Background: The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users’ subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. Objective: This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). Methods: Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non–digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. Results: Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). Conclusions: The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.

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中文翻译：

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数字健康干预参与、体力活动和久坐行为之间的关联：系统评价和荟萃分析


背景：数字健康干预措施的有效性通常被认为与用户对数字健康干预措施的参与程度有关，包括数字健康干预措施使用和用户主观体验的衡量。然而，人们对数字健康干预措施与身体活动或久坐行为之间的关系知之甚少。目的：本研究旨在描述成人数字健康干预参与与身体活动或久坐行为之间关联的方向和强度，并探讨数字健康干预参与与身体活动或久坐行为的关联方向是否因类型而异。参与数字健康干预的程度（即主观体验、完成的活动、时间和登录）。方法：检索了四个数据库，从建库到2019年12月。还检索了关键系统评价和期刊的灰色文献和参考文献列表。如果研究检验了针对身体活动的数字健康干预措施的参与度与成人（年龄≥18岁）的身体活动或久坐行为的测量之间的定量关联，则研究符合纳入资格。根据预先存在的健康相关状况故意取样或招募个体的研究被排除在外。此外，如果参与数字健康干预的个人不是身体活动干预的目标，研究有非数字健康干预成分，或者数字健康干预针对多种健康行为，则研究被排除。 随机效应荟萃分析和关联计票方向（针对未纳入荟萃分析的研究）用于解决目标 1。目标 2 使用关联方向计票。结果：总体而言，识别出 10,653 个独特引文，并对 375 篇全文进行了审查。其中，19 项研究（26 个关联）被纳入该评价，但没有研究报告对久坐行为的测量。对 11 项研究的荟萃分析表明，数字健康参与度（基于所有使用指标）与体力活动之间存在统计上显着的小幅正相关关系（0.08，95% CI 0.01-0.14，SD 0.11）。异质性很高，77% 的点估计变异是由研究间异质性解释的。计票表明，身体活动与数字健康干预参与度之间的关系在以下三项指标上始终呈正相关：主观体验指标（3 个关联中的 2 个）、完成的活动（8 个关联中的 5 个）和登录（10 个关联中的 6 个）。然而，身体活动和基于时间的使用测量（使用干预措施所花费的时间）之间的关联方向是混合的（5 个关联中的 2 个支持该假设，2 个不确定，1 个拒绝该假设）。结论：研究结果表明，参与身体活动数字健康干预与身体活动结果之间存在微弱但一致的正相关关系。没有研究针对久坐行为的结果。研究结果在大多数参与结构中都是一致的；然而，这些协会的力量很薄弱。


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