JMIR Publications

ABSTRACT

Background:

Noncommunicable diseases contribute substantially to health and economic burdens and are associated with modifiable behavioral risk factors, including physical inactivity and poor diet. Digital delivery may provide a practical and scalable approach to evaluating lifestyle interventions, but its implementation presents opportunities and challenges that require further understanding.

Objective:

This scoping review of reviews aimed to map digital delivery methods used in online lifestyle clinical trials and synthesize reported opportunities and challenges associated with their delivery.

Methods:

Evidence was synthesized from existing peer-reviewed review papers to map the digital delivery methods in online lifestyle intervention trials, focusing on technologies, recruitment, engagement and retention strategies, and reported strengths, limitations, and future directions. PubMed, EMBASE, CINAHL, Web of Science, and Scopus were searched for reviews published between January 2013 and May 2025. Reviews were excluded if more than 50% of interventions involved face-to-face delivery, or if they primarily focused on acute conditions, or telehealth consultations without a structured lifestyle intervention component.

Results:

Eligible reviews (n=39) discussed digital interventions targeting diet, physical activity, or both to support lifestyle improvement, chronic disease prevention or management. The most common hardware used in online lifestyle clinical trials included smartphones and wearables, with the most frequent software modes being web-based platforms, mobile applications, and SMS. Recruitment strategies were infrequently reported but included websites, social media and email. Engagement strategies often combined behavior change techniques, such as goal setting, self-monitoring, and personalized feedback, with human support. These techniques were integrated into intervention design or embedded within software. Reported strengths of conducting clinical trials online included improved accessibility, scalability, potential cost-efficiency and personalization, whereas limitations discussed were poor engagement and retention, digital literacy barriers, and rapid technological change outpacing evaluation capabilities. Social Cognitive Theory, the Transtheoretical Model, and the Theory of Planned Behavior were the most frequently reported theoretical frameworks. Engagement and retention varied considerably across online trials, suggesting that the success of these studies may be influenced by how interventions and technologies are designed, including the integration of behavioral theory and behavior change techniques.

Conclusions:

This review suggests that online delivery of lifestyle intervention trials may offer advantages, including improved reach, increased scalability, potential cost-efficiency, and greater personalization of the intervention. To further improve the conduct of online clinical trials, future research should address the use of behavior change theory, equitable access to clinical trial participation, management of data privacy and security, personalization, and evaluation of novel technologies such as artificial intelligence in this rapidly evolving field. Clinical Trial: The protocol was prospectively registered with the Open Science Framework https://osf.io/umcfv; 5 September 2023