JMIR Publications

ABSTRACT

Background:

Increased accessibility to the internet and mobile devices has seen a rapid expansion in e-health behaviour change interventions delivered to cancer patients and survivors using synchronous and asynchronous delivery methods. There is a need to characterise effective delivery methods of electronic health interventions to enable improved design and implementation of evidence-based health behaviour change interventions. This will enable scaled up translation to impact health change in this growing population.

Objective:

To systematically review the literature and synthesise evidence on the success of e-health behaviour change interventions in cancer patients and/or survivors delivered by synchronous or asynchronous methods compared to a control group. Engagement with the intervention, behaviour change and quality of life were the outcomes examined. We also sought to describe the behaviour change theory and behaviour change techniques employed in these studies.

Methods:

A search of SCOPUS, Ovid MEDLINE, EMBASE, CINAHL Plus, PsychINFO and Cochrane CENTRAL was conducted for studies published 2007 to March 2019. We looked for randomised controlled trials (RCTs) examining interventions delivered to adult cancer patients and/or survivors via e-health with a measure of health behaviour change taken at the end of the intervention. Random effects meta-analysis and meta-regression were performed examining whether the method of e-health delivery impacted the level of engagement, behaviour change, or change in quality of life. Meta-regression analyses were also performed to examine whether amount of behaviour change impacted on change in quality of life.

Results:

Twenty RCTs were included predominantly examining dietary and physical activity behaviour change interventions. There were 11 studies that used a synchronous approach while nine studies used an asynchronous delivery method. Participant initiation of use of e-health interventions was high (95%). Use of e-health interventions changed exercise and diet behaviour (ES 0.32, 95% CI: 0.19 to 0.46 and ES 0.44, 95% CI: 0.18 to 0.70) respectively. The synchronous delivery mode showed a small, favourable effect on quality of life (ES 0.14, 95% CI: 0.03 to 0.25). Mode of delivery did not influence the amount of physical activity behaviour change observed. There were no identified interaction effects between the mode of delivery and amount of behaviour change affecting health outcomes observed.

Conclusions:

Physical activity and dietary behaviour change e-health interventions delivered to patients with or survivors of cancer have a small to moderate impact on behaviour change and a small to very small benefit to quality of life. There is insufficient evidence to determine if asynchronous or synchronous delivery modes yield superior results. Three arm RCTs comparing asynchronous and synchronous delivery modes to a control with robust engagement reporting are required to determine the most successful delivery method for promoting behaviour change and ultimately favourable health outcomes. Clinical Trial: This systematic review was registered with PROSPERO CRD42018103855.