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. 2022 Oct 1;37(5):daac085.
doi: 10.1093/heapro/daac085.

Systematic review of digital interventions to support refusal self-efficacy in child and adolescent health promotion

Johanna Nyman  1 , Anna Tornivuori  1   2 , Sanna Salanterä  1   3 , Teresa Barroso  4 , Heidi Parisod  1   5
Affiliations

Systematic review of digital interventions to support refusal self-efficacy in child and adolescent health promotion

Johanna Nyman et al. Health Promot Int. .

Abstract

Refusal self-efficacy protects against risky health behavior. Digital interventions have the potential to support self-efficacy due to the enactive experience provided by digital technologies. The aim of this systematic literature review was to evaluate the evidence of digital interventions to support refusal self-efficacy in child and adolescent health promotion. Following the Cochrane Collaboration guidelines, five electronic databases were searched from 2009 to 2020. The studies were assessed by two independent reviewers according to the eligibility criteria. Eligible studies were included in the review, assessed for risk of bias, synthesized narratively and assessed for evidence quality with the GRADE approach. Twenty-three studies, that examined 18 different interventions, were included in the review. The interventions included various digital elements as means to support the child and adolescent refusal self-efficacy (e.g. games, videos, feedback and activities for regulating feelings). The interventions improving refusal self-efficacy were more often used at home setting and addressed the four sources of self-efficacy with different digital elements regardless of intervention duration and intensity. Although the results on intervention effects varied and the evidence quality remained low, the overall evidence concerning these interventions was encouraging. Based on the subgroup analysis, the results were mainly encouraging among girls. When these interventions are implemented in health promotion, their benefits and weaknesses need to be considered comprehensively. The results provide information for designing and developing digital interventions to support child and adolescent refusal self-efficacy. Further research with larger sample sizes and more rigorous study designs is needed to strengthen the evidence of these interventions.

Keywords: adolescent; child; digital health intervention; health behavior; health promotion; self-efficacy; systematic review.

Plain language summary

Refusal self-efficacy determines children’s and adolescents’ health behavior, for example when they are being offered cigarettes or alcohol and they face the challenge of refusing it. Since digital interventions are potential tools to support refusal self-efficacy, this review examined digital interventions to support refusal self-efficacy in child and adolescent health promotion. Twenty-three studies that examined such interventions were found. Most of the interventions that improved child and adolescent refusal self-efficacy were used in home settings and addressed all sources of self-efficacy regardless of intervention duration. Although the results varied, the interventions in general seemed to improve refusal self-efficacy, especially among girls. However, this study suggests that more high-quality research with more study participants is still needed to make stronger conclusions. Also, the benefits and weaknesses of digital interventions to support refusal self-efficacy need to be considered comprehensively before using them in child and adolescent health promotion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1:
Fig. 1:
Study selection presented with PRISMA flow diagram (Moher et al., 2009).
Fig. 2:
Fig. 2:
Manifestation of refusal self-efficacy in the digital health interventions according to Bandura’s self-efficacy theory (Bandura, 1997).
See this image and copyright information in PMC

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References

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