JMIR Publications

ABSTRACT

Background:

Electronic and mobile health (e- and m-health) interventions show promise in promoting healthy behaviours among children and adolescents.

Objective:

The aim of this systematic umbrella review and meta-meta-analysis was to evaluate the effectiveness of e- and m-health interventions in promoting healthy behaviours among children and adolescents.

Methods:

Nine databases were searched for systematic reviews and meta-analyses of randomised controlled trials (RCTs) of e- and m-health interventions targeting physical activity, sedentary behaviour, sleep, and dietary outcomes in children and adolescents were eligible. Screening and data extraction, and all assessments were completed by two reviewers. Study quality was assessed using the AMSTAR-2 tool, and meta-analyses were conducted to combine effect sizes using random effects models. Subgroup analyses examined participant and intervention characteristics.

Results:

Twenty-five systematic reviews comprising 440 RCTs and 133,501 participants, mostly involving healthy children and adolescents (n=18) or those with overweight/obesity (n=4) were included. Interventions mostly included active video games or serious games (n=8), various m-health (n=6), various e-health (n=5), combined e- and m-health (n=4), wearables (n=1), and computer-based interventions (n=1) and most had a critically low AMSTAR-2 score (n=18). Meta-analyses based on standardised mean difference (SMD) showed significant effects (all p<0.05) for moderate-to-vigorous physical activity (MVPA, SMD=0.18 [95% CI=0.09, 0.27]), total physical activity (SMD=0.24 [95% CI= 0.13, 0.35]), fat intake (SMD=0.10 [95% CI= 0.02, 0.18]), fruit and vegetable intake (SMD=0.11 [95% CI= 0.00, 0.22]), body mass index (BMI) (SMD=0.19 [95% CI=0.11, 0.27]), and body weight (SMD=0.15 [95% CI=0.01, 0.30]). No effects were found for sedentary behaviour (SMD=0.12 [95% CI=-0.11, 0.35]) or sleep (SMD=0.27 [95% CI=-0.09, 0.63]). Shorter interventions (<8 weeks) had a greater effect on MVPA than longer interventions (≥8 weeks), while longer interventions (≥12 weeks) had a greater effect on BMI compared with shorter interventions.

Conclusions:

E- and m-health interventions offer modest but meaningful improvements in physical activity, diet, and weight management in children and adolescents, with important implications for integrating digital tools into health promotion strategies. Clinical Trial: The protocol was preregistered on PROSPERO (ID: CRD42024537019)