JMIR Publications

ABSTRACT

Background:

Computer-tailored health communication (CTHC) has been shown to be effective for the general population in increasing physical activity (PA) and many other health behaviour changes. However, CTHC studies on behaviour change for people with long-term conditions are still comparatively limited.

Objective:

This systematic review and meta-analysis aimed to assess evidence of CTHC effectiveness for people with or at risk of long-term conditions.

Methods:

A systematic review and meta-analysis was carried out to evaluate the effect of CTHC in increasing PA for people with or at risk of long-term conditions. Hedge’s g was used to calculate mean effect size. Total effect size was pooled and weighted by inverse-variance (IV). When possible, potential moderator variables were synthesised and their effectiveness was evaluated by subgroups analysis with Q-test for between group heterogeneity Q_b. Potential moderator variables included the behaviour change theories and models providing the fundamental logic on CTHC design, behaviour change techniques and tailoring strategies to compose messages, as well as computer algorithms to achieve tailoring.

Results:

In total 24 studies were included in the systematic review, and 18 studies were included in the meta-analysis. Significant small to medium effect size values were found when comparing CTHC to general health information (g = 0.16, P = 0.0006) and to no information sent to patients (g = 0.29, P = 0.0001 ). Half of the included studies had low to moderate risk of bias, and the remained studies had moderate to high risk of bias. Message tailoring strategies, implementation strategies, behaviour change theories and models applied, as well as behaviour change techniques were synthesized from the studies. No strong evidence was found from subgroup analyses on the effectiveness of using particular behaviour change theories and models, nor from using particular message tailoring and implementation strategies.

Conclusions:

This study demonstrates that CTHC is effective in increasing physical activity for people with or at risk of long-term conditions with significant small to medium effects compared to general health information or no information. More CTHC studies are needed to guide design decisions for maximising the effectiveness of CTHC.