A systematic umbrella review and meta-meta-analysis of eHealth and mHealth interventions for improving lifestyle behaviours

Abstract

The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = -426.3 [95% CI = -850.2, -2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = -102.9 kcals/day), saturated fat consumption (MD = -5.5 grams/day), and bodyweight (MD = -1.89 [95% CI = -2.42, -1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = -0.90, 95% CI = -1.14, -0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.

Fig. 1. PRISMA flow chart.

This diagram illustrates the selection process of studies for the systematic review, from initial identification through final inclusion.

Fig. 2. Forest plot showing the mean differences in total physical activity (minutes per week) resulting from eHealth and mHealth interventions compared to control groups.

CI confidence interval.

Fig. 3. Forest plot showing the mean differences in moderate-to-vigorous physical activity (minutes per week) resulting from eHealth and mHealth interventions compared to control groups.

CI confidence interval.

Fig. 4. Forest plot showing the mean differences in daily steps resulting from eHealth and mHealth interventions compared to control groups.

CI confidence interval.

Fig. 5. Forest plot showing the mean differences in sedentary behaviour (minutes per week) resulting from eHealth and mHealth interventions compared to control groups.

CI confidence interval.

Fig. 6. Forest plot showing the mean differences in daily energy intake (kilocalories per day) resulting from eHealth and mHealth interventions compared to control groups.

CI confidence interval.