JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) have emerged as promising tools to promote health behavior change and improve health outcomes. However, there is a noticeable gap in a comprehensive synthesis of strategies that contribute to these interventions.

Objective:

This study aims to (1) identify and categorize the strategies used in DHIs over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) to serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions.

Methods:

This study employed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span is the last 25 years, from January 1, 1999 to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies employed. The strategies were identified and categorized based on the principles of Behavior Change Techniques (BCTs) and Behavior Strategies (BSs).

Results:

A total of 885 papers met the eligibility criteria, involving 954,847 participants. We identified 173 unique strategies used in DHIs, categorized into 19 themes. The three most frequently used strategies were "guide" (492 sample papers, 55.6%), "monitor" (490 sample papers, 55.4%), and "communication" (392 sample papers, 44.3%). The number of strategies employed in each paper ranged from 1 to 32. The majority of interventions targeted clients (95.4%) and took place in hospitals (30.3%) . High-Income Countries (HICs) demonstrated a substantially higher number and diversity of identified strategies than Low and Middle-Income Countries (LMICs), and the number of studies targeting the general public (73.1%) far exceeded those focusing on vulnerable groups (26.9%).

Conclusions:

DHIs and the strategies have developed considerably over the past 25 years. DHIs strategies have evolved from simple approaches to sophisticated, personalized techniques and the trend towards multi-faceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations and more attention should be given to vulnerable groups.