JMIR Publications

ABSTRACT

Background:

Digital interventions are used increasingly in an attempt to improve health behaviors. Improvements in access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children.

Objective:

The goal of this systematic review was three-pronged: 1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (i.e., 3 to 5 years old); 2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and 3) to examine theoretical application and implementation outcomes to ascertain current approaches to digital PA interventions.

Methods:

This review identified and summarized studies of digitally-supported interventions for promoting physical activity in preschool-age children. Three lists of relevant search terms were generated that included technology-related terms, physical activity-related terms and (iii) weight-related terms). The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same two authors assessed study quality using a standardized tool; and three authors completed data extraction on PA outcomes, theory application, and implementation outcomes.

Results:

In total, 601 studies were identified; 8 met inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality/low risk of bias. All but one study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with week overall quality, both of which were child-directed approaches with the intervention centering on providing direct opportunities for PA to children. In total, 5 studies applied a behavioral theory to the design of the intervention. However, no clear patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; one study did not assess any implementation outcomes, and no single study reported on more than two implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n= 4), and researchers assessed fidelity in three studies.

Conclusions:

The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA in the reviewed studies. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components from other intervention components will advance understanding of the effectiveness of digital interventions for increasing child PA and their potential to be implemented more broadly.