JMIR Publications

ABSTRACT

Background:

People living with chronic health conditions need support to manage risk factors such as physical inactivity and poor diet. Access to websites providing health information may be an efficient and effective way to manage chronic disease.

Objective:

To determine whether having access to self-directed websites improves physical activity levels and/or diet quality in people living with chronic health conditions. Secondary aims are to evaluate effectiveness of self-directed websites on self-efficacy and quality of life and to compare self-directed websites to websites with additional supports (e.g., tailored interventions or interventions supported by a health care professional).

Methods:

This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, CINAHL and PEDro databases were searched from earliest available until February 2023. Randomized controlled trials (RCTs) evaluating effectiveness of self-directed websites on levels of physical activity and/or diet quality in adults with a chronic health condition were included. If included trials reported on quality of life and/or self-efficacy, these data were also extracted. Two independent reviewers completed data extraction. Risk of bias of included trials was assessed using the Physiotherapy Evidence Database Scale. The overall certainty of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. For outcomes where values were presented as the same unit of measure, data were pooled for meta-analysis to yield an overall mean difference (MD). A standardized mean difference (SMD) was calculated for pooled data where different units were used for the same outcome. Where data of trials could not be included in a pooled analysis, individual trial data were described.

Results:

Twenty-nine trials (n= 6418 participants) were included for analysis. There was moderate certainty evidence that access to self-directed websites increased levels of moderate-to-vigorous physical activity (mean difference [MD], 39 minutes/week; 95% CI, [18.60 – 58.47]), quality of life (SMD 0.36, 95% CI [0.12 to 0.59]) and self-efficacy (SMD 0.26, 95% CI [0.05 to 0.48]) and high certainty evidence for reduction in processed meat consumption (MD, 1.1 portions per week, 95% CI [0.70 to 1.58]) when compared with usual care. No differences were detected for other measures of diet quality. There was no added benefit of providing additional support to website access when compared with self-directed websites.

Conclusions:

Access to self-directed websites can improve physical activity levels, quality of life and self-efficacy. It can also reduce processed meat consumption in people living with chronic health conditions when compared with usual care. Our findings support the development and implementation of disease specific self-directed websites to facilitate long term risk factor management related to physical activity and diet quality for people living with chronic health conditions. Clinical Trial: PROSPERO (CRD42021283168)