OBJECTIVE: Physical activity (PA) interventions are part of many interdisciplinary programs for the management of children and adolescents with or without physical or psychological conditions or disabilities. Aiming to summarize the available evidence, we conducted an umbrella review of meta-analyses of PA interventions that included psychosocial outcomes in populations of children and adolescents.
METHOD: Literature searches were conducted in PubMed, Cochrane Central, Web of Science, Medline, SportDiscus, and PsychInfo from Jan 1, 2010 to May 6, 2022. Meta-analyses of randomised and quasi-randomised studies investigating the efficacy of PA interventions for psychosocial outcomes in children and adolescents were included. Summary effects were recalculated using common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected due to the chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. Quality was assessed using the AMSTAR-II tool. This study is registered with the Open Science Framework, https://osf.io/ap8qu.
RESULTS: A total of 112 studies from 18 meta-analyses generating 12 new meta-analyses with 21232 children and adolescents with conditions or disabilities as ADHD, cancer, cerebral palsy, chronic respiratory diseases, depression, neuromotor impairment, obesity and in general populations were included. PA interventions were efficacious in reducing psychological symptoms in all meta-analyses across the different population groups using random-effects models. However, umbrella review criteria suggested a weak strength of association for this outcome, and GRADE credibility of evidence ranged from moderate to very low. For psychological wellbeing, three out of five meta-analyses identified significant effects, but the strength of these associations was weak, and GRADE credibility of evidence ranged from moderate to very low. Similarly, for social outcomes, meta-analyses reported a significant summary effect, but the strength of association was weak, and GRADE credibility of evidence ranged from moderate to very low. For self-esteem, one meta-analysis in children with obesity failed to show any effect.
CONCLUSION: Even though existing meta-analyses suggested a beneficial effect of PA interventions on psychosocial outcomes across different population groups, the strength of associations was weak, and the credibility of evidence was variable, depending on the target population, outcome, and condition or disability. Randomised studies of PA interventions in children and adolescents with and without different physical and psychological conditions or disabilities should always include psychosocial outcomes as an important dimension of social and mental health.
Poor quality diet, physical inactivity, and obesity are prevalent, covariant risk factors for chronic disease, suggesting that behavior change techniques (BCTs) that effectively change one risk factor might also improve the others. To examine that question, registered meta-review CRD42019128444 synthesized evidence from 30 meta-analyses published between 2007 and 2017 aggregating data from 409,185 participants to evaluate whether inclusion of 14 self-regulatory BCTs in health promotion interventions was associated with greater improvements in outcomes. Study populations and review quality varied, with minimal overlap among summarized studies. AMSTAR-2 ratings averaged 37.31% (SD = 16.21%; range 8.33-75%). All BCTs were examined in at least one meta-analysis; goal setting and self-monitoring were evaluated in 18 and 20 reviews, respectively. No BCT was consistently related to improved outcomes. Although results might indicate that BCTs fail to benefit diet and activity self-regulation, we suggest that a Type 3 error occurred, whereby the meta-analytic research design implemented to analyze effects of multi-component intervention trials designed for a different purpose was mismatched to the question of how BCTs affect health outcomes. An understanding of independent and interactive effects of individual BCTs on different health outcomes and populations is needed urgently to ground a cumulative science of behavior change.
PURPOSE: Health interventions based on theory may be more effective than those that are not. This review of reviews synthesizes all published randomized controlled trial (RCT) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective adult health behaviour change interventions.
METHODS: Systematic reviews including meta-analyses were identified by searching Medline, CINAHL, PsycINFO, and CDSR. A narrative synthesis was used to summarize and analyse the evidence. Only reviews including RCTs of health behaviour change interventions with adults aged 18+ published from 2007 to 2017 were included.
RESULTS: Of 8,659 articles, nine systematic reviews met inclusion criteria. The majority of reviews (n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour. Less than half of the RCTs included in the reviews reported the use of theory (85/183). Two reviews suggested interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Methodological and reporting issues limit the conclusions.
