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Table 1 Characteristics of behavioural e-& mHealth intervention studies included in the review

From: The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: A systematic review

Author Year Country Study design Duration Sample (sample size, mean age/range, sex) Intervention Outcome measures (PA, SB, diet) Retention rate Acceptability Participation rate Results
Lana et al. 2014 [35] Mexico and Spain Study design
3-group RCT
Duration
Intervention exposure: 9 months
Measurement points: baseline and 9 months
Sample
N = 2001 (737 analysed);
12–16 years students;
45.2 % (M), 54.8 % (F)
IG 1 & IG 2: Website targeting cancer risk behaviours (advantages of healthy/disadvantages of risky behaviours, skills training to avoid risk behaviours, expert advice, videos, forums, documents, web links, educational games) based on the Theory of Planned Behavior and the Transtheoretical Model
IG 2: Additional weekly text messages encouraging health behaviours
CG: No intervention
Behavioural outcomes Diet (fruit and vegetable intake, fat intake); PA (doing PA less than 360 min/week)
Measures Online questionnaire
Other relevant outcomes BMI
Retention 36.8 % Diet: Sig. within-group increase in percentage of students consuming enough fruits in all groups (67.0 % mean decrease, p < .001); no sig. within-group changes for other diet behaviours
PA: No sig. within-groups change in percentage of students doing less than 360 min/week PA
BMI: Sig. within-group changes in percentage of overweight/obese students in IG 2 (19.6 % decrease, p < .05)
Rotheram–Borus et al. 2012 [50] South Africa Study design
1-group pre-post-follow-up
Duration
Intervention exposure: 3 months;
Measurement points: baseline, 3 and 6 months
N = 22;
53.0 year/21–74 years diabetic township residents; 100 % (F)
3-component PA and diet program: Weekly educational group sessions addressing healthy lifestyle; daily text messages asking about adherence to healthy behaviours; peer support for lifestyle changes via text messages or call Behavioural outcomes
PA (daily step count)
Measurements
Pedometer
Other relevant outcomes
BMI
Retention
100 %
Participation rate
Participants responded to 54 % of text messages sent by study team; peers exchanged on average 123 text messages weekly
PA: No sig. change in daily step counts from baseline to 3 months (d = 0.03), and from baseline to 6 months (d = 0.27)
BMI: No sig. changes (d = −0.07 to 0.07)
Ramachandran et al. 2013; Ram et al. 2014 [40, 41] India Study design
Prospective 2-group RCT
Duration
Mean duration of follow-up 20.2 months (SD 7.0), either intervention exposure of 24 months or until participants developed diabetes
Sample
N = 537 (517 analysed);
46.0 year/35–55 years working men with impaired glucose tolerance; 100 % (M)
IG & CG: Face-to-face education and motivation about healthy lifestyle plus written information about diet and PA (balance food intake and PA to achieve/maintain healthy body weight
IG: Additional 2–4 weekly text messages; messages based on the Transtheoretical Model and contained information about diet and PA, benefits of healthy diet and PA, strategies for relapse prevention and motivation to maintain healthy diet and PA
Behavioural outcomes
Diet (total dietary energy intake, adherence to dietary recommendations, portion size, oil intake, carbohydrate consumption); PA (PA score ranging from 7 to 70, adherence to PA recommendations)
Measurements
Diet (24 h recall), PA (own questionnaire)
Other relevant outcomes
BMI, waist circumference
Retention
96 %
Acceptability
Test messages were welcomed, 3 % were disturbed by text messages at least once
Diet: Sig. difference in mean change = −43.7 kcal/day (95 % CI:−65.5;−22.0) favouring IG; Sig. more participants in IG adhered to dietary recommendations at follow-up (OR 1.36, 95 % CI: 1.01; 1.83); higher percentage of participants in IG improved portion size OR = 0.39 (95 % CI: 0.25; 0.60), oil intake OR = 0.46 (95 % CI: 0.30; 0.69), carbohydrate consumption OR = 0.52 (95 % CI: 0.34; 0.78) vs CG (p < .05)
PA: Non-sig. difference in mean change in PA score = −1.0 point (95 % CI:−2.0; 0); Adherence to PA recommendations did not sig. differ at follow-up (OR 1.11, 95 % CI: 0.78; 1.57, p > .05)
BMI: Difference in mean change = −0.05 kg/m2 (95 % CI: −0.46; 0.37)
Waist circumference: Difference in mean change = 0.04 cm (95 % CI: −0.56; 0.64)
The mean lifestyle score was higher in the IG than the CG (2.59 ± 1.13 vs. 2.28 ± 1.17; p = .002)
Shetty et al. 2011 [42] India Study design
2-group RCT
Duration
Intervention exposure: 12 months
Measurement points: baseline and 12 months
Sample
N = 215 (144 analyzed); 50.3 years/type 2 diabetic patients; Both sexes (no further information)
IG & CG: During initial and follow-up visits education program with individual advice on nutrition and PA
IG: Additional 2–4 weekly text messages; reminders/instructions to follow regimen of healthy diet and PA; messages on healthy habits
Behavioural outcomes
Diet (scores for components of healthy diet and frequency of adherence to it); PA (scores for occupation and leisure time PA)
Measurements
Questionnaire
Other relevant outcomes
BMI
Retention
67 %
Acceptability
Text messages highly acceptable reminder tool
Diet: No sig. changes in percentage of participants adhering to diet regiment (IG: from 60.3 to 58.4 %; CG: from 54.5 to 52 %)
PA: No sig. changes in percentage of participants complying with PA advice (IG: 47 to 56 %; CG: 47 to 52 %)
BMI: No sig. changes
Zolfaghari et al. 2012 [47] Iran Study design
2-group CT
Duration
Intervention exposure: 3 months
Measurement points: baseline and 3 months
Sample
N = 80 (77 analysed); 18–65 years diabetes patients; 53 % (F) 47 % (M)
IG1: Phone counselling about diabetes management including health behaviour twice weekly for 1st month and weekly for months 2 and 3.
