1 Introduction and rationale
2 Methodology
2.1 Search strategy
2.2 Study selection and eligibility criteria
2.3 Study screening
2.4 Data extraction
2.5 Statistical calculations of results
3 Results
3.1 Studies included for analysis
3.2 Quality assessment of reported studies
3.3 Synthesis of results
3.4 Subgroup analysis: automated email messaging with web applications
3.5 Results in the context of methodological quality of the included studies
First author, Year | Country | Study Design | Sample size (intervention group) | Setting | Follow-up duration | DHI method utilised (intervention group) | Control group | Outcaome measure | Fully adjusted mean difference (95% CI) | Confounders adjusted for | Funding |
---|---|---|---|---|---|---|---|---|---|---|---|
Gonzalez-Sanchez et al. [26] | Spain | RCT | 833 (n = 415) | General population recruited from Primary Care | 12 Months | Smartphoneapplication + in-person counselling | In-person counselling only | D’Agostino | 0.01 (-1.39 to 1.41) | Outcome adjusted for anti-hypertensive drugs, lipid-lowering drugs | Spanish Ministry of Science and Innovation and Carlos III Health Institute/European regional Development Fund; and the Regional Health Management of Castilla and León |
Liu et al. [33] | Canada | RCT | 86 (n = 43) | General population, primary prevention, recruited online | 4 months | Automated messaging (Email), Web-based application | Usual care | FRS | -2.00 (-2.53 to -1.47) | Outcome controlled for baseline CVD risks | Heart and Stroke Foundation of Canada, Focus on Stroke Award and Canadian Institute of Health research |
Nolan et al. [32] | Canada | RCT | 240 (n = 133) | Multi-centre population-based study, recruited online | 12 months | Automated messaging (Email), Web-based application | Usual care + self care education | FRS | -0.20 (-2.32 to 1.92) | Outcome adjusted for baseline CVD risk, gender and medication | Canadian Institutes of Health Research |
Salisbury et al. [27] | England | Pragmatic RCT | 641 (n = 325) | General population recruited from Primary Care | 12 Months | Automated messaging (Email), Web-based application | Usual care | QRISK2 | 0.10 (-1.50 to 1.70) | Outcome adjusted for baseline CVD risk smoking history and General practice | National Institute for Health research (NIHR) |
Vernooij et al. [28] | Netherlands | RCT | 330 (n = 164) | Secondary and Tertiary care | 12 months | Web-based application | Usual care | FRS | -1.30 (-2.60 to 0.00) | Outcome controlled for baseline CVD risk | ZonMw, the Netherlands Organization for Health Research and Development |
Sheridan et al. [34] | USA | RCT | 154 (n = 77) | General population recruited from Primary Care | 3 months | Automated messaging (Email), Web-based application | Usual care | FRS | 0.00 (-2.33 to 2.33) | Outcome adjusted for baseline CVD risk, education level | American Heart Association, the National Heart Lung and Blood Institute, and the National Cancer Institute |
First author, YHr | DHI method utlUsed (lni-ntlon group) | Control group | Trial and DHI details |
---|---|---|---|
Gonzalez-Sanchez et al. [26] | Smartphone application + in person counselling | In-person counselling | A smartphone application was developed by software designers and dieticians. The application offered functionality to record food intake, and utilised the smartphone's accelerometer to calculate physical activity such as step count. Trial parrticipants were also instructed to use the application regularly and record data to ensure engagement |
Liu et al. [33] | Automated messaging (Email), Web-based application | Usual care | Participants underwent pre-trial clinical assessment, and communication with participants' physicians was sought. From this data, a user-driven web-application was created offering governmental health guidance, and information on exercise and diet plans. Emails containing dietary and exercise plans were also sent to participants |
Nolan et al. [32] | Automated messaging (Email), Web-based application | Usual care + self care education | Communication with participants' physicians and assessment of participants' English language skills was sought. A web application for participants offered links to health resources. Self-monitoring tools were also provided, such as interactive forms to track progress. The transtheoretical model of cognitive behavioural change was used to help participants create targets for themselves |
Salisbury et al. [27] | Automated messaging (Email), Web-based application | Usual care | Health advisors supported participants via interactive software with interactive, computerised scripts to help them set individual health goals. Participants could also access the 'Healthlines' web portal to learn about CVD. Blood pressure and other metrics could be uploaded to the Healthlines portal, which calculated an average of the readings and offered automated advice to participants |
Vernooij et al. [28] | Web-based application | Usual care | A website application was personalised for individual patients, based on their cardiovascular risk. Patients could submit blood pressure, weight, smoking and cholesterol levels. Messages could also be sent and received between themselves and nurse practitioners. The application also offered links to further information on vascular diseases and health information |
Sheridan et al. [34] | Automated messaging (Email), Web-based application | Usual care | A decision aid was provided to participants encouraging them to reduce their CVD risk, and counselled them in communicating with their physician regarding CVD. The tailoredtext- messaging system aimed to develop participant skills in overcoming barriers to exercise and healthy eating. The messaging system included a collection of 76 unique messages. This could be adjusted with over a million combinations tailored to individual participants dependant on their answers to an initial set of survey questions |