JMIR Publications

ABSTRACT

Background:

Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to healthcare. However, there is a lack of evidence about the equalising effects of these interventions in chronic conditions.

Objective:

To establish and investigate differences in the effectiveness of web-based behavioural change interventions for the self-care of high burden chronic health conditions (asthma, COPD, diabetes and osteoarthritis) across socio-economic and cultural groups. 

Methods:

A systematic review, following standing Cochrane review guidelines. We searched OVID search (Medline, AMED (Allied and Complimentary Medicine), Embase, PsycInfo), Cumulative Index to Nursing and Allied Health Literature (CINAHL). Any quantitative or mixed methods study design was included published between 1st January 2006 and 20th February 2019. Studies were included if they investigated self-care web-based interventions targeting asthma, COPD, diabetes and osteoarthritis, were conducted in any high income country, and reported variation in health, behaviour, or psychosocial outcomes by social group. Study outcomes were investigated for heterogeneity and the possibility of meta-analysis was explored. Narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes.

Results:

7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. Meta-analysis was not possible due to heterogeneity of outcomes. There was some evidence that intervention effectiveness was modified by participants’ social characteristics. Minority ethnic groups were found to benefit more from interventions then majority ethnic groups. There was some evidence from single studies with variable quality that those with higher education, with divorced parents (adolescent) and who were employed benefitted more from interventions. Evidence for differences by age, gender and health literacy were conflicting (e.g. in some instances older people benefitted more and in others younger people did). There was no evidence of differences by income, numeracy or household size.

Conclusions:

There was some evidence that web-based self-care interventions for chronic conditions can advantage (minority ethnic groups, divorced parents) and disadvantage (low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across diabetes studies, and the findings for age were mixed across the asthma, COPD and diabetes studies. There was no evidence of an income, numeracy or the number of people living in the household modified intervention effectiveness. We conclude that, there do appear to be interaction effects, which warrant exploration in future research and recommends a priori consideration of predicted interaction effects. Clinical Trial: The protocol on PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163).