A systematic review of randomized control trials (RCT) was undertaken to evaluate the effectiveness of eHealth behavioral interventions aiming to improve smoking rates, nutrition behaviors, alcohol intake, physical activity levels and/or obesity (SNAPO) in young adults. Seven electronic databases were searched for RCTs published in English from 2000 to April 2015 and evaluating eHealth interventions aiming to change one or multiple SNAPO outcomes, and including young adult (18-35years) participants. Of 2,159 articles identified, 45 studies met the inclusion criteria. Most interventions targeted alcohol (n=26), followed by smoking (n=7), physical activity (n=4), obesity (n=4) and nutrition (n=1). Three interventions targeted multiple behaviors. The eHealth interventions were most often delivered via websites (79.5%). Most studies (n=32) compared eHealth interventions to a control group (e.g. waiting list control, minimal intervention), with the majority (n=23) showing a positive effect on a SNAPO outcome at follow-up. Meta-analysis demonstrated a significantly lower mean number of drinks consumed/week in brief web or computer-based interventions compared to controls (Mean Difference -2.43 [-3.54, -1.32], P<0.0001, n=10). Sixteen studies compared eHealth delivery modes, with inconsistent results across target behaviors and technology types. Nine studies compared eHealth to other modes of delivery (e.g. in person) with all finding no difference in SNAPO outcomes between groups at follow-up. This review provides some evidence for the efficacy of eHealth SNAPO interventions for young adults, particularly in the short-term and for alcohol interventions. But there is insufficient evidence for their efficacy in the longer-term, as well as which mode of delivery is most effective.
This is relevant information. Yet, there is a so what question. What do clinicians do with this information?
This systematic review results are very relevant for chronic disease prevention strategies with this client population for public health nurses and nurses working in primary care settings. These results will inform the greater use of e-health in the delivery of prevention programs.
Given the small number of e-health studies selected for study that attempted to modify behaviors related to nutrition, physical activity, and obesity, this review does not provide much in the way of useful information about interventions for these behaviors. Only the studies focusing on alcohol use included enough subjects for detailed statistical analysis. However, the findings relative to e-health interventions for alcohol use among young adults are of limited value because the definition of an e-health intervention for this study encompassed such a wide range of methods. Coupled with the absence of evidence that the interventions studied produced sustained modifications in unhealthy behaviors, I think the value of this study for practicing public health professionals is limited.
The notion of using websites, e-mails, and text messages to promote behavioral changes is a new, potentially useful, and likely cost-effective treatment method that is bound to increase in popularity over coming months-to-years. This article cites success in improving young adults' alcohol intake as evidence that eHealth interventions can be effective, at least in the short term, and should be considered as a potentially effective intervention in efforts to modify other adverse lifestyle behaviors, such as smoking and unhealthy eating.
This is a well done and wide ranging systematic review of eHealth interventions for smoking, weight, alcohol and physical activity. As is typical, the underlying studies are of variable quality and size. The conclusion that eHealth hasn't been solidly proven is useful as there is a lot of enthusiasm and not much data.