JMIR Publications

ABSTRACT

Background:

Interventions to promote healthy diet, physical activity and weight management in pregnancy are increasingly embracing digital technologies. Whilst some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach, and as such can be a valuable resource for healthcare providers, provided they can affect positive behaviour change.

Objective:

This systematic review focussed on exclusively digital interventions, determining their effectiveness, identifying behaviour change techniques (BCTs) and investigating user engagement.

Methods:

Six databases (Medline, Embase, PsychInfo, CINCHAL Plus, Web of Science and ProQuest) were searched for randomised control trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity and/or appropriate weight gain in pregnancy. Outcome measures were gestational weight gain (GWG) and/or changes in physical activity and/or diet. Study quality was assessed using the Cochrane Risk of Bias 2.0. Where possible data were meta-analysed.

Results:

A total of 11 studies met the inclusion criteria. Risk of bias was mostly high (n=5) or moderate (n= 3). Six studies reported on GWG as the primary outcome, four of which also measured changes in physical activity and dietary behaviours. Five studies focussed either dietary behaviours only (n=2) or physical activity only (n=3). Meta-analyses showed no significant benefit of interventions on total GWG, for either intention-to-treat data (-0.28 kg; 95% CI: -1.43, 0.87) or per protocol data (-0.65kgs; 95% CI: -1.98, 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviours and physical activity precluded meta-analyses. Three of the seven studies measuring changes in physical activity reported significant effects of the intervention compared to control, as did one of the six studies targeting dietary changes. BCT coding identified seven BCTs common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning and feedback and monitoring domains as ineffective interventions (mean: 8 vs 3). Six studies reported on user engagement and these data indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement.

Conclusions:

In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage healthy diet, physical activity and/or weight management in pregnancy. In this review effective exclusively digital interventions reported high levels of user engagement with key BCTs and used proactive messaging, such as reminding participants to engage in BCTs and/or providing feedback or tips. Given the self-directed nature of exclusively digital interventions, such interactivity may play a critical role in encouraging and sustaining engagement, thereby contributing to effectiveness. Given the cost and reach benefits of digital interventions, further research is needed to understand how to use ever advancing technologies to enhance user engagement and improve effectiveness.