The effectiveness of app-based mobile interventions on nutrition behaviours and nutrition-related health outcomes: A systematic review and meta-analysis

Karoline Villinger, Deborah R Wahl, Heiner Boeing, Harald T Schupp, Britta Renner, Karoline Villinger, Deborah R Wahl, Heiner Boeing, Harald T Schupp, Britta Renner

Abstract

A systematic review and meta-analysis were conducted to assess the effectiveness of app-based mobile interventions for improving nutrition behaviours and nutrition-related health outcomes, including obesity indices (eg, body mass index [BMI]) and clinical parameters (eg, blood lipids). Seven databases were searched for studies published between 2006 and 2017. Forty-one of 10 132 identified records were included, comprising 6348 participants and 373 outcomes with sample sizes ranging from 10 to 833, including 27 randomized controlled trials (RCTs). A beneficial effect of app-based mobile interventions was identified for improving nutrition behaviours (g = 0.19; CI, 0.06-0.32, P = .004) and nutrition-related health outcomes (g = 0.23; CI, 0.11-0.36, P < .001), including positive effects on obesity indices (g = 0.30; CI, 0.15-0.45, P < .001), blood pressure (g = 0.21; CI, 0.01-0.42, P = .043), and blood lipids (g = 0.15; CI, 0.03-0.28, P = .018). Most interventions were composed of four behaviour change technique (BCT) clusters, namely, "goals/planning," "feedback/monitoring," "shaping knowledge," and "social support." Moderating effects including study design, type of app (commercial/research app), sample characteristics (clinical/non-clinical sample), and intervention characteristics were not statistically significant. The inclusion of additional treatment components besides the app or the number or type of BCTs implemented did not moderate the observed effectiveness, which underscores the potential of app-based mobile interventions for implementing effective and feasible interventions operating at scale for fighting the obesity epidemic in a broad spectrum of the population.

Keywords: BCT; diet; intervention; m-Health; mobile apps; nutrition behaviour; nutritional outcomes; obesity.

© 2019 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Figures

Figure 1
Figure 1
Study selection process
Figure 2
Figure 2
Heat map visualizing the assessment of the 25 Consolidated Standards of Reporting Trials (CONSORT) criteria of study quality for the 41 studies included. Colours range from dark blue (item fulfilled) to light blue (item not fulfilled or unclear) and grey (not applicable). *Wharton et al (2014): semirandomized trial
Figure 3
Figure 3
Absolute frequency of behaviour change technique (BCT) clusters implemented across studies (k = 41) and relative proportion of implemented BCTs within each of the BCT clusters, as classified in the BCT taxonomy.48 The number before the decimal point denotes the BCT cluster; decimal and colour denote the specific BCT. Note. Only nine out of the 16 BCT clusters were implemented across the 41 studies. See Table 1 and Data S7 for absolute frequencies of implemented BCTs
Figure 4
Figure 4
Forest plot showing the effects of app‐based mobile interventions on nutrition behaviours and nutrition‐related health outcomes (k = 41, outcome n = 224; adjusted data set)
Figure 5
Figure 5
Forest plot showing the effects of app‐based mobile interventions on nutrition behaviours (primary outcome) for short‐term, intermediate‐term, and long‐term follow‐up intervals (k = 21, outcome n = 24; adjusted data set)
Figure 6
Figure 6
Forest plot showing the effects of app‐based mobile interventions on nutrition‐related health outcomes (secondary outcome) for short‐term, intermediate‐term, and long‐term follow‐up intervals (k = 34, outcome n = 42; adjusted data set)

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