Interactive Digital Interventions Research Articles

Effectiveness of Instant Messaging-Based Online Group Support for Preventing Smoking Relapse: a Pragmatic Randomized Controlled Trial

AbstractOnline group support potentially help prevent smoking relapse. This two-arm, pragmatic, open-label randomized controlled trial assessed the effectiveness of instant messaging (IM) (i.e., WhatsApp) online group support versus text messages for smoking relapse prevention. The intervention group (n = 469) participated in 8-week counsellor-moderated IM-based online discussion groups and receive messages on preventing relapse via WhatsApp. The control group (n = 459) received similar messages via text messaging for 8 weeks. Primary outcome was biochemically validated tobacco abstinence (exhaled carbon monoxide < 4 parts per million; or saliva cotinine < 10 ng/ml) at 12-month follow-up. By intention-to-treat, intervention and control groups showed similar prevalence of biochemically validated abstinence (11.9% versus 11.7%, risk ratio [RR] = 1.01; 95%CI 0.71–1.44; P = 0.93). The interactive IM-based online group support was costly but did not increase smoking abstinence compared to simple text messaging. More interactive digital health interventions are more costly but may not be more effective than simple text messaging. ClinicalTrials.gov Identifier: # NCT03717051.

Turning FOP nutrition labels into action: A systematic review of label+ interventions

The effectiveness of nutrition labels in modifying dietary choices remains limited. Information provision alone is a necessary yet insufficient condition for behavior change to occur. Individuals need to (1) turn information into knowledge and (2) turn knowledge into behavior. This article provides a theoretical framework that suggests that complementary interventions may be needed to target barriers that prevent individuals from processing and acting upon FOP nutrition labels. Evidence about which interventions can support nutrition labels for behavioral change is scattered. This article addresses this research gap through a systematic review of multicomponent nutrition label interventions (label+ interventions) and their effects on the actual healthfulness of dietary choices. From the 3519 records identified, 85 label+ interventions were included. The findings provide limited evidence for the effectiveness of supporting nutrition labels with educational material or reference information. The evidence for supporting nutrition labels with interactive digital interventions, such as basket feedback, or financial incentives is promising. Overall, the findings indicate that more intrusive interventions are required to give cause to act on nutrition labels. Implications and future research avenues for the various label+ categories are discussed.Trial registration: PROSPERO systematic review registration number: CRD42020183141.

Effectiveness, feasibility, and acceptability of interactive digital interventions for the treatment of sexual difficulties: a systematic review

Sexual difficulties are common in the UK, but availability of treatment services is scarce. Interactive digital interventions (IDIs) have the potential to deliver tailored psychotherapies for the treatment of sexual difficulties. However, more evidence is needed to determine their effectiveness, feasibility, and acceptability, before widespread implementation. Systematic review across 5 databases, following Cochrane review methods. Meta-analysis of functional, cognitive, emotional, and behavioural outcomes associated with sexual experiences, taken from randomised-controlled trials (RCTs) only, were used to measure effectiveness of IDIs for sexual difficulties. Subgroup analysis was carried out, by gender and IDI level of guidance. A thematic analysis of qualitative and quantitative studies was performed to evaluate feasibility and acceptability. 9 RCTs were included in the meta-analysis and 10 studies in the thematic analysis. Guided IDIs improve functional (SMD 0.68; 95%CI 0.21-1.15), cognitive (SMD 0.62; 95%CI 0.17-1.07), and behavioural (SMD 0.35; 95%CI 0.11-0.59) outcomes for women with sexual difficulties. Little data on men meant no significant conclusions could be drawn. Although study attrition and intervention adherence need addressing, IDIs were found to be feasible and acceptable provided content is personalised and relevant to a diverse range of participants. Users appreciated interventions involving partners and valued therapist support. This review strengthens evidence that IDIs can be effective, feasible, and acceptable for people with sexual difficulties. Incorporation of partner involvement, therapist support, and personalisation when developing IDIs is recommended. IDIs offer an alternative to face-to-face treatments, which could help to reduce waiting-lists and increase availability of services for sexual difficulties. None

