Effectiveness of digital interventions for reducing behavioral risks of cardiovascular disease in nonclinical adult populations: Systematic review of reviews

Natalie Gold*, Amy Yau, Benjamin Rigby, Chris Dyke, Elizabeth Alice Remfry, Tim Chadborn

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    22 Citations (Scopus)


    Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. Objective: This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. Methods: We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. Results: We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. Conclusions: Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short.

    Original languageEnglish
    Article numbere19688
    Number of pages51
    JournalJournal of Medical Internet Research
    Issue number5
    Publication statusPublished - 14 May 2021

    Bibliographical note

    Funding Information:
    The authors are grateful to Nicola Pearse-Smith for conducting the searches, Rachel Clarke for advice, and Shevez Jeffers for help with the copyediting. This work was funded by Public Health England (PHE). The authors were employed by, or were interns at, PHE when researching this paper. AY was affiliated with the Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, when this work was undertaken and is currently affiliated with the Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine.

    Publisher Copyright:
    © Natalie Gold, Amy Yau, Benjamin Rigby, Chris Dyke, Elizabeth Alice Remfry, Tim Chadborn.


    • Alcohol
    • Behavior change
    • Cardiovascular disease
    • Diet
    • Digital interventions
    • Digital medicine
    • Internet interventions
    • MHealth
    • Mobile interventions
    • Mobile phone
    • Physical activity
    • Smoking
    • Tobacco


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