CONCLUSIONS: Theory-based interventions as currently operationalized in systematic reviews were not found to be more effective than non-theory-based interventions. Methodological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions. The promotion of theory use may benefit from using a multifaceted argument, rather than a narrow focus of increased effectiveness. Statement of contribution What is already known on this subject? Theory use is regularly promoted by claiming that it will lead to more effective behaviour change interventions. Theory use has been frequently linked to effectiveness within systematic reviews of behaviour change interventions. The theory-effectiveness hypothesis has not been systematically examined at the systematic review level. What does this study add? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic reviews examining randomized controlled trials of behaviour change interventions in adults. Interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Theory use should be promoted using a multifaceted argument, and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this claim.
Programmes that promote dietary behaviour change for the prevention of chronic disease must include components that are rooted in best practice and associated with effectiveness. The purpose of this overview of systematic reviews was to examine the characteristics and dietary behaviour change outcomes of nutrition interventions among populations with or at risk of non-communicable chronic diseases. Systematic reviews of randomised controlled trials (RCTs) testing dietary behaviour change interventions published between January 2006 and November 2015 were identified via searches in Cochrane Library, PubMed, EMBASE and PsycINFO. Quality of reviews were appraised using AMSTAR. Dietary behaviour change and intervention details were extracted and systematically summarised. Fifteen articles met the inclusion criteria. Dietary behaviour changes in response to nutrition interventions were significant in over half of interventions. Reducing dietary fat and increasing fruits and vegetables were the most common behaviour changes. The characteristics of nutrition interventions and their relationship to effectiveness for dietary behaviour change among chronic disease or at-risk populations were reported inconsistently. However, associative evidence exists to support more frequent contacts and the use of specific behaviour change techniques. No clear relationships were found between effectiveness and intervention setting, mode of delivery or intervention provider, although some population-specific relationships were identified. Interventions that promote long-term maintenance of dietary behaviour changes are lacking in the literature. This comprehensive umbrella review identifies specific characteristics of interventions that are associated with effectiveness in interventions that promote dietary behaviour change among different at-risk populations. In order to maximise outcomes, public health, health promotion and healthcare organisations should consider these results in order to inform the development and improvement of nutrition programmes.
BACKGROUND: Systematic reviews (SRs) have shown that clinical decision support systems (CDSSs) have the potential to improve diabetes care. However, methods of measuring and presenting outcomes are varied, and conclusions have been inconsistent. In addition, the reporting and methodological quality in this field is unknown, which could affect the integrity and accuracy of research. Therefore, it is difficult to confirm whether CDSSs are effective in improving diabetes care. OBJECTIVE: To comprehensively evaluate the effects of CDSS on diabetes care and to examine the methodological and reporting qualities. METHODS: We searched PubMed, EMBASE, and Cochrane Library from their inception to February 2017. Systematic reviews investigating the effects of CDSS on diabetes care were included. Outcomes were determined in advance and assessed separately for process of care and patient outcomes. Methodological and reporting qualities were assessed by AMSTAR and PRISMA, respectively. RESULTS: Seventeen SRs, consisting of 222 unique randomized controlled trials and 102 nonrandomized controlled trials, were included. Evidence that CDDS significantly impacted patient outcomes was found in 32 of 102 unique studies of the 15 SRs that examined this effect (31%). A significant impact of CDSS on process of care was found in 117 out of 143 unique studies of the 11 SRs that examined this effect (82%). Ratings for overall scores of AMSTAR resulted in a mean score of 6.5 with a range of scores from 3.5 to 10.0. Reporting quality related to methodological domains was particularly incomplete. CONCLUSIONS: Clinical decision support systems improved the quality of diabetes care by inconsistently improving process of care or patient outcomes. There is evidence that CDSS for providing alerts, reminders, or feedback to participants were most likely to impact diabetes care. Poor reporting of methodological domains, together with qualitative or narrative methods to combine findings, may limit the confidence in research evidence.