Effectiveness, feasibility, and acceptability of interactive digital interventions for the treatment of sexual difficulties: a systematic review

Sexual difficulties are common in the UK, but availability of treatment services is scarce. Interactive digital interventions (IDIs) have the potential to deliver tailored psychotherapies for the treatment of sexual difficulties. However, more evidence is needed to determine their effectiveness, feasibility, and acceptability, before widespread implementation. Systematic review across 5 databases, following Cochrane review methods. Meta-analysis of functional, cognitive, emotional, and behavioural outcomes associated with sexual experiences, taken from randomised-controlled trials (RCTs) only, were used to measure effectiveness of IDIs for sexual difficulties. Subgroup analysis was carried out, by gender and IDI level of guidance. A thematic analysis of qualitative and quantitative studies was performed to evaluate feasibility and acceptability. 9 RCTs were included in the meta-analysis and 10 studies in the thematic analysis. Guided IDIs improve functional (SMD 0.68; 95%CI 0.21-1.15), cognitive (SMD 0.62; 95%CI 0.17-1.07), and behavioural (SMD 0.35; 95%CI 0.11-0.59) outcomes for women with sexual difficulties. Little data on men meant no significant conclusions could be drawn. Although study attrition and intervention adherence need addressing, IDIs were found to be feasible and acceptable provided content is personalised and relevant to a diverse range of participants. Users appreciated interventions involving partners and valued therapist support. This review strengthens evidence that IDIs can be effective, feasible, and acceptable for people with sexual difficulties. Incorporation of partner involvement, therapist support, and personalisation when developing IDIs is recommended. IDIs offer an alternative to face-to-face treatments, which could help to reduce waiting-lists and increase availability of services for sexual difficulties. None

Interactive digital interventions for prevention of sexually transmitted HIV.

Background:Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV.Methods:We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining ‘interactive’ as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic.Results:We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies.Conclusion:There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video

The Sextherapylondon interactive website for sexual difficulties: content, design and rationale

Sexual difficulties are common, but there is limited access to specialist services. People concerned about their sexual functioning may not seek help, and patients and health professionals can find it difficult to raise the topic. This intervention description paper details the aims, design and therapeutic rationale underpinning an interactive website which provides stand-alone, tailored advice and self-help for sexual difficulties. Sextherapylondon (STL) is an interactive digital intervention (IDI) offering evidence-based sex therapy including psychoeducation, cognitive-behavioural and systemic therapy techniques within a social constructionist framework. An online triage module identifies those who need clinical assessment before proceeding with online sex therapy, generating a referral letter. STL offers online self-help for getting or keeping erections, early ejaculation, sexual pain, difficulties with orgasm, and lack or loss of sexual desire. In this paper we describe the content and design of the STL web-based sex therapy programs, including the theoretical and therapeutic rationale which underpins the website structure and content. Sextherapylondon replicates key aspects of therapist-delivered sex therapy from a range of theoretical approaches, to provide tailored, personalised feedback. By offering private, convenient online access, interactive digital interventions can address the needs of people with sexual difficulties who may not otherwise receive help.

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review.

Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.

An interactive website for informed contraception choice: randomised evaluation of Contraception Choices.

