Table 3

Health-promoting lifestyle behaviours and ICT

Author and date	ICT employed	Health promoting-lifestyle behaviour	Outcome of interest	Findings	Conclusion
Ammann et al (2012)39	Email, website	PA	PA and BMI	No significant differences between the age groups were found with regard to BMI and PA level at baseline. All age groups increased their weekly total PA minutes and the number of total PA sessions significantly over time from baseline to 1-month follow-up. Old-age group increased PA more than the other two age groups.	The study suggests that website-delivered PA interventions can be suitable and effective for older aged adults.
Bardus et al (2014)38	Website, email and text messaging (SMS)	PA	PA	Reasons for participation included a need to be more active, increase motivation to engage in PA, and better weight management. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation are lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment.	In developing workplace PA interventions, it is important to identify salient motivators and barriers to participation through formative research with the target population. Programme enrolment procedures should be simple and not time consuming, so that burden on participants is reduced and early attrition is minimised. It is also important that employers find ways to actively promote WHPPs to their staff while also maintaining confidentiality and individual rights on employees, so that larger segments of the workforce can be reached.
Bardus et al (2015)49	Mobile phone and web V.2.0 technologies	PA, diet and weight loss management	Diet and PA	This review categorised the identified articles into two overarching themes, which described use of technologies for either (1) promoting behaviour change (309/457, 67.6%) or (2) measuring behaviour (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%).	Limited evidence exists on use of social media for behaviour change, but a segment of studies deals with content analyses of social media. Future research should analyse mobile phone and web V.2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility and efficacy/effectiveness for behaviour change, in order to understand which technological components and features are likely to result in effective interventions.
Bert et al (2014)51	Smart phones	Nutrition lifestyles, PA, health in elderly, prevention of sexually transmitted diseases	Nutrition and PA	Out of 21 articles identified as specifically centred on health promotion, the nutrition field has applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies. While in the PA many applications suggest exercises with measurement of sports statistics and some applications deal with lifestyles suggestions and tips.	The promotion of healthy lifestyles, adequate nutrition and PA are all possible and desirable through use of smartphones but it is important to underline the crucial role of healthcare providers in the management of the patient while using these tools. There is also a need to analyse the usefulness, quality and accuracy of smartphones applications in the field of preventive medicine.
Buhi et al (2013)52	SMS, MMS, internet	Breast cancer prevention, diabetes management, weight loss or obesity prevention, smoking cessation, asthma self-management and PA	PA and breast cancer prevention	One journal assessed PA promotion and breast cancer prevention, respectively. Twenty interventions (59%) were evaluated using experimental designs, and most resulted in statistically significant health behavioural changes.	Consideration should be given for the deployment of mHealth applications to combat coronary heart disease, HIV/AIDS and other high-priority problems contributing to high mortality. A mobile video-based modality, using sight and sound, may show even greater promise in health behaviour change interventions.
Carr et al. (2013)48	Internet website	PA	PA	The EI arm increased PA in relation to the SI arm at 3 months but between-group differences were not observed at 6 months. EI participants maintained PA from 3–6 months. This result suggests that a non-face-to-face, user-guided and theory-guided internet PA programme is more efficacious for producing immediate increases in PA among sedentary adults than what is currently available to the public.	The EI programme was efficacious at improving PA levels in relation to publicly available websites initially, but differences in PA levels were not maintained at 6 months. Future research should identify internet features that promote long-term maintenance.
Fanning et al (2012)27	Mobile device, mobile software, SMS	PA	PA	Four studies were of ‘good’ quality and seven of ‘fair’ quality. In total, 1351 individuals participated in 11 unique studies. This study suggests that mobile devices are effective means for influencing PA behaviour.	Our focus must be on the best possible use of these tools to measure and understand behaviour. Therefore, theoretically grounded behaviour changes interventions that recognise and act on the potential of smartphone technology could provide investigators with an effective tool for increasing PA.
Frank et al (2016)40	Website, email	Exercise, nutrition, bone health	PA, nutrition, waist circumference, BMI	There were no significant differences found in the BMI and waist circumference of soldiers in both control and intervention group over the course of study. There were significant increases in body fat, osteocalcin and sports index for the telehealth group.	A 9-month deployment to Afghanistan increased body fat, bone turnover and PA among soldiers randomised to receive telehealth strategies to build bone with nutrition and exercise. This study indicates that diet and exercise coaching via telehealth methods to deployed soldiers is feasible but limited in its effectiveness for short-term overseas deployments.
Guertler et al (2015)41	Smartphone app and website	PA	PA	Compared with other freely accessible web-based health behaviour interventions, the 10 000 Steps programme showed high engagement.	Use of an app alone or in addition to the website can enhance programme engagement and reduce risk of attrition.