BACKGROUND: Optimizing body composition for healthy aging in the community is a significant challenge. There are a number of potential interventions available for older people to support both weight gain (for those who are underweight) and weight loss (for overweight or obese people). While the benefits of weight gain for underweight people are generally clearly defined, the value of weight loss in overweight or obese people is less clear, particularly for older people.
OBJECTIVES: This umbrella review aimed to measure the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to explore theirqualitative perceptions.
INCLUSION CRITERIA TYPES OF PARTICIPANTS: The participants were older adults, 60 years of age or older, living in the community.
TYPES OF INTERVENTIONS: The review examinedsix types of nutritional interventions: (i) dietary programs, (ii) nutritional supplements, (iii) meal replacements, (iv) food groups, (v) food delivery support and eating behavior, and (vi) nutritional counselling or education.
TYPES OF STUDIES: This umbrella review considered any quantitative systematic reviews and meta-analyses of effectiveness, or qualitative systematic reviews, or a combination (i.e. comprehensive reviews).
TYPES OF OUTCOMES: The quantitative outcome measures of body composition were: (i) nutritional status (e.g. proportion of overweight or underweight patients); (ii) fat mass (kg), (iii) lean mass or muscle mass (kg), (iv) weight (kg) or BMI (kg/m), (v) bone mass (kg) or bone measures such as bone mineral density, and (vi) hydration status.
PHENOMENA OF INTEREST: The phenomena of interestwere the qualitative perceptions and experiences of participants.
SEARCH STRATEGY: We developed an iterative search strategy for nine bibliometric databases and gray literature.
METHODOLOGICAL QUALITY: Critical appraisal of 13 studies was conducted independently in pairs using standard Joanna Briggs Institute tools. Six medium quality and seven high quality studies were identified.
DATA EXTRACTION: Data was extracted independently in pairs from all 13 included studies using the standard Joanna Briggs Institute data extraction tool.
DATA SUMMARY: Only quantitative studies of effectiveness were included. The strength of evidence assessing the effectiveness of interventionswas graded using a traffic light system (green, amber, red). An overall assessment of the quality of the evidence for each comparison was undertaken.
RESULTS: More systematic reviews investigating weight gain than those investigating weight loss were included. Studies onweight gain showed improved body composition for oral nutritional supplements on its own, for oral nutritional supplements in combination with resistance exercise training, and for oral nutritional supplements in combination with nutrition counselling. Studies on weight loss showed that diet in combination with exercise, diet in combination with exercise and nutrition counselling, and nutrition counselling on its own all can lead to reduced weight in older people. The outcomes of lean mass and weight/BMI were responsive to nutritional interventions, but fat mass did not vary. There were no qualitative reviews identified.
CONCLUSIONS: Although effective interventions for weight gain and weight loss to optimize body composition of older people in the community were identified,making long term, clinically relevant changes in body composition is difficult. Multiple interventions are more effective than single interventions.
OBJECTIVE: The present review aims to summarize the evidence about the effectiveness of physical activity (PA) promotion interventions in primary care (PC) and the intervention or sample characteristics associated with greater effectiveness.
METHODS: MEDLINE, EMBASE, and Cochrane Library were searched to identify systematic reviews and meta-analyses published from 2002 to 2012 that assessed the effectiveness of PA-promoting interventions in PC. Information was extracted and recorded about each of the selected studies and their reported results. Methodological and evidence quality was independently rated by two reviewers using the nine-item OQAQ scale and the SIGN classification system.
RESULTS: Ten of the 1664 articles identified met the inclusion criteria: five meta-analyses, three systematic reviews, and two literature reviews. Overall, PA promotion interventions in PC showed a small to moderate positive effect on increasing PA levels. Better results were obtained by interventions including multiple behavioral change techniques and those targeted to insufficiently active patients. No clear associations were found regarding intervention intensity or sample characteristics.
CONCLUSION: Although several high-quality reviews provided clear evidence of small but positive effects of PA intervention in PC settings, evidence of specific strategies and sample characteristics associated with greater effectiveness is still needed to enhance the implementation of interventions under routine clinical conditions.