ObjectiveImproving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception.MethodsThe Contraception Choices website is an interactive digital intervention which offers tailored advice to aid contraception decision-making (www.contraceptionchoices.org). In a parallel single-blind trial, we randomised 927 women aged 15–30 years from six clinic settings to access the intervention website (n = 464) or to a waiting-list control group (n = 463). The study was initially a feasibility trial, evolving into an evaluation of efficacy, with two primary outcomes at six months: long-acting reversible contraception (LARC) use, and satisfaction with contraceptive method. Secondary outcomes included self-reported pregnancy and sexually transmitted infection diagnoses. Free-text comments on the 3 and 6 month outcome surveys were analysed thematically.FindingsThere was no significant difference between intervention and control groups in the proportion of women using LARC [30.4% intervention versus 31.0% control; adjusted odds ratio 0.87 (95% confidence interval 0.60 to 1.28)]; satisfaction with contraceptive method [82.6% versus 82.1%; adjusted ordinal odds ratio 0.93 (95% CI 0.69 to 1.25)]; self-reported pregnancy [3.3% versus 4.1%; adjusted odds ratio 0.90 (95% CI 0.45 to 1.79)] nor sexually transmitted infection [5.3% versus 4.7%; adjusted odds ratio 0.72 (95% CI 0.55 to 2.36)]. Highly positive free-text comments from intervention participants indicated that the website facilitates contraception choice and can help women feel better prepared before consultation with healthcare providers.InterpretationThe Contraception Choices website was popular for its design, trustworthy information and decision aids but it was not associated with significant differences in use of LARC or satisfaction with contraceptive method. An interactive website can aid contraception choice, but interventions that address factors beyond women’s control, such as access to services, and partner, family or community influences are needed to complement this approach.Research in contextPreventing unintended pregnancy through effective use of contraception is essential for women’s health, but choosing between different contraceptive methods can be challenging, and the opportunity for adequate discussion during routine consultations is often constrained.Evidence before this studyWe conducted two systematic literature reviews: 1) Factors influencing contraception choice, uptake and use: a meta-synthesis of systematic reviews; and 2) Effectiveness of interactive digital interventions (IDI) for contraception choice, uptake and use. For the first review we searched PubMed, CDSR, Epistemonikos, DoPHER, DARE, NHS Economic Evaluation Database, Campbell Library, NIHR Health Technology Assessment, and Health Evidence Canada databases for systematic reviews which addressed contraceptive choice, uptake or use, from 2000 to 2017. PROSPERO registration number: CRD42017081521 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81521. We synthesised the findings of 18 systematic reviews of mostly moderate or high quality. They highlighted the importance of women’s knowledge, beliefs, perceptions of side effects and health risks, as well as relationship status, social network, economic and healthcare factors on contraception choice and use. For the second review, we searched 23 electronic databases, trials registers and reference lists for randomised controlled trials of IDI for contraception, including CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, ASSIA and PsycINFO, from start date to June 2017. PROSPERO registration number: CRD42017081636. We found only five randomised trials of IDI, all from the USA. Risk of bias prevented synthesis of results. www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81636.Added value of this study Women’s common concerns about contraception – fear of hormones, weight gain, cancer, infertility, mood changes, breaks from contraception and changes in bleeding patterns – underpinned development of a new interactive website (www.contraceptionchoices.org). Contraception Choices addresses women’s concerns through succinct text; Q and A format (Frequently Asked Questions, Did you Know?; videos of women and health professionals); an effectiveness infographic, and an interactive decision aid (What’s right for me?).In an online randomised trial with 927 women attending clinics, we found no association of the Contraception Choices intervention with the primary outcomes – satisfaction with contraceptive method and uptake of long-acting reversible methods at 6 months. Nor did we find an association with secondary adverse outcomes – sexually transmitted infections or pregnancy. Comments from women indicated that the website can meet young women’s need for information on the benefits and drawbacks of contraception, help them to make informed decisions, and feel better prepared before healthcare consultations. Contraception Choices is now available on the NHS website: www.nhs.uk/conditions/contraception/which-method-suits-meImplications of all the available evidenceInteractive digital interventions (websites) can aid contraception choice, but other intervention research is needed to address wider influences on unintended pregnancy, including partner views, friends, family, the media, wider society and experiences with healthcare professionals. Future research could examine the impact of the website in different settings, e.g. schools or different countries. We hypothesise that use of the website during contraceptive consultations might improve the efficiency or quality of consultation, for both patients and healthcare providers. Appropriate methodology and time-scale for evaluating digital health interventions remains a key question.

