BACKGROUND
There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of such interventions are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood.
OBJECTIVE
As such, the aim of this systematic review is to describe the association between DHI engagement (both usage and subjective experience) and dietary intake.
METHODS
A comprehensive search for peer-reviewed literature was undertaken in four electronic databases (EMBASE, MEDLINE, PsychINFO, Scopus) from inception to December 2019. A hand search of targeted journals, grey literature searches and a search of relevant references of similar reviews was also conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). Authors single screened studies, with a pair of review authors assessing quality of studies and extracting relevant data. Narrative syntheses using vote counting was undertaken to explore to relationship between measures of engagement and dietary intake.
RESULTS
The search resulted in 10,653 citations, of which seven studies (from nine articles) were included in the review. The majority of studies (n=5) included usage measures of engagement rather than subjective experience (n=2). Logins were the most commonly reported usage measure (n=5 studies), and fruit and vegetable intake was the most common measure of dietary intake (n=4 studies). The heterogeneity of engagement and dietary intake measures limited the use of meta-analytic techniques, however narrative review (vote counting) found mixed evidence of an association with usage measures (5 of 12 associations indicating a positive relationship, 7 were inconclusive). No evidence regarding an association with subjective experience was found (0 of 2 associations were inconclusive). The majority of included studies (n=5) were rated poor quality according to the Newcastle Ottawa Scale.
CONCLUSIONS
The findings provide some evidence supporting an association between measures of usage and fruit and vegetable intake, however this was inconsistent. No evidence was found regarding an association with subjective experience. Given the limited number of studies included in the review and poor quality of available evidence further research examining the association between DHI engagement and dietary intake using consistent measures, with an additional focus on subjective experience is warranted.
CLINICALTRIAL
CRD42018112189