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

Journal: The international journal of behavioral nutrition and physical activity 2021;18(1):148

PMID: 34753490

Free Full Text on BioMed Central View on PubMed

Plain Language Summary

Low physical activity levels are responsible for many non-communicable diseases and a huge cost to health services. Low socioeconomic status is associated with lower physical activity levels and therefore it is important to increase activity amongst this group of people. The use of digital technologies to increase exercise has become popular in recent years, however it is unknown whether they have differing effectiveness depending on the socioeconomic status of the user. This systematic review and meta-analysis of 19 studies aimed to determine whether digital technologies which target physical activity levels are beneficial for those from low socioeconomic status. The results showed that digital interventions targeting activity have differing effectiveness depending on the socioeconomic status, with those from high socioeconomic status benefitting from these interventions, and those from a low socioeconomic status did not. It was concluded that future technologies need to be tailored to target individuals from low socioeconomic status to improve effectiveness. This study could be used by healthcare professionals to understand that digital technologies designed to increase physical activity may not be sufficient for individuals from a low socioeconomic status and extra support and guidance may be needed.

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 (I = 0.18) and high (I = 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.

Address: Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.; Centre for Exercise, Nutrition and Health Science, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.; PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.; Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK.; School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XN, UK.; Department of Mathematics/Institute of Data Science and Artificial Intelligence, University of Exeter, Laver Building, Exeter, EX4 4QE, UK. [email protected].

DOI: 10.1186/s12966-021-01218-4