Interactive digital interventions for sexual health promotion: a systematic review and meta-analysis of randomised controlled trials

Abstract

BackgroundSexual ill-health is a global concern. Digital technology offers enormous potential for health promotion. This systematic review assessed the effectiveness of interactive digital interventions (IDIs) for sexual health promotion compared with minimal interventions (eg, waiting list), face-to-face interventions, and compared effectiveness of different designs of digital intervention. MethodsIDIs are interactive programmes that require users' contributions (eg, entering personal data, making choices) to produce personally relevant information, decision support, and behaviour change, emotional support, or both. We searched 40 electronic databases for randomised controlled trials of IDIs for sexual health promotion from start dates to April 30, 2013, with no language restrictions (appendix). Separate meta-analyses were conducted using Cochrane Collaboration methods for all comparisons by type of outcome (knowledge, self-efficacy, intention, sexual behaviour, and biological outcomes). Results were pooled using random effects models to calculate standardised mean differences (SMDs) and odds ratios (ORs). Subgroup analyses tested the following prespecified factors: age, risk grouping, and setting (online, health care, educational). FindingsWe identified 36 randomised controlled trials (11 818 participants) conducted in developed countries. Compared with minimal interventions, IDIs had beneficial effects on knowledge (SMD 0·48, 95% CI 0·19–0·76), safer sex self-efficacy (SMD 0·11, 0·04–0·19), intention (SMD 0·13, 0·05–0·22), and sexual behaviour (OR 1·20, 1·02–1·41), but had no effect on biological outcomes (OR 0·81, 0·56–1·16). IDIs delivered in educational settings significantly improved sexual behaviour (OR 2·09, 95% CI 1·43–3·04), but not when delivered in health-care settings (OR 1·17, 0·94–1·45) or online (OR 0·96, 0·79–1·17) (pinteraction=0·005). Compared with face-to-face interventions, IDIs improved knowledge (SMD 0·36, 95% CI 0·13–0·58) and intention (SMD 0·46, 0·06–0·85), but not self-efficacy (SMD 0·38, −0·01 to 0·77). No difference in effectiveness of tailored IDIs compared with non-tailored IDIs for knowledge, intention, or sexual behaviour was observed. No data were available for cost-effectiveness. InterpretationIDIs can effectively enhance knowledge, self-efficacy, intention, and sexual behaviour. Further evidence is needed to understand how IDIs work, their cost-effectiveness, and how these positive effects can be translated into improved sexual health. FundingThis project was funded by the National Institute for Health Research Public Health Research Programme (reference PHR - 11/3009/04)