Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review

Natalie Gold, Xiao Yang Hu, Sarah Denford, Ru Yu Xia, Lauren Towler, Julia Groot, Rachel Gledhill, Merlin Willcox, Ben Ainsworth, Sascha Miller, Michael Moore, Paul Little, Richard Amlot, Tim Chadborn, Lucy Yardley

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Abstract

Background: Digital interventions have potential to efficiently support improved hygiene practices to reduce transmission of COVID-19.
Objective: To evaluate the evidence for digital interventions to improve hygiene practices within the community.
Methods: We reviewed articles published between 01 January 2000 and 26 May 2019 that presented a controlled trial of a digital intervention to improve hygiene behaviours in the community. We searched MEDLINE, Embase, PsycINFO, Cochrane Controlled Register of Trials (CENTRAL), China National Knowledge Infrastructure and grey literature. Trials in hospitals were excluded, as were trials aiming at prevention of sexually transmitted infections; only target diseases with transmission mechanisms similar to COVID-19 (e.g. respiratory and gastrointestinal infections) were included. Trials had to evaluate a uniquely digital component of an intervention. Study designs were limited to randomised
controlled trials, controlled before-and-after trials, and interrupted time series analyses. Outcomes could be either incidence of infections or change in hygiene behaviours. The Risk of Bias 2 tool was used to assess study quality.
Results: We found seven studies that met the inclusion criteria. Six studies reported successfully improving self-reported hygiene behaviour or health outcomes, but only one of these six trials, Germ Defence, confirmed improvements using objective measures (reduced consultations and antibiotic prescriptions). Settings included kindergartens, workplaces, and service station restrooms. Modes of delivery were diverse: WeChat, website, text messages, audio messages to mobiles, electronic billboards, and electronic personal care records. Four interventions targeted parents of young children with educational
materials. Two targeted the general population; these also used behaviour change techniques or theory to inform the intervention. Only one trial had low risk of bias, Germ Defence; the most common concerns were lack of information about the randomisation, possible bias in reporting of behavioural outcomes, and lack of an analysis plan and possible selective reporting of results.
Conclusion: There was only one trial that was judged to be at low risk of bias, Germ Defence, which reduced incidence and severity of illness, as confirmed
by objective measures. Further evaluation is required to determine the
effectiveness of the other interventions reviewed.
Original languageEnglish
Article number1180 (2021)
JournalBMC Public Health
Volume21
Issue number1
DOIs
Publication statusPublished - 21 Jun 2021

Bibliographical note

Funding Information: This review was initiated and managed by Public Health England (PHE) Behavioural Insights, PHE ERD Behavioural Science, University of Southampton, University of Bristol, and University of Bath. The researchers are collaborating on “Rapid co-design, implementation and evaluation of a digital behaviour change intervention to improve hand hygiene and limit spread of the COVID-19 outbreak”, funded by the UKRI/MRC Rapid Response Call: UKRI CV220–009, see: https://www.southampton.ac.uk/psychology/research/projects/germ-defence.page.
Lucy Yardley is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC).
MLW’s salary is funded by the National Institute of Health Research (NIHR), under grant CL-2016-26-005.
XYH is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR).
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. The funders had no role in the design of the study, collection, analysis, and interpretation of data or in writing the manuscript.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher copyright: © The Author(s). 2021.

Citation: Gold, N., Hu, XY., Denford, S. et al. Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review. BMC Public Health 21, 1180 (2021).

DOI: https://doi.org/10.1186/s12889-021-11150-8

Keywords

  • Behaviour
  • Behaviour change
  • Behavioural medicine
  • COVID-19
  • Community health
  • Digital medicine
  • Handwashing
  • Hygiene
  • Infection control
  • Novel coronavirus
  • eHealth

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