JMIR Publications

ABSTRACT

Background:

Many unhealthy habits develop in early childhood and can lead to long-term health risks, which disproportionately affect children with low socioeconomic position (SEP) backgrounds. Digital health interventions (DHIs) can promote a healthier lifestyle, yet families with lower SEP remain underrepresented, and often face unique barriers to healthy behaviours and to accessing such interventions. As a result, it remains unclear which intervention characteristics are most effective or appropriate for these populations.

Objective:

This review identifies eHealth lifestyle interventions for preschool-aged children and compares interventions for general and low SEP populations on intervention characteristics and effectiveness to gain insight into effective elements for interventions targeting low SEP populations.

Methods:

A comprehensive search was conducted across Scopus, Web of Science, Cochrane Library, ERIC, and ACM Digital Library to identify studies on digital or blended interventions for preschool-aged children (6 months - 5 years) addressing behaviours related to nutrition, physical activity, sedentary behaviour, sleep, or oral health. Screening and selection were supported by AI-assisted software (ASReview). Data were extracted on intervention targets, populations, theoretical and guideline foundations, delivery modes and settings, and persuasive systems design (PSD) features. The methodological quality of (quasi-)experimental studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools.

Results:

73 records that described 51 interventions were included. 33 targeted the general population and 18 focused solely on low SEP families. Interventions across groups were largely similar: typically parent-focused, targeting several lifestyle domains, and informed by theories, frameworks, or evidence-based guidelines. Low SEP interventions more often used text messaging, included fewer persuasive design features, and tended toward single delivery channels. Effectiveness findings were mixed across populations; no consistent patterns were evident when interventions were grouped by their characteristics. Among low SEP interventions only, less effective interventions more often targeted multiple behaviours and included more PSD features.

Conclusions:

This review suggests that differences in effectiveness across lifestyle interventions for preschool-aged children may relate not only to intervention characteristics, but also how well programs fit within families’ everyday contexts and resources. Future research should explore multi-level approaches that address both individual behaviour change and the broader structural conditions influencing health in early childhood and invest in creating environments that equitably and sustainably support families in adopting healthy lifestyles.