JMIR Publications

ABSTRACT

Background:

Health risk behaviors are significant contributors to morbidity, premature mortality, and rising healthcare costs. Traditional interventions to change health behaviors often yield modest effects and have limited scalability. To enhance health outcomes, innovative approaches using smart technologies are being implemented to create personalized digital behavior change interventions. Unsafe sex, along with low physical activity, smoking, and alcohol consumption, is linked to over half of premature deaths. Daily, over 1 million people globally contract sexually transmitted infections (STIs), including HIV, result in high personal, social, and economic costs globally.

Objective:

This overview aims to synthesize evidence on the effectiveness of digital behavior change interventions for preventing STIs/HIV, considering the possible influence of variables such as the intervention content or its application mode.

Methods:

A literature search until August 31, 2024, was performed in four electronic databases for this Overview: Cochrane Database of Systematic Reviews (CDSR), MEDLINE via PubMed, Epystemonikos, and PsyclNFO. No language restrictions were imposed. Data were included and extracted from all systematic reviews on digital behavior change interventions used in the prevention of sexually transmitted infections STIs/HIV, and that their use can prevent STIs and/or reduce risky sexual behavior. Two reviewers independently screened the identified articles and extracted data related to the study characteristics and behavior change techniques, mechanism of action and intervention types using standardized classifications whenever available. The AMSTAR-2 tool was used to evaluate the methodological quality of the included studies.

Results:

3,218 identified records, 19 systematic reviews met inclusion criteria, encompassing 428 primary studies and 117,010 participants. Most reviews focused on mobile-based interventions, text messaging (SMS), and web-based platforms. The most effective BCTs included Goal Setting, Feedback on Behavior, and Prompts/Cues, particularly in increasing STI/HIV testing and service uptake. However, evidence for sustained condom use and reductions in STI/HIV acquisition remained inconsistent. While high-income countries dominated the literature, significant gaps persist in low- and middle-income settings. Only three reviews explicitly reported using BCTs or TDF frameworks.

Conclusions:

Digital interventions, particularly SMS and mobile applications, effectively promote HIV prevention behaviors, yet their impact on long-term adherence and biological outcomes remains uncertain. Future research should prioritize low-resource settings, explore AI-based interventions, and enhance the systematic application of BCTs to optimize effectiveness. Addressing gender-disaggregated data gaps and ensuring equitable intervention access will be essential for maximizing public health impact. Clinical Trial: Registered in PROSPERO (CRD42023485887) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=485887