OBJECTIVE: Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers.
METHOD: We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications.
RESULTS: Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0).
CONCLUSION: SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.
OBJECTIVE: To undertake a scoping review and to map research in the area of digital media use in public health.
STUDY DESIGN: Scoping review.
METHODS: PubMed, PsycINFO, Google and major textbooks of public health communication and health psychology were searched for primary studies or systematic reviews examining the use of digital media in a health context. Searches focussed on studies published between the start of 2000 and the end of June 2013. Abstracts of reviews of public health interventions were examined with respect to target groups, health topic, intervention characteristics, media used, study design, issues of quality and ethics, and outcomes. To map this area of work fully, this information was supplemented by adding information from primary studies. Areas were identified where systematic review evidence was scarce or non-existent by comparing the final map with information from the reviews analysed.
RESULTS: 221 systematic reviews related to digital media use in a public health context were included. Most reviews included studies with an experimental design and general 'at risk' target populations. Specific settings were not specified in the majority of reviews. A large variety of health topics were covered. About a quarter of reviews did not specify a health topic but were concerned with broader issues of health promotion, disease prevention, or health education. Over half of the reviews focussed on eHealth and telemedicine, and another third were concerned with mass media - social marketing. Reviews most frequently reported behaviour-related outcomes or conducted some form of content analysis or analysis of the use of particular media. Research gaps were identified relating to community-based research, participation and empowerment, active media use (especially with respect to visual media und use of specific visual methodologies), and the use of salutogenic or assets-based approaches.
CONCLUSION: The available research relating to digital media use in public health is dominated by studies relating to eHealth, telehealth or social marketing; emphasising the passive reception of messages and a focus on individual behaviour change approaches. Issues of quality and ethics need to be taken into account more consistently. Further research is needed with respect to more participatory methods, particularly those which would seek to use digital media as a means to harness individual and community assets.
BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.
DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.
RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.
CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.
Physical activity (PA) interventions are part of many interdisciplinary programs for the management of children and adolescents with or without physical or psychological conditions or disabilities. Aiming to summarize the available evidence, we conducted an umbrella review of meta-analyses of PA interventions that included psychosocial outcomes in populations of children and adolescents.
METHOD:
Literature searches were conducted in PubMed, Cochrane Central, Web of Science, Medline, SportDiscus, and PsychInfo from Jan 1, 2010 to May 6, 2022. Meta-analyses of randomised and quasi-randomised studies investigating the efficacy of PA interventions for psychosocial outcomes in children and adolescents were included. Summary effects were recalculated using common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected due to the chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. Quality was assessed using the AMSTAR-II tool. This study is registered with the Open Science Framework, https://osf.io/ap8qu.
RESULTS:
A total of 112 studies from 18 meta-analyses generating 12 new meta-analyses with 21232 children and adolescents with conditions or disabilities as ADHD, cancer, cerebral palsy, chronic respiratory diseases, depression, neuromotor impairment, obesity and in general populations were included. PA interventions were efficacious in reducing psychological symptoms in all meta-analyses across the different population groups using random-effects models. However, umbrella review criteria suggested a weak strength of association for this outcome, and GRADE credibility of evidence ranged from moderate to very low. For psychological wellbeing, three out of five meta-analyses identified significant effects, but the strength of these associations was weak, and GRADE credibility of evidence ranged from moderate to very low. Similarly, for social outcomes, meta-analyses reported a significant summary effect, but the strength of association was weak, and GRADE credibility of evidence ranged from moderate to very low. For self-esteem, one meta-analysis in children with obesity failed to show any effect.
CONCLUSION:
Even though existing meta-analyses suggested a beneficial effect of PA interventions on psychosocial outcomes across different population groups, the strength of associations was weak, and the credibility of evidence was variable, depending on the target population, outcome, and condition or disability. Randomised studies of PA interventions in children and adolescents with and without different physical and psychological conditions or disabilities should always include psychosocial outcomes as an important dimension of social and mental health.
