Methodological challenges in systematic reviews of mHealth interventions: Survey and consensus-based recommendations

Jesus Lopez-Alcalde; L Susan Wieland; Jürgen Barth; Rebecca Grainger; Nancy Baxter; Neil Heron; Andreas Triantafyllidis; Carme Carrion; Eleonora M C Trecca; Felix Holl; Ana Maria Wägner; Sarah Edney; Yuqian Yan; Concepción Campos-Asensio; Gemma Villanueva; Rachelle R Ramsey; Claudia M Witt

doi:10.1016/j.ijmedinf.2024.105345

Methodological challenges in systematic reviews of mHealth interventions: Survey and consensus-based recommendations

Int J Med Inform. 2024 Apr:184:105345. doi: 10.1016/j.ijmedinf.2024.105345. Epub 2024 Jan 29.

Authors

Jesus Lopez-Alcalde¹, L Susan Wieland², Jürgen Barth³, Rebecca Grainger⁴, Nancy Baxter⁵, Neil Heron⁶, Andreas Triantafyllidis⁷, Carme Carrion⁸, Eleonora M C Trecca⁹, Felix Holl¹⁰, Ana Maria Wägner¹¹, Sarah Edney¹², Yuqian Yan³, Concepción Campos-Asensio¹³, Gemma Villanueva¹⁴, Rachelle R Ramsey¹⁵, Claudia M Witt¹⁶

Affiliations

¹ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Unidad de bioestadística clínica, Hospital Universitario Ramón y Cajal, (CIBERESP), Madrid, Spain. Electronic address: jesus.lopez@usz.ch.
² Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
³ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁴ Department of Medicine, University of Otago Wellington, New Zealand.
⁵ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
⁶ Centre for Public Health, Queen's University Belfast, Northern Ireland, School of Medicine, Keele University, Staffordshire, England, United Kingdom.
⁷ Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece.
⁸ eHealth Lab Research Group, Universitat Oberta de Catalunya (UOC), Spain.
⁹ Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy.
¹⁰ DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany.
¹¹ Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
¹² Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
¹³ Biblioteca Médica, Hospital Universitario de Getafe, Madrid, Spain.
¹⁴ Cochrane Response, Cochrane, London, UK.
¹⁵ Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
¹⁶ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Objective: Mobile Health (mHealth) refers to using mobile devices to support health. This study aimed to identify specific methodological challenges in systematic reviews (SRs) of mHealth interventions and to develop guidance for addressing selected challenges.

Study design and setting: Two-phase participatory research project. First, we sent an online survey to corresponding authors of SRs of mHealth interventions. On a five-category scale, survey respondents rated how challenging they found 24 methodological aspects in SRs of mHealth interventions compared to non-mHealth intervention SRs. Second, a subset of survey respondents participated in an online workshop to discuss recommendations to address the most challenging methodological aspects identified in the survey. Finally, consensus-based recommendations were developed based on the workshop discussion and subsequent interaction via email with the workshop participants and two external mHealth SR authors.

Results: We contacted 953 corresponding authors of mHealth intervention SRs, of whom 50 (5 %) completed the survey. All the respondents identified at least one methodological aspect as more or much more challenging in mHealth intervention SRs than in non-mHealth SRs. A median of 11 (IQR 7.25-15) out of 24 aspects (46 %) were rated as more or much more challenging. Those most frequently reported were: defining intervention intensity and components (85 %), extracting mHealth intervention details (71 %), dealing with dynamic research with evolving interventions (70 %), assessing intervention integrity (69 %), defining the intervention (66 %) and maintaining an updated review (65 %). Eleven survey respondents participated in the workshop (five had authored more than three mHealth SRs). Eighteen consensus-based recommendations were developed to address issues related to mHealth intervention integrity and to keep mHealth SRs up to date.

Conclusion: mHealth SRs present specific methodological challenges compared to non-mHealth interventions, particularly related to intervention integrity and keeping SRs current. Our recommendations for addressing these challenges can improve mHealth SRs.

Keywords: Digital health; Meta-analysis; Survey; Systematic reviews; eHealth.

Publication types

Review

MeSH terms

Consensus
Humans
Research Design*
Surveys and Questionnaires
Systematic Reviews as Topic
Telemedicine*

Abstract

Publication types

MeSH terms

Grants and funding