The effect of interactive digital interventions on physical activity in people with inflammatory arthritis: a systematic review

The aim of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of interactive digital interventions (IDIs) for physical activity (PA) and health related quality of life (HRQoL) in people with Inflammatory Arthritis [rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) axial Spondyloarthritis (AS) and psoriatic arthritis (PsA)]. Seven electronic databases identified published and unpublished studies. Two reviewers conducted independent data extraction and quality assessment using the Cochrane risk of bias tool (RoB). The primary outcome was change in objective PA after the intervention; secondary outcomes included self-reported PA and HRQoL after the intervention and objective or self-reported PA at least 1 year later. Five manuscripts, reporting four RCTs (three high and one low RoB) representing 492 (459 RA, 33 JIA) participants were included. No trials studying PsA or AS met the inclusion criteria. Interventions ranged from 6 to 52 weeks and included 3–18 Behaviour Change Techniques. Due to heterogeneity of outcomes, a narrative synthesis was conducted. No trials reported any significant between group differences in objective PA at end of intervention. Only one low RoB trial found a significant between group difference in self-reported vigorous [MD Δ 0.9 days (95% CI 0.3, 1.5); p = 0.004], but not moderate, PA in people with RA but not JIA. There were no between group differences in any other secondary outcomes. There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS.

Seven lessons for interdisciplinary research on interactive digital health interventions.

Research and development for interactive digital health interventions requires multi-disciplinary expertise in identifying user needs, and developing and evaluating each intervention. Two of the central areas of expertise required are Health (broadly defined) and Human–Computer Interaction. Although these share some research methods and values, they traditionally have deep differences that can catch people unawares, and make interdisciplinary collaborations challenging, resulting in sub-optimal project outcomes. The most widely discussed is the contrast between formative evaluation (emphasised in Human–Computer Interaction) and summative evaluation (emphasised in Health research). However, the differences extend well beyond this, from the nature of accepted evidence to the culture of reporting. In this paper, we present and discuss seven lessons that we have learned about the contrasting cultures, values, assumptions and practices of Health and Human–Computer Interaction. The lessons are structured according to a research lifecycle, from establishing the state of the art for a given digital intervention, moving through the various (iterative) stages of development, evaluation and deployment, through to reporting research results. Although our focus is on enabling people from different disciplinary backgrounds to work together with better mutual understanding, we also highlight ways in which future research in this interdisciplinary space could be better supported.

Announcement: Community Preventive Services Task Force Recommendation for Interactive Digital Interventions to Improve Blood Pressure Self-Management

<i>Announcement: </i>Community Preventive Services Task Force Recommendation for Interactive Digital Interventions to Improve Blood Pressure Self-Management

O38 The contraception choices interactive decision-aid: development, content and design

IntroductionWomen have many concerns about contraception which can put them off using reliable methods, and their worries may not surface in consultations with health professionals. An online intervention can offer convenient help with decisions. We describe the design and development of the Contraception Choices website which addresses myths and misconceptions about contraception, and provides tailored recommendations for contraceptive methods.MethodsWe gathered several sources of evidence: 1) A qualitative synthesis of systematic reviews of factors influencing contraceptive choice; 2) Views on contraception expressed on YouTube (35 videos); 3) A meta-analysis of randomised controlled trials of interactive digital interventions for contraceptive decision-making; 4) A narrative synthesis of reviews of interventions for contraceptive decision-making; 5) Seven focus groups with 75 women aged 15 to 30 recruited in clinical settings, to explore beliefs and concerns about contraception and suggestions for website content.YouTube videos and qualitative data were analysed thematically. Themes from the qualitative field work and findings from the evidence reviews were tabulated, and implications for the design of the Contraception Choices website were debated.ResultsThe most common myths and misconceptions about contraception were worries about hormones being unnatural, weight gain, altered bleeding patterns, cancer and future infertility. The Contraception Choices website addresses women’s concerns through videos, information which highlights contraception benefits, and an interactive tool which gives tailored suggestions for contraceptive methods.DiscussionThe role of digital decision-aids for contraception will be discussed. The website will be tested in a pilot randomised controlled trial starting in March 2017.

Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review.

