What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Abstract

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods.Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change.Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites.Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention—but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review

“…While the gold standard for evaluating a health intervention is conducting a randomized controlled trial, these can take a long time and typically require many participants and extensive financial resources. Long delays to evaluate novel digital interventions in the rapidly evolving field might result in the digital interventions becoming obsolete or nonfunctional by the time the trial is completed [ 73 ]. Thus, the evaluation of digital interventions potentially requires new study designs and methods that take the iterative and rapidly evolving nature of such interventions and continuous data collection into account.…”

How do digital lives affect resident mental health in the digital era? Empirical evidence based on Chinese general social survey

“…According to recent statistics, the Health and Fitness category accounts for a large proportion of apps in both the Android and Apple app stores—the eighth-largest categories of apps ( 35 ). Previous literature has shown that smartphone app usage is one of the most frequently used methods of digital health interventions for enhancing physical activity ( 36 ), and the use of apps can increase cognitive patterns encouraging exercise and physical activity, so those who use fitness apps participate in significantly more physical activity than those who do not ( 37 ). A growing literature recognizes the positive effects of exercise on emotional states such as anxiety, stress and depression, including helping people with mood disorders achieve better mental health outcomes ( 38 ).…”

Wearables and smartphones for modifiable risk factors in metabolic health: a scoping review protocol

“…Here, we focus on two. First, recent perspectives highlight the importance of tracking multi-modal vs. single risk factors [12] for a more comprehensive lens into an individual's metabolic health profile [20]. However, the extent to which different studies focus on one vs. more risk factors in digital metabolic health contexts remains unclear.…”

“…These include lifestyle determinants (i.e., nutrition, physical activity, sleep, stress, and substance abuse) and physiological markers (i.e., blood sugar, triglycerides, and HDL cholesterol) [6–10]. Following a complex systems perspective, modifiable factors interact dynamically [11] and together shape disease outcomes over time, with up to 70% of cardiovascular disease cases and mortality attributed to modifiable risk factors [12] [9].…”