Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

Abstract

Background Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC. Method Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' g (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy. Results A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy ( g = 0.38; 95% CI, 0.15 to 0.61; I 2 = 0) and combined disease-related outcomes ( g = −0.13; 95% CI, −0.25 to −0.01 ; I 2 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies. Conclusion The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions

“…No patient participated in e-Health services because they are not yet available in standard care. The rapidly growing availability of evidence-based and Internet-based interventions, as well as health apps, may increase mental health care accessibility for the young digital generation33,[62][63][64] and reduce the risk of chronification due to prolonged waiting periods, but Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths…”

Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review

“…Importantly, participants were most often adolescents, with only 16% (4/25) of eligible studies evaluating interventions for children, suggesting an additional research gap for this younger age group. Here, all interventions for children were conducted with the involvement of parents, suggesting a crucial role of the accompanying human support in DHIs for younger children, which must be corroborated and further specified by forthcoming research [12,79]. In studies evaluating DHI HP , only cognitive mediators (perceived norm and alcohol-related expectation) were investigated.…”

Digital health interventions for improving mental health outcomes and wellbeing for youth with type 1 diabetes: A systematic review

“…For example, a recent meta-analysis explored the efficacy of digital health interventions for youth with chronic health conditions. 25 Researchers included 19 randomized controlled trials, 5 of which included children and adolescents with T1D. Results suggested that digital health interventions were linked with improvements in self-efficacy and disease-related outcomes.…”

“…Previous studies have also highlighted that digital interventions may be beneficial for improving levels of self-efficacy. 25,26 However, these studies have also emphasized the lack of evidence for improving other psychological/psychosocial outcomes in youth.…”