BackgroundLow back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.ObjectiveThe study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes?MethodsBibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively.ResultsOf the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm.ConclusionsThe literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak.

Interactive digital interventions to promote self-management in adults with asthma: systematic review and meta-analysis.

BackgroundTo identify, summarise and synthesise the evidence for using interactive digital interventions to support patient self-management of asthma, and determine their impact.MethodsSystematic review with meta-analysis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The selection criteria requirement was studies of adults (16 years and over) with asthma, interventions that were interactive digital interventions and the comparator was usual care. Outcomes were change in clinical outcomes, cost effectiveness and patient-reported measures of wellbeing or quality of life. Only Randomised Controlled Trials published in peer-reviewed journals in English were eligible.Potential studies were screened and study characteristics and outcomes were extracted from eligible papers independently by two researchers. Where data allowed, meta-analysis was performed using a random effects model.ResultsEight papers describing 5 trials with 593 participants were included, but only three studies were eligible for inclusion for meta-analysis. Of these, two aimed to improve asthma control and the third aimed to reduce the total dose of oral prednisolone without worsening control. Analyses with data from all three studies showed no significant differences and extremely high heterogeneity for both Asthma Quality of Life (AQLQ) (Standardised Mean Difference (SMD) 0.05; 95 % Confidence Interval (CI) 0.32 to −0.22: I2 96.8) and asthma control (SMD 0.21; 95 % CI −0.05 to .42; I2 = 87.4). The removal of the third study reduced heterogeneity and indicated significant improvement for both AQLQ (SMD 0.45; 95 % CI 0.13 to 0.77: I2 = 0.34) and asthma control (SMD 0.54; 95 % CI 0.22 to 0.86: I2 = 0.11). No evidence of harm was identified.ConclusionDigital self-management interventions for adults with asthma show promise, with some evidence of small beneficial effects on asthma control. Overall, the evidence base remains weak due to the lack of large, robust trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0248-7) contains supplementary material, which is available to authorized users.

Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis.

Objective:To synthesize the evidence for using interactive digital interventions (IDIs) to support patient self-management of hypertension, and to determine their impact on control and reduction of blood pressure.Method:Systematic review with meta-analysis was undertaken with a search performed in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The population was adults (>18 years) with hypertension, intervention was an IDI and the comparator was usual care. Primary outcomes were change in SBP and DBP. Only randomized controlled trials and studies published in journals and in English were eligible. Eligible IDIs included interventions accessed through a computer, smartphone or other hand-held device.Results:Four out of seven studies showed a significantly greater reduction for intervention compared to usual care for SBP, with no difference found for three. Overall, IDIs significantly reduced SBP, with the weighted mean difference being −3.74 mmHg [95% confidence interval (CI) −2.19 to −2.58] with no heterogeneity observed (I-squared = 0.0%, P = 0.990). For DBP, four out of six studies indicated a greater reduction for intervention compared to controls, with no difference found for two. For DBP, a significant reduction of −2.37 mmHg (95% CI −0.40 to −4.35) was found, but considerable heterogeneity was noted (I-squared = 80.1%, P = <0.001).Conclusion:IDIs lower both SBP and DBP compared to usual care. Results suggest these findings can be applied to a wide range of healthcare systems and populations. However, sustainability and long-term clinical effectiveness of these interventions remain uncertain.

Implementation of digital interventions for sexual health for young people

Implementation of digital interventions for sexual health for young people

Sexual health promotion for young people delivered via digital media: a scoping review

BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.

