JMIR Publications

ABSTRACT

Background:

People of low socioeconomic position such as those on a low income are disproportionately affected by diabetes, and by unhealthy eating patterns that contribute to poor disease self-management and prognosis. Digitally-delivered interventions have the potential to address some of the barriers to healthy eating experienced by this group. However, little is known about their effectiveness among underserved populations.

Objective:

This systematic review was conducted to assess the effectiveness of digitally-delivered interventions for improving nutrition behaviours and nutrition‐related health outcomes among underserved people with type 2 diabetes (T2D).

Methods:

MEDLINE complete, Global Health, EMBASE, CINAHL complete, Informit Health, IEEE Xplore, Applied science and technology source were searched for digitally-delivered nutrition intervention for disadvantaged people with T2D, published between 1990 and 2022. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane Risk of Bias Assessment Tool. The Behavioural Change Technique Taxonomy V1 (BCTTv1) was used to identify BCTs used in the design of interventions.

Results:

Ten out of 2434 identified records met eligibility criteria and were included, comprising 947 participants. Two digital platforms, web and messaging services (SMS or MMS) were used to deliver interventions. Significant improvements in dietary behaviours were reported in five out of 10 studies, representing improvements in healthier food choices, or increases in dietary knowledge and skills or self-efficacy. Seven studies examined changes in blood glucose level, of which four achieved significant decreases in HbA1C level ranging from 0.3% to 1.8%. The most frequently identified BCTs across all studies were “Instruction on how to perform the behaviour”, “information about health consequences” and “social support”.

Conclusions:

This review provided some support for the efficacy of digitally-delivered interventions on improving healthy eating behaviours of disadvantaged people with T2D, an essential dietary prerequisite for changes in clinical metabolic parameters. Further research is needed into how underserved people with T2D may benefit more from digital approaches and to find the specific features of effective digital interventions for supporting healthy behaviours amongst disadvantaged populations.