IG2: 6 weekly text messages on diabetes management including behavioural health.
Behavioural outcomes
Adherence to diet and PA recommendations as a score
Measurements Questionnaire
Retention
96.3 %
Diet Adherence: Sig. within-group increase in IG1 (18.24 ± 2.46, p < .001) and IG2 (16.50 ± 1.98, p < .001) but no sig. between-group changes (d = −0.78, p = .44)
PA Adherence: Sig. within-group increase in IG1 (35.66 ± 0.68, p < .001) and IG2 (40.02 ± 1.43, p < .001) but no sig. between-group changes (d = 4.13, p = .33)
Chen et al. 2014 [51] China Study design
1-group pre-post
Duration
Intervention exposure: 1 to 6 months
Measurement points: baseline and 1 to 6 months
Sample
N = 253; 40+ yrs pre diabetic patients in rural area; 68 % (F) 32 % (M)
Computer tailored web-based intervention for diabetes prevention. Delivered each time a patient presents at medical clinic to see general practitioner. Includes education, diabetes risk scoring and tailored feedback on changes on lifestyle behaviours (diet and PA) and barriers. Prompts general practitioner. Behavioural outcomes
PA (one question at follow up to determine increased leisure time exercise)
Diet (two questions at follow up to determine reduced calorie intake and increased fruit and vegetable intake)
Measurements
Interview
Other relevant outcomes
Body weight, BMI
Retention
91 %
Acceptability
8.76–9.20 out of 10.
PA: Sig. change in number of participants who increased leisure time exercise from 16 (6.3 %) to 49 (21.2 %, p < .001)
Diet: Sig. increase in number participants who reduced caloric intake from 4 (1.6 %) to 165 (71.4 %, p < .001); Sig. increase in number of participants who increased fruit-and vegetable intake from 43 (17 %) to 205 (88.7 %, p < .001)
BMI: Sig. reduction from 24.8 kg/m2 (±3.21) to 23.4 kg/m2 (±2.95) (d = 0.49, p < .001)
Body weight: Sig. reduction from 62.1 kg (±9.85) to 58.3 kg (±9.18) (d = 3.43, p < .001)
Tamban et al. 2013 [43] Philippines Study design
2-group RCT
Duration
Intervention exposure: 6 months Measurement points: baseline, 3 months and 6 months
Sample
N = 125 (104 analysed); 19–50 year diabetes patients; 48 % (F) 52 % (M).
IG & CG: Lecture from diabetes educator and usual appointments with diabetes educator and endocrinologist.
IG: Additional text messages 3 times weekly for 6 months on healthy diet, exercise and consequences of negative health behaviours.
Behavioural outcomes
PA (adherence to 30 mins of exercise on 5 days weekly)
Diet (Number of meals meeting diet recommendations and number of days adhered to 3 proper meals recommendation)
Measurement
Interview
Other relevant outcomes
BMI, Body weight
Retention
79 %
PA: Sig. between-group increase in minutes of exercise at 6 months favouring the IG (p = .02); no sig. between-group changes in mean number of days meeting PA recommendations
Diet: Sig. between-group improvements in adherence to 3 meals per day recommendation favouring IG (p = .02); no sig. between-group changes in mean number of days meeting diet recommendations.
