Use of Biological Feedback as a Health Behavior Change Technique in Adults: Scoping Review

Abstract

Background: Recent advancements in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data are used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored.

Objective: The purpose of this review was to (1) map the domains of research where biological feedback has been used as a behavior change technique and (2) describe how it is implemented in behavior change interventions for adults.

Methods: A comprehensive systematic search strategy was used to query 5 electronic databases (Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global) in June 2021. Eligible studies were primary analyses of randomized controlled trials (RCTs) in adults that incorporated biological feedback as a behavior change technique. DistillerSR was used to manage the literature search and review.

Results: After removing 49,500 duplicates, 50,287 articles were screened and 767 articles were included. The earliest RCT was published in 1972 with a notable increase in publications after 2000. Biological feedback was most used in RCTs aimed at preventing or managing diabetes (n=233, 30.4%), cardiovascular disease (n=175, 22.8%), and obesity (n=115, 15%). Feedback was often given on multiple biomarkers and targeted multiple health behaviors. The most common biomarkers used were anthropometric measures (n=297, 38.7%), blood pressure (n=238, 31%), and glucose (n=227, 29.6%). The most targeted behaviors were diet (n=472, 61.5%), physical activity (n=417, 54.4%), and smoking reduction (n=154, 20.1%). The frequency and type of communication by which biological feedback was provided varied by the method of biomarker measurement. Of the 493 (64.3%) studies where participants self-measured their biomarker, 476 (96.6%) received feedback multiple times over the intervention and 468 (94.9%) received feedback through a biosensing device.

Conclusions: Biological feedback is increasingly being used to motivate behavior change, particularly where relevant biomarkers can be readily assessed. Yet, the methods by which biological feedback is operationalized in intervention research varied, and its effectiveness remains unclear. This scoping review serves as the foundation for developing a guiding framework for effectively implementing biological feedback as a behavior change technique.

Trial registration: Open Science Framework Registries; https://doi.org/10.17605/OSF.IO/YP5WAd.

International registered report identifier (irrid): RR2-10.2196/32579.

Keywords: adults; biological; biomarkers; biosensing; cardiovascular disease; device; electronic database; feedback, psychological; health behavior; health promotion; intervention; monitoring, physiologic; obesity; support; technology.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of included studies. RCT: randomized controlled trial.

Figure 2

The use of biological feedback in randomized controlled trials from 1972 to 2021 (N=767). CVD: cardiovascular disease.

Figure 3

Most frequently assessed biomarkers and targeted behaviors (N=767). The thickness of each node (eg, “Anthropometry”) represents the number of studies that incorporated the given biomarker or behavior. The thickness of the links between the biomarkers and behaviors (eg, “Anthropometry” to “Diet”) represents the number of studies for which the given biomarker was used to promote the linked behavior. The total number of studies does not add up to 767 (100%) because only the top 10 biomarkers and top 3 behaviors are displayed. Additionally, some studies provided feedback on multiple biomarkers and targeted multiple behaviors. HbA1c: glycated hemoglobin.

Figure 4

Type of communication by collection method and frequency of delivery (N=767). Biological feedback was communicated to participants through (1) the device itself, such as through a continuous glucose monitor or heart rate monitor, (2) 1-way communication, such as through an app, email, mail, or 1-way text message, (3) 2-way communication, such as an in-person discussion or 2-way messaging platform, or through a combination of these feedback modalities. Feedback on the biological data was provided either (1) once, such as a singular genetic test, or (2) more than once, such as multiple glucose tests. The biological data provided as feedback was either collected via (1) self-measurement, such as through a body weight scale or (2) other, such as a health care provider collecting a laboratory sample.