with a specific focus on physical activity, dietary intake, and weight loss in patients before and after surgery (PROSPERO: CRD42019127972). The Joanna Briggs Institute critical appraisal checklist was used to assess study quality. Results Of 3021 citations screened, 17 studies were included comprising 4923 surgical patients; these included experimental (pre–post design, feasibility studies, and RCTs) and observational studies. Three factors were identified as effective for supporting health behaviour change in elective surgical populations: digital technology delivery, implementation, and theoretical underpinning. Six of eight studies that referred to behaviour change theories observed significant improvements in health behaviour relating to reduced weight regain, and improved lifestyle choices for physical activity and diet. Meta-analysis was not possible because of heterogeneous outcome measures. Conclusion Digital technologies may effectively support behavioural change in patients undergoing elective surgery.

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…This study contributes further evidence to support gaps in the literature, which relate to the timing of intervention use, including the initiation and continuation points of intervention use. This gap has also been acknowledged in recent systematic reviews and research by Jansson et al [16], Mirkovic et al [67], and our research team [12,27]. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial.…”

“…Interviews were conducted with participants over the telephone or by using video call-based software, such as Zoom and Microsoft Teams, and all participants were offered the choice of which they would prefer. The semistructured interview topic guide was developed based on 3 pilot interviews and covered key issues identified through a systematic literature review [12], meta-ethnography [27], and narrative review [28]. These issues included participants' understanding and experiences of surgery, awareness of perioperative lifestyle behavior change, perspectives on digital health technology use within the surgical pathways, and the optimal design of such technologies.…”

“…In recent digital health literature, there are various interventions that have successfully supported patients in managing long-term health conditions [8] and medication adherence [9,10] and supporting positive lifestyle behavior change before and after surgery to improve postoperative outcomes [11,12]. Health behavior changes made during the perioperative period can be fundamental in determining the outcomes and success of elective surgeries.…”

Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review

“…Recent contributions to the health behavior change literature have cited the importance of empowered patient-centered strategies and use of self-regulation [60] and self-determination theoretical frameworks [61,62] to improve patient motivation. Digital technologies underpinned by behavior change theory can promote a proactive and holistic strategy to influence behavior change in a modern health care system such as the UK National Health Service [21].…”

“…Although health behavior changes made in the pre-and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries [19][20][21], there are variable amounts of support and education currently provided to patients undergoing elective surgery to motivate these health behavior changes [22][23][24]. A recent study evaluating patient attitudes to health behavior changes found that although preoperative patients understood the health benefits of improved behaviors, they lacked the confidence to make such changes without intervention or support [19].…”