Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 13, 2021
Date Accepted: Mar 31, 2022
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Barriers and facilitators in eHealth-based lifestyle interventions for people with lower socioeconomic status: A scoping review of the current State
ABSTRACT
Background:
Promoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with low socioeconomic status (SES) remains a major challenge. eHealth interventions are a promising approach to change unhealthy behaviors within this target group.
Objective:
This review aimed to identify key components, barriers, and facilitators in the development, reach, use, evaluation and implementation of eHealth lifestyle interventions for people with low SES. This review provides an overview for researchers and eHealth developers and can assist in the development of eHealth interventions for people with low SES.
Methods:
We performed a scoping review based on the framework of Arksey and O’Malley’s. Appropriate key terms were used to systematically search for relevant peer-reviewed articles in Pubmed, Embase, Web of Science, Cochrane Library.
Results:
The search resulted in 1323 studies, of which 42 met our inclusion criteria. An update of the search led to the inclusion of 17 additional studies. eHealth lifestyle interventions for people with low SES are often delivered via internet-based methods (e.g., websites, email, Facebook, smartphone apps) and offline methods, such as texting. A minority of the interventions combined eHealth lifestyle interventions with face-to-face or telephone coaching, or wearables (blended care). We identified the use of different behavioral components (e.g., social support) and technological components (e.g., multi-media) in eHealth lifestyle interventions. Facilitators in the development included iterative design, working with different disciplines, and resonating intervention content with users. Facilitators for intervention reach were utilizing a personal approach and the social network, reminders and self-monitoring. Nevertheless, barriers such as technological challenges for developers and limited financial resources may hinder intervention development. Furthermore, passive recruitment was a barrier to intervention reach. Technical difficulties and the use of self-monitoring devices were common barriers for users of eHealth interventions. Only limited data on barriers and facilitators for intervention implementation and evaluation were available.
Conclusions:
While we found large variations between the studies regarding key intervention components, and barriers and facilitators, our findings suggest that one-size-fits-all eHealth interventions may be less suitable for people with a low SES. Future research should investigate how to customize eHealth lifestyle interventions to meet the needs of low SES participants, and it should identify the components that enhance their reach, use, and effectiveness.
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