P02.01 Systematic review and meta-analysis of randomised control trials of interactive digital interventions for sexual health promotion

<h3>Background</h3> Sexual ill-health is a global concern. Digital technology offers enormous potential for health promotion. This systematic review assessed effectiveness of interactive digital interventions (IDI) for sexual health promotion. <h3>Methods</h3> IDI are interactive programmes providing information, decision support, behaviour-change support and/or emotional support. We searched 40 electronic databases for randomised controlled trials (RCT) of IDI for sexual health promotion. Cochrane Collaboration methods were used to determine the effectiveness of IDI vs. minimal interventions (e.g. waiting list) (comparison1); face-to-face interventions (comparison 2); and different designs of IDI (comparison 3). Separate meta-analyses were conducted for comparisons 1, 2, and 3, by type of outcome (knowledge, self-efficacy, intention, sexual behaviour and biological outcomes). Results were pooled using a random effects model to calculate standardised mean differences (SMDs) and odds ratios (ORs). Subgroup analyses tested the following pre-specified factors: age, risk grouping, and settings (online, healthcare, educational). <h3>Results</h3> We identified 34 RCTs (10,758 participants). Comparison 1: IDI had beneficial effect on knowledge (SMD 0.43, 95% CI 0.14 to 0.71); safer sex self-efficacy (SMD 0.11, 95% CI 0.03 to 0.18) and intention (SMD 0.13, 95% CI 0.05 to 0.22). There was no effect on sexual behaviour (OR 1.15, 95% CI 0.97 to 1.36) or biological outcomes (OR 0.81, 95% CI 0.56 to 1.16). Comparison 2: IDI improved knowledge (SMD 0.36, 95% CI 0.1 to 0.58), and intention (SMD 0.46, 95% CI 0.06 to 0.85), but not self-efficacy (SMD 0.38, 95% CI 0.01 to 0.77). Comparison 3: Tailoring showed a beneficial effect on sexual behaviour (OR 2.64, 95% CI 1.45 to 4.80). No subgroup differences were noted. No data were available for cost-effectiveness. <h3>Conclusions</h3> IDIs can effectively enhance knowledge, self-efficacy, intention, and tailored IDIs can improve sexual behaviour. Further evidence is needed to understand how to translate these positive effects of IDIs into improved sexual health, and how IDIs work. <h3>Disclosure of interest</h3> Nothing to Declare.

P54 Systematic review and meta-analysis of randomised control trials of interactive digital interventions for sexual health promotion

Background Digital technology offers potential for sexual health promotion. Aims We conducted systematic review examining effectiveness of sexual health promotion interactive digital interventions (IDI) compared to 1) minimal interventions (e.g. leaflet); 2) face-to-face interventions; 3) different IDI designs. Methods IDI require users’ contributions to produce personally relevant feedback. We searched 40 electronic databases for randomised controlled trials (RCT) of IDI for sexual health promotion from start dates to 30/04/2013. Separate meta-analyses were conducted for comparisons 1, 2, and 3, by outcome types (knowledge, self-efficacy, intention, sexual behaviour, biological outcomes) using random effects models. Subgroup analyses tested: age, risk grouping, setting (online, healthcare, educational). Results We identified 36 RCTs (11,818 participants) from developed countries. Comparison 1: IDI improved knowledge ((standardised mean difference (SMD) 0.48, 95% CI 0.19 to 0.76)); self-efficacy (SMD 0.11, 95% CI 0.04 to 0.19), intention (SMD 0.13, 95% CI 0.05 to 0.22), sexual behaviour ((Odds Ratio (OR) 1.20, 95% CI 1.02 to 1.41)), but not biological outcomes (OR 0.81, 95% CI 0.56 to 1.16). IDI delivered in educational settings improved sexual behaviour (OR 2.09, 95% CI 1.43 to 3.04), but not in healthcare settings (OR 1.17, 95% CI 0.94 to 1.45), or online (OR 0.96, 95% CI 0.79 to 1.17). Comparison 2: IDI improved knowledge (SMD 0.36, 95% CI 0.13 to 0.58), intention (SMD 0.46, 95% CI 0.06 to 0.85), but not self-efficacy (SMD 0.38, 95% CI -0.01 to 0.77). Comparison 3: Tailoring had no effect on outcomes. Conclusion IDIs can enhance knowledge, self-efficacy, intention, and sexual behaviour.

The Men's Safer Sex (MenSS) trial: protocol for a pilot randomised controlled trial of an interactive digital intervention to increase condom use in men

IntroductionSexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed...