Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review, 2020, Crawley, Loades et al

Andy

Andy

Retired committee member
Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years).

Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention.

Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality.

Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design.

Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents.
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Open access, https://www.jmir.org/2020/7/e16924/

My bolding.
Objectives
This systematic review aimed to investigate digital interventions for the management of chronic health conditions in children aged between 5 and 12 years. We used an inclusive definition of chronic health conditions that included both physical and mental health. Conceptually, behavioral interventions for physical and mental health conditions are the same; they are designed to change the child’s behavior to improve the clinical outcome. Furthermore, there is a strong overlap between physical and mental conditions; comorbidity of physical and mental health conditions is common [45], and many conditions involve both mental and physical health issues (eg, chronic fatigue syndrome or myalgic encephalomyelitis, pain, and obesity), thus developing integrated approaches toward mental and physical health is increasingly becoming a priority [46].

In this review, we aimed to answer the following questions: (1) Which of these interventions are effective in promoting behavior change for the management of the chronic health condition? (2) What are the characteristics of effective interventions, considering the following: recipients, what is being delivered (BCTs), how this content is being delivered (the mode of delivery), the theoretical basis, and the modality of the intervention? and (3) What are the users’ experiences of the digital intervention?
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Since none of the interventions they included involved kids with CFS, I have no idea why that bit about CFS / ME was included in the objectives. It looks like most of the studies they found were useless, with only a very few for obesity and anxiety being possibly marginally useful.
 
Trish said:
Since none of the interventions they included involved kids with CFS, I have no idea why that bit about CFS / ME was included in the objectives. It looks like most of the studies they found were useless, with only a very few for obesity and anxiety being possibly marginally useful.
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Repeat something often enough and it becomes the established truth?
 
Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise
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Many of those "interventions" have been used for years and the best they can come up with is that they "have promise". They do not show, they "have" the greatest promise.

What kind of nonsense is that?

Over the last several years I have had the displeasure of skimming (reading this stuff should be classified as torture) dozens of papers on this topic. This field has exactly two themes and only two themes: 1) how to make the stuff that's been used in practice for years actually work and 2) why are the patients so resistant to it. That's about 90% of the work going directly to those two themes, with the rest being peripheral but mostly related to those two themes.

Billions of have been spent on the broader concepts. Thousands of people have invested their career dating back more than a century. Research and development in those conditions has been blocked on the basis that this is better than nothing and therefore good enough, despite decades of failure in practice.

This is genuinely criminally insane. There are millions of lives at stake here and these people can't stop jerking each other over how great what they are accomplishing is while at the same being utterly puzzled that it doesn't actually work and that the patients hate it. This may not be the letter of the horror that happened in asylums before publicizing the scandals ended the practice but it is very much in that same spirit. The walls may have disappeared but the mental and physical torture are every bit as criminal.
 
The funding bodies for this genre of health propaganda need to start paying attention to their fiscal responsibilities. Instead of systematic reviews of the literature they need to consider total costs sunk into decades long repeats of the same thing and has that provided them real value as opposed to larger funding (per study) directed toward science and the discovery of new information relating to how the body works and how the broken bits can be modified to actually improve health.

The longer they keep this up the more the scale tips in favour of science.

Edit: to remove a word for clarity
 
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Snowdrop said:
The funding bodies for this genre of health propaganda need to start paying attention to their fiscal responsibilities.
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Yes, absolutely. There are 10 authors on this "super important" study. If they each spent 10 weeks total on this at an average of $2000 weekly salary plus benefits, that's $200,000 that could have been spent on something useful. (sorry for $, I know this is the U.K.).
 
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