Hou et al (2014)53	Computer-based information and communication technology	Tobacco prevention, alcohol prevention, weight loss, PA, nutrition, HIV and chronic diseases	PA and nutrition	There were seven studies focused primarily on increasing PA, and additionally five studies also examined related factors, such as nutrition and binge eating. Two studies were categorised as nutrition only interventions, with one focused on folic acid intake and the other targeted FJV consumptions.	Findings from the current review study indicated that, overall, internet or WIs produce favourable results and are effective in producing and increasing targeted health or behavioural outcomes.
Howarth et al (2018)47	Smartphone, email, either as a website, app or downloadable software.	Self-reported measures of sleep, PA levels and healthy lifestyle rating, mental health	Blood pressure and BMI, PA, mental health	There was a high level of heterogeneity across these studies, significant improvements were found for a broad range of outcomes such as sleep, mental health, sedentary behaviours and PA levels. Standardised measures were not always used to quantify intervention impact. All but one study resulted in at least one significantly improved health-related outcome, but attrition rates ranged widely, suggesting sustaining engagement was an issue.	This review found modest evidence that digital-only interventions have a positive impact on health-related outcomes in the workplace. High heterogeneity impacted the ability to confirm what interventions might work best for which health outcomes, although less complex health outcomes appeared to be more likely to be impacted. A focus on engagement along with the use of standardised measures and reporting of active intervention components would be helpful in future evaluations.
King et al (2016)44	Smartphone’s built-in accelerometer	PA	PA behaviour	Over the 8-week period, the social app users showed significantly greater overall increases in weekly accelerometery-derived moderate to vigorous PA relative to the other three arms. Participants reported that the apps helped remind and motivate them to increase their PA levels as well as sit less throughout the day.	The results provide initial support for use of a smartphone-delivered social frame in the early induction of both PA and sedentary behaviour changes. The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion areas.
Kirwan et al (2012)45	Smartphone, website	PA	PA	Over the study period (90 days), the intervention group logged steps on an average of 62 days, compared with 41 days in the matched group. Use of the application was associated with an increased likelihood to log steps daily during the intervention period compared with those not using the application.	Using a smartphone application as an additional delivery method to a website-delivered PA intervention may assist in maintaining participant engagement and behaviour change.
Kohl et al (2013)54	Internet-delivered intervention	Dietary behaviours, PA, alcohol use, smoking and condom use	Dietary behaviours and PA	According to health priorities, interventions are largely targeted at weight-related behaviours, such as PA and dietary behaviour. Eleven studies targeted weight management and they were on dietary behaviours and PA. The main aimed of these studies were weight loss; five reviews also included interventions on weight maintenance. Six studies included three or more behaviours. The other groups included studies aimed at PA, five reviews were on smoking and alcohol, respectively. Four papers combined alcohol and smoking, while three were on dietary behaviours. An additional manual search showed one study on condom use.	More research is needed on effective elements instead of effective interventions, with special attention to long-term effectiveness. The reach and use of interventions need more scientific input to increase the public health impact of internet-delivered Interventions.
Lara et al (2016)37	Web-based platform	Diet, PA, social connection and anthropometric status	Diet, PA, social connection, BMI and waist circumference	‘Eating well’ and ‘being social’ were the most visited modules. At interview, participants reported that diet and PA modules were important and acceptable within the context of healthy ageing.	The trial procedures and the LEAP (Living, Eating, Activity and Planning through retirement) intervention proved feasible and acceptable. Overall participants reported that the LEAP domains of ‘eating well’, were important for their health and well-being in retirement.
Laranjo et al (2014)17	SNS	Fitness, sexual health, food safety, smoking and health promotion	Fitness (PA)	The study found a statistically significant positive effect of SNS interventions on behaviour change, boosting encouragement for future research in this area.	The study showed a positive effect of SNS interventions on health behaviour-related outcomes, but there was considerable heterogeneity.
Lee et al (2018)56	Mobile apps	Diet, PA and overall healthy lifestyle improvement	Diet, PA and overall healthy lifestyle improvement	Across all studies, health outcomes were shown to be better for mobile app users compared with non-users. Mobile app-based health interventions may be an effective strategy for improving health promotion behaviours in the general population without diseases.	This study suggests that mobile app use is becoming commonplace for a variety of health-promoting behaviours in addition to PA and weight control. Future research should address the feasibility and effectiveness of using mobile apps for health promotion in developing countries.