BMI: No sig. between-within group changes
Body weight: No sig. between-within group changes
Nurgul et al. 2015 [52] Turkey Study design
1-group pre-post
Duration
Intervention exposure: 3 months
Measurement points: baseline and 3 months
Sample
N = 44 (30 analysed); 18–55 years university employees; 100 % (F)
Web-based health intervention: Modules delivered every 3 weeks. 1 module on nutrition, 1 on diet and 1 on smoking and stress. Modules consist of an audio-visual lecture. Behavioural outcomes
PA and Diet (Health Promotion Lifestyle Profile)
Measurement
Online Questionnaire
Retention
68.2 %
PA: Sig. increase from 16.63 points (±5.33) to 19.20 points (±5.25), d = −0.48, p = .004
Diet: Sig. increase from 20.70 points (±3.90) to 23.47 points (±3.41), d = −0.81, p = .001
Bombem et al. 2013 [48] Brazil Study design
2-group CT
Duration
Intervention exposure: 6 months
Measurement points: baseline and 6 months
Sample
N = 279 (236 analysed); 18–64 years adult employees; 42.3 % (M), 57.7 % (F)
IG: Healthy Weight Program incl. dietary and PA education through tailored monthly email messages, as well as goal setting, and self-monitoring of weight. Based on Social Cognitive Theory.
CG: Wait-list control
Healthy weight program at the end of 6-months intervention
Behavioural outcomes
Diet (food and beverage intake incl. fruits, vegetables, grains, dairy, meat, legumes; fat and sodium intake)
Measures
24 h dietary recall, phone interview
Retention
85 %
Diet: Sig. decrease in overall diet quality score in both groups (p < .05). Sig. more decrease in diet quality score in CG compared to IG (adjusted impact: 3.55, 95 % CI: 1.52; 5.57). Sig. increase in grains, but decrease in vegetable consumption, meat, eggs, sodium intake, and overall diet quality score (p < .05).
Sriramatr et al. 2014 [44] Thailand Study design
2-group RCT
Duration
Intervention exposure: 3 months
Measurement points: baseline, 3 and 6 months
Sample
N = 110;
19.0 year/18–24 years students; 100 % (F)
IG: Website and weekly emails incl. PA education, tailored advice, goal setting and self-monitoring via pedometer. Based on the Social Cognitive Theory.
CG: Pedometer without website and emails.
Behavioural outcomes
PA (daily step count, weekly leisure-time PA score)
Measurements
Online Questionnaire
Pedometer
Retention
79 %
Participation Rate
90–95 % accessed website, recorded PA and set PA goals each week
PA daily step counts: Mean difference in change from baseline to 3 months between groups was 3766 steps favouring IG. Mean difference in change from baseline to 6 months between groups was 3360 steps favouring IG
PA leisure time activity score: Mean difference in change from baseline to 3 months between groups was 15.13 points favouring IG. Mean difference in change from baseline to 6 months between groups was 14.87 points favouring IG
Shahid et al. 2015 [45] Pakistan Study design
2-group RCT
Duration
Intervention exposure: 4 months
Measurement points: baseline and 4 months
Sample
N = 440;
49.08 years/18–70 year, type-2 diabetes patients; 61.4 % (M), 38.6 % (F)
IG & CG: Usual care plus leaflet on diet and a healthy lifestyle
IG: Additional regular (every 15 days) mobile phone calls to provide feedback on self-monitored blood glucose levels over the past readings of 15 days.
Behavioural outcomes
Diet; PA (if they are following diet plan and are physically active)
Measures
Not reported
Other relevant outcomes
BMI
Retention
Not reported
Diet: Sig. increase in proportion of participants following dietary plan from baseline (17.3 %) to 4 months (43.6 %) in IG (p < .001). Non-sig. in CG
PA: Sig. increase in proportion of physically active participants from baseline (16.4 %) to 4 months (44.5 %) in IG (p < .001) Non-sig. in CG
BMI: Sig. reduction (p < .001) in IG (.96 ± .09) and CG (1.02 ± .09); d of difference in change − 0.67 favouring CG
Müller et al. 2016 [46] Malaysia Study design
2-group RCT
Duration
Intervention exposure (text messaging): 3 months
Measurement points: baseline, 3 and 6 months
Sample
N = 43 (39 analysed);
63.3 years/55–70 year,
26 % (M), 74 % (F)
IG & CG: Printed exercise booklet with 12 age appropriate exercises.
IG: Additional 60 encouraging text messages over 3 months (content based on effective Behavior Change Techniques
Behavioural outcomes
PA (weekly exercise frequency using the exercise booklet; PA-related energy expenditure; daily time spent sitting)
Measures
Exercise diary
International PA Questionnaire (short)
Other relevant outcomes
BMI
Retention
86 %
Acceptability
IG participants liked the text messages and those who faced exercise barriers benefited from them.
