Culturally adapting internet- and mobile-based health promotion interventions might not be worth the effort: a systematic review and meta-analysis

Abstract

Health promotion interventions offer great potential in advocating a healthy lifestyle and the prevention of diseases. Some barriers to communicating health promotion to people of certain cultural groups might be overcome via the internet- and mobile-based interventions (IMI). This systematic review and meta-analysis aims to explore the effectiveness of culturally adapted IMI for health promotion interventions among culturally diverse populations. We systematically searched on Cochrane Central Register of Controlled Trials (CENTRAL), EbscoHost/MEDLINE, Ovid/Embase, EbscoHost/PsychINFO, and Web of Science databases in October 2020. Out of 9438 records, 13 randomized controlled trials (RCT) investigating culturally adapted health promotion IMI addressing healthy eating, physical activity, alcohol consumption, sexual health behavior, and smoking cessation included. From the included studies 10,747 participants were eligible. Culturally adapted IMI proved to be non-superior over active control conditions in short- (g = 0.10, [95% CI -0.19 to 0.40]) and long-term (g = 0.20, [95% CI -0.11 to 0.51]) in promoting health behavior. However, culturally adapted IMI for physical activity (k = 3, N = 296) compared to active controls yielded a beneficial effect in long-term (g = 0.48, [95%CI 0.25 to 0.71]). Adapting health promotion IMI to the cultural context of different cultural populations seems not yet to be recommendable given the substantial adaption efforts necessary and the mostly non-significant findings. However, these findings need to be seen as preliminary given the limited number of included trials with varying methodological rigor and the partly substantial between-trial heterogeneity pointing in the direction of potentially useful culturally adapted IMI which now need to be disentangled from the less promising approaches.PROSPERO registration number: 42020152939.

Fig. 1. Risk of bias summary.

Reviewers’ judgments about each risk of bias item for each included study.

Fig. 2. Risk of bias graph.

Reviewers' judgments about each risk of bias item presented as percentages across all included studies.

Fig. 3. Summary of culturally adapted IMI of health promotion vs. active controls in the long-term.

Due to substantial heterogeneity among the culturally adapted IMI of health promotion vs. active controls in long-term meta-analytical pooling did not perform.

Fig. 4. Summary of culturally adapted IMI of health promotion vs. active controls in the short-term.

A summary plot of effect sizes of four studies of culturally adapted IMI of health promotion vs. active controls in short-term are presented.

Fig. 5. Summary of culturally adapted IMI of health promotion vs. passive controls.

Due to few numbers of studies (two studies reported data in the long-term, two in the short-term, while one study reported dichotomous outcome) comparing culturally adapted IMI to a passive control group, meta-analytic pooling did not perform.

Fig. 6. Fixed effects meta-analysis of culturally adapted IMI for physical activity vs. active control conditions.

Forest plot presenting fixed effects meta-analysis of culturally adapted IMI for physical activity vs. active controls.

Fig. 7. Summary of culturally adapted IMI for smoking cessation vs. active controls in short-term.

Three studies reported smoking cessation outcomes measuring short-term abstinence at the end of the intervention vs. active controls are presented on the forest plot.

Fig. 8. Prisma Flow chart.

Study identification, selection, and inclusion represented on the diagram. An asterisk symbol represents a parallel review conducted regarding the culturally adapted internet- and mobile-based interventions concerning mental health.