Mackenzie et al (2015)36	Email, reminder software, twitter	Reduced workplace sitting	Increased PA	Therefore, ‘completers’ demonstrated a range of levels of PA. In addition, ‘completers’ generally demonstrated positive health behaviours with 0% being smokers, over 50% eating five fruits or vegetables/day and almost 25% not drinking alcohol.	Evaluation of this intervention provides useful information to support participatory approaches during intervention development and the potential for more sustainable low-cost interventions.
Naimark et al (2015)20	Web-based app	Nutrition and PA	Nutrition, PA, BMI and waist circumference	The app group increased their weekly duration of PA to the healthy range of more than 150 min a week, which may afford substantial health benefits, they lost more weight and had increased nutritional knowledge compared with the control group.	We showed a positive impact of a newly developed web-based app on lifestyle indicators during an intervention of 14 weeks. These results are promising in the app’s potential to promote a healthy lifestyle, although larger and longer duration studies are needed to achieve more definitive conclusions.
Rogers et al (2017)55	Website internet-delivered intervention	Diet, PA, alcohol and tobacco use, mental health intervention, disease management, sexual health	Diet and PA	The efficacy of the interventions for diet and PA, although significant, was modest (eg, 2.1 kg mean weight reduction compared with a 0.4 kg increase in controls). People who completed the internet intervention reduced their waist circumference by 2.6 cm, whereas people who did not complete the intervention added 0.3 cm to their waist circumference.	A wide range of evidence-based internet programme are currently available for health-related behaviours, as well as disease prevention and treatment. However, the majority of internet-delivered health interventions found to be efficacious in RCTs do not have websites for general use. Increased efforts to provide mechanisms to host ‘interventions that work’ on the web and to assist the public in locating these sites are necessary.
Schneider et al (2013)46	Internet-delivered computer-tailored lifestyle programme	PA, fruit and vegetable consumption, smoking status, alcohol consumption	PA, fruit and vegetable consumption	Sending prompt 2 weeks after the first visit was more effective compared with using a longer time period, adding a preview of new website content to a standard prompt increased its effectiveness in persuading people to log in to the programme and sending a prompt with additional content after a 2-week period significantly increased programme log-ins compared with using a reactive approach in which no additional prompts were used.	The key findings suggest that boosting revisits to a CT programme benefits most from relatively short prompt timing. Furthermore, a preview of new website content may be added to a standard prompt to further increase its effectiveness in persuading people to log in to the programme.
Schneider et al (2013)46	Internet-delivered computer-tailored intervention.	PA, fruit and vegetable intake, alcohol consumption and smoking behaviour	PA, fruit and vegetable intake, BMI, mental health status	Approximately 50% of all participants had a healthy body weight, 35% were overweight, and 10% were obese. In terms of PA, 21% with a minimum of 150-min exercise per week, whereas 46% and 69% were not adhering to the Dutch guidelines of fruit and vegetable intake, respectively. More than one-third (36%) complied with three lifestyle guidelines, while 1% of the respondents complied with none of these guidelines. Older and respondents with a higher educational degree, as well as respondents with relatively healthier lifestyle and a healthy BMI, were more likely to participate in the intervention.	The study concluded that there is need to put additional effort to ensure that at-risk individuals (low socioeconomic status and unhealthy lifestyle) have increase interest in a lifestyle intervention and they should also be encouraged to employ lifestyle intervention.
Stratton et al (2017)50	Websites, smartphone and tablet apps.	Cognitive behavioural therapy, stress management, mindfulness-based approaches,	Stress management	The stress management interventions differed by whether delivered to universal or targeted groups with a moderately large effect size at both postintervention (g=0.64, 95% CI 0.54 to 0.85) and follow-up (g=0.69, 95% CI 0.06 to 1.33) in targeted groups, but no effect in unselected groups.	There is reasonable evidence that eHealth interventions delivered to employees may reduce mental health and stress symptoms postintervention and still have a benefit, although reduced at follow-up.
Tsai et al (2015)18	Website	HPLP	HPLP, BMI, physical and mental component summary	The eHealth education intervention had the effect of significantly increasing nurses’ postintervention HPLP total scores, PCS, MCS and decreases in BMI.	Tailored eHealth education is an effective and accessible intervention for enhancing health-promoting behaviour among nurses.

BMI, body mass index; EI, enhanced internet; FJV, fruit juice and vegetable; HPLP, Health-promoting lifestyle profile; ICT, information and communication technology; MCS, mental component summary; MMS, multimedia messaging service; PA, physical activity; PCS, physical component summary; RCT, randomised controlled trial; SI, standard internet; SMS, short messaging service; SNS, social networking siteWHPP, workplace health promotion programme; WIs, web-based interventions.;