The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status:  a systematic review and meta-analysis

Max J Western; Miranda E G Armstrong; Ishrat Islam; Kelly Morgan; Una F Jones; Mark J Kelson

doi:10.1186/s12966-021-01218-4

The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis

Max J Western
, Miranda E G Armstrong
, Ishrat Islam
, Kelly Morgan
, Una F Jones
, Mark J Kelson

University of Aberdeen
Nutrition and Health Sciences School for Policy Studies University of Bristol
University of Bristol
PRIME Centre Wales
School of Medicine
Cardiff University
University of Exeter

Research output: Contribution to journal › Review article › peer-review

160 Citations (SciVal)

Abstract

BACKGROUND: Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects.

METHODS: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2.

RESULTS: Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs.

DISCUSSION: Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.

Original language	English
Article number	148
Pages (from-to)	148
Number of pages	21
Journal	International Journal of Behavioral Nutrition and Physical Activity
Volume	18
Issue number	1
Early online date	9 Nov 2021
DOIs	https://doi.org/10.1186/s12966-021-01218-4
Publication status	Published - 9 Nov 2021

Bibliographical note

Data Availability Statement

All data and code to replicate our analysis are freely available at https://github.com/MarkKelson/REPAID

Acknowledgements

We would like to extend a big thank you to all of the corresponding authors
of the studies we included in this review and their co-author teams for providing
the data that enabled us to conduct our analysis. We would also like to
thank Delyth Morris, Medical Subject Librarian and Ms Mala Mann, Systematic
Review Consultant at Cardiff University, for helping us to put the literature
search together. During the course of this project the team welcomed four
babies to the world and their contributions must be acknowledged: thanks to
Joseph Kelson, Alexander Armstrong, Orla Western and Cara Kelson. Without
your input the review would have been done in half the time.

Funding

The research team received seed funding from the GW4 Alliance (https:// gw4. ac. uk) via Cardiff University mHealth Network collaboration to start the project. MW received a fellowship from the GetAMoveOn Network+ (EPSRC Grant ref.: EP/N027299/1), the activities of which contributed to his drafting of the manuscript. MA has been supported by grants from the UK Centre for Ageing Better, the Elizabeth Blackwell Institute, the Medical Research Council, and from the University of Bristol, outside the submitted work. KM was funded by a Health and Care Research Wales Health Fellowship Award [grant number HF-16-1164] and her work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Part of MK’s time was funded by a fellowship from the Alan Turing Institute. Neither the GW4 Alliance or any funders of the authors time had any input on the design or execution of this review, nor the writing of the manuscript.

Keywords

Behavior Therapy
Chronic Disease
Exercise
Humans
Mobile Applications
Social Class

Access to Document

10.1186/s12966-021-01218-4Licence: CC BY

Cite this

Western, M. J., Armstrong, M. E. G., Islam, I., Morgan, K., Jones, U. F., & Kelson, M. J. (2021). The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 148. Article 148. https://doi.org/10.1186/s12966-021-01218-4

The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. / Western, Max J ; Armstrong, Miranda E G; Islam, Ishrat et al.
In: International Journal of Behavioral Nutrition and Physical Activity, Vol. 18, No. 1, 148, 09.11.2021, p. 148.

Research output: Contribution to journal › Review article › peer-review

Western, MJ , Armstrong, MEG, Islam, I, Morgan, K, Jones, UF & Kelson, MJ 2021, 'The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis', International Journal of Behavioral Nutrition and Physical Activity, vol. 18, no. 1, 148, pp. 148. https://doi.org/10.1186/s12966-021-01218-4

Western MJ , Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2021 Nov 9;18(1):148. 148. Epub 2021 Nov 9. doi: 10.1186/s12966-021-01218-4

@article{c357e7a39ca4469fa4ffad223941a32d,

title = "The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis",

abstract = "BACKGROUND: Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects.METHODS: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2.RESULTS: Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95\%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs.DISCUSSION: Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.",

keywords = "Behavior Therapy, Chronic Disease, Exercise, Humans, Mobile Applications, Social Class",

author = "Western, \{Max J\} and Armstrong, \{Miranda E G\} and Ishrat Islam and Kelly Morgan and Jones, \{Una F\} and Kelson, \{Mark J\}",

note = "{\textcopyright} 2021. The Author(s).",

year = "2021",

month = nov,

day = "9",

doi = "10.1186/s12966-021-01218-4",

language = "English",

volume = "18",

pages = "148",

journal = "International Journal of Behavioral Nutrition and Physical Activity",

issn = "1479-5868",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status

T2 - a systematic review and meta-analysis

AU - Western, Max J

AU - Armstrong, Miranda E G

AU - Islam, Ishrat

AU - Morgan, Kelly

AU - Jones, Una F

AU - Kelson, Mark J

PY - 2021/11/9

Y1 - 2021/11/9

N2 - BACKGROUND: Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects.METHODS: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2.RESULTS: Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs.DISCUSSION: Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.

AB - BACKGROUND: Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects.METHODS: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2.RESULTS: Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs.DISCUSSION: Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.

KW - Behavior Therapy

KW - Chronic Disease

KW - Exercise

KW - Humans

KW - Mobile Applications

KW - Social Class

UR - https://www.scopus.com/pages/publications/85118771489

U2 - 10.1186/s12966-021-01218-4

DO - 10.1186/s12966-021-01218-4

M3 - Review article

C2 - 34753490

SN - 1479-5868

VL - 18

SP - 148

JO - International Journal of Behavioral Nutrition and Physical Activity

JF - International Journal of Behavioral Nutrition and Physical Activity

IS - 1

M1 - 148

ER -