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

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)