PA (exercise frequency): Sig. more often exercise in IG (3.7 ± 1.3) compared to CG (2.5 ± 1.85) at 3 months (d = 0.76, p = .027); Non-sig. difference at 6 months (3.1 ± 1.3 vs. 2.3 ± 1.9, d = 0.45, p = .18)
PA (PA related energy expenditure): No sig. between-within group changes
PA (daily time spent sitting): No sig. between-within group changes
BMI: No sig. between-group changes
Rubinstein et al. 2016 [36] Peru, Argentina, Guatemala Study design
2-group RCT
Duration
Intervention exposure: 12 months
Measurement points: baseline and 12 months
Sample
N = 637 (553 analysed);
43.4 years/30–60 year, adults with prehypertension
46 % (M), 54 % (F)
IG and CG: Leaflet with information on adoption of healthy lifestyle
IG: Additional monthly calls to motivate participants to adhere to healthy behaviours (diet and PA) plus max. 5 text messages per month that were based on the Transtheoretical Model (target on chosen diet/PA behaviour).
Behavioural outcomes
PA (weekly MET-minutes) Diet (daily intake of sodium, fat and sugar, fruits and vegetables)
Measures
International PA Questionnaire (short)
Food Frequency Questionnaire
Other relevant outcomes
BMI, body weight, waist circumference
Retention: 86.8 %
Acceptability: Participants found call and text messages helpful
Participation rate: Only 3 % received all 12 calls, call duration 20–30 min, median of 23 text messages over 12 months
PA: Mean difference in change between groups − 80.4 (95 % CI:−386; 225.5, p = .61)
Diet (daily sodium intake): Mean difference in change between groups − 0.07 (95 % CI:−0.25;0.12 p = .49)
Diet (daily fat and sugar intake): Mean difference in change between groups − 0.75 (95 % CI:−1.30;−0.20, p = .008)
Diet (daily intake of fruits and vegetables): Mean difference in change between groups 0.25 (95 % CI:−0.01; 51, p = .05)
BMI: Mean difference in change between groups − 0.30 (95 % CI: −0.59; 0.06, p = .02)
Body weight: Mean difference in change between groups −0.66 (95 % CI: −1.24; −0.07, p = .04)
Waist circumference: Mean difference in change between groups −0.64 (95 % CI: −1.62; 0.35, p = .21)
Ganesan et al., 2016 [37] 92 % of participants from developing countries (India, China, Philippines) Study design
1-group pre-post
Duration
Intervention exposure: 2.5 months
Measurement points: baseline and 2.5 months
Sample
N = 69219 (36652 analysed); 36.0 year (±9 years), adult employees; 76.1 % (M), 23.9 % (F)
100-day Stepathlon programme: Participants received pedometer and entered daily step count into Stepathlon website or app. Website to facilitate motivation and engagement via self-monitoring, social networking, quizzes, expert chats and competition between employees. Encouraging emails daily and when milestones were reached. Behavioural outcomes
PA (daily step count, weekly exercise days, daily sitting time)
Measures
Pedometer
Online survey
Other relevant outcomes
Body weight
Retention: 53.0 % PA (daily step count): Sig. increase of 3519 steps (95 % CI: 3484; 3553, p < .001)
PA (weekly exercise days): Sig. increase of 0.89 days/week (95 % CI: 0.87; 0.92, p < .001)
PA (daily sitting time): Sig. decrease of 0.74 h/day steps (95 % CI:−0.78;−0.71, p < .001)
Body weight: Sig. reducion of 1.45 kg (95 % CI:−1.53;−1.38, p < .001)
Pfammatter et al., 2016 [49] India Study design
2-group CT
Duration
Intervention exposure: 6 months
Measurement points: baseline and 6 months
Sample
N = 1925 (1243 analysed);
32.2 years (±10.6 years);
88.52 % (M), 11.48 % (F)
IG: 56 motivational text messages addressing awareness of diabetes and diabetes risk behaviours
CG: No intervention
Behavioural outcomes
PA (current exercise)
Diet (fruit, vegetable and fat intake)
Measures
Telephone survey
Retention: 64.6 % PA: No sig. between-group change in exercise participation (p > .05)
Diet (daily intake of fruit and vegetables): Sig. between-group increase favouring the IG (p < .001)
Diet (fat intake): Sig. between-group decrease favouring the IG (p < .001)
  1. Abbreviations: IG intervention group, CG control group, PA physical activity, BMI body mass index in kg/m2, MET metabolic equivalent of task