JMIR Publications

ABSTRACT

Background:

Smoking tobacco, poor nutrition, risky alcohol use and physical inactivity (SNAP) behaviours tend to cluster together. Health benefits may be maximised if interventions targeted multiple health risk behaviours together rather than addressing single behaviours. The internet has wide reach and is a sustainable mode for delivery of interventions for multiple health behaviours. However, no systematic reviews have examined the long-term effectiveness of internet-based interventions on any combination of and/or all SNAP behaviours in adults aged 18 years or older.

Objective:

This systematic review examined among adults (aged 18+ years) the effectiveness of internet-based interventions on SNAP behaviours collectively in the long-term compared to a control condition.

Methods:

The electronic databases Medline, PsycINFO, Embase, CINAHL and Scopus were searched to retrieve studies describing the effectiveness of internet-based interventions on two or more SNAP behaviours published by 18 November 2019. The reference lists of retrieved articles were also checked to identify eligible publications. The inclusion criteria were randomised controlled trials or cluster randomised controlled trials with adults examining an internet-based intervention measuring the effect on two or more SNAP behaviours at least 6 months post-recruitment and published in English in a peer-reviewed journal. Two reviewers independently extracted data from included studies and assessed methodological quality using the Quality Assessment Tool for Quantitative Studies. A multivariate meta-analysis was performed to examine the long-term effectiveness of internet-based interventions on all four SNAP risk behaviour outcomes, using robust meta-analysis to take into account correlation between outcomes within each study. All SNAP outcomes were coded so they were in the same direction with higher scores equating to worse health risk behaviours.

Results:

Eleven studies met inclusion criteria. Seven studies measured the effect of an internet-based intervention on nutrition and physical activity, one study on smoking, nutrition and physical activity and three studies on all SNAP behaviours. Compared with the control group, internet-based interventions achieved an overall significant improvement across all SNAP behaviours in the long-term (SMD -0.12 (improvement as higher scores=worse health risk outcomes), 95% CI -0.19, -0.05, I2=1.5%, p=0.01). The global methodological quality rating was ‘moderate’ for one study, while the remaining 10 studies were rated as ‘weak’.

Conclusions:

Targeting multiple SNAP behaviours allows individuals to apply techniques used to successfully change one behaviour to another behaviour. Internet-based interventions were found to produce an overall significant improvement across all SNAP behaviours collectively in the long-term. Internet-based interventions targeting multiple SNAP behaviours have the potential to maximise long-term improvements to preventive health outcomes.