Behaviour change: digital and mobile health interventions (NG183)

NICE (2020)

NICE - ISBN: 978-1-4731-3872-8

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Evidence Categories

• Care setting: Virtual and digital
• Population group: General Population
• Population group: General population
• Population group: Adults living with overweight and obesity
• Intervention: Intra-/Inter-personal: Multicomponent programme remote
• Outcome: Healthy Eating: Energy intake
• Outcome: Healthy Eating: Fruit and veg intake
• Outcome: Healthy Eating: Wholegrain intake
• Outcome: Healthy Eating: Fat intake
• Outcome: Healthy Eating: Salt intake

Type of Evidence

Guidance

Overview

Evidence Review C, which underpins NICE guideline NG183 aims to provide evidence to answer the following question:

"What components and characteristics of digital and mobile health interventions are effective at changing established behaviours relating to physical activity, sedentary behaviour and diet?"

The authors state:

• "The review therefore aims to describe individual-level digital and mobile health interventions for changing unhealthy diets, poor physical activity levels or sedentary behaviour as well as identifying the critical components and intervention characteristics shown to be effective. Intervention components may include:
  • Specific behaviour change techniques used
  • Digital platform
  • Intervention intensity and duration of provision (e.g. number of sessions or messages, total digital contact time or duration of active digital support).
  • Recommendation or professional endorsement of an intervention
  • Extent of targeting to a group or tailoring/personalisation to an individual
  • Sociodemographic factors of the target audience (such as age, gender, socioeconomic group, and ethnicity and digital literacy)
  • Level of healthcare professional/practitioner induction or interaction
  • How often the intervention has been designed to be used (such as multiple times a day, once a week, or once only)"
• "In total 42 primary studies met the inclusion criteria"
• "All included studies in this review were randomised controlled trials with a follow-up of 6 months or longer."
• "The quality of the evidence for the effectiveness outcomes ranged from moderate to very low, and the majority was very low in quality. This is because most of the included studies had either serious or very serious risk of bias. In addition, many of the effect estimates were imprecise because of small sample sizes and wide confidence intervals."
• "The [NICE guideline] committee considered that this enabled them to only make a recommendation on one component of mobile and digital health interventions that was found to be effective for behaviour change in diet and physical activity."
• "They agreed that many of the interventions that showed benefits adopted the following behaviour change techniques: feedback and monitoring, goals and planning and social support."

Seven studies were in general populations of adults or adults with overweight or obesity, and reported dietary outcomes.

Recommendations

Taking into consideration evidence and stakeholder input, the subsequent guidance (NG183) recommends:

• "1.4.1 Consider digital and mobile health interventions as an option for people who would benefit from improving their diet or increasing their physical activity levels as an adjunct to existing services. Be aware that their effectiveness is variable.
• 1.4.2 Advise people to use digital and mobile health interventions that include self-monitoring, such as recording by activity trackers, or food or physical activity diaries. This can help the person to review their own progress towards their diet or physical activity goals.
• 1.4.3 If you are aware that the person is at risk of developing or resuming an eating disorder or another unhealthy behaviour such as excessive exercise, consider interventions that do not include self-monitoring.