Electronic media may be an effective health intervention for teens, but better-quality studies are needed to confirm this association, researchers found.
Of 19 studies included in a literature review of electronic health interventions, 17 showed statistically significant outcomes for increased fruit, juice, or vegetable consumption; increased physical activity; improved asthma self-management; increased street and fire safety skills knowledge; and sexual abstinence, according to Kimberly Hieftje, PhD, of Yale University, and colleagues.
However, only five of the 19 studies were of "excellent quality" based on Oxford Quality Scoring System ratings, and only four of those five indicated statistically significant outcomes for electronic health interventions, they wrote online in JAMA Pediatrics.
The authors noted that "electronic media-based interventions lend themselves to experiential learning and ... offer distinct advantages over conventional methods of health education," and added that prior studies on the subject had primarily looked at video games and excluded other forms of electronic media, safety behavior outcomes, and youth populations.
They found the significance of the outcomes promising for interventions with "potentially broad applicability," but cautioned that "higher-quality evaluations of existing electronic media-based interventions are needed."
The systematic literature review looked at 19 studies involving electronic media-based interventions focused on promoting health and safety behavior changes in youth. The studies included interventions related to nutrition and physical activity (seven studies), asthma or lung function (six studies), safety behaviors (three studies), sexual risk behaviors (two studies), and diabetes (one study).
Media content included video games, video clips, CD-Roms, and Internet-based interventions that required a user to access content electronically.
Study quality was evaluated through a three-item instrument designed to assess the quality of randomized clinical trials.
Participants ranged in age from 3 to 18 years old in 17 studies, and were a mean age of 12.5 and 13 years in two studies; the number of study participants ranged from five to 1,876. The majority of studies (11) used computer games or simulation, while three used console video games, two used Internet-based interventions, two used video clips or interactive video, and the last used "computer-based elements."
By behavior outcome, electronic interventions improved fruit, vegetable, and 100% juice consumption (P<0.05 for all), increased consumption of dairy (P=0.001), decreased sugar consumption (P<0.001), and improved fiber (P<0.05) and calcium (P<0.001) consumption. One study showed improved self-care, while other studies showed significant improvement in physical activity and decreases in sedentary behavior.
Electronic interventions also improved asthma self-management (P=0.008), lowered asthma symptom score (P=0.02), lowered clinical appointment return rates (P=0.04), and reduced oral steroid use (P=0.03).
Sexual health behaviors were statistically better for students who participated in an electronic rather than control intervention, including abstinence (P=0.02), lower condom failure (P=0.027), and a trend for lower sexually transmitted infection rates (P=0.05).
The interventions also improved fire safety understanding, and increased driving skills in younger and inexperienced drivers.
There was no significant association between diabetes behavior and health outcomes and use of an electronic intervention, though a there was a nonsignificant improvement in self-efficacy ratings and reductions in urgent care visits.
For quality measures, studies that were regarded as excellent quality scored three of five possible points. Studies that scored well were randomized and had randomization methods explained, in addition to reporting on withdrawals and dropouts. No study reported blinding.
"Although our review provides support for using electronic media to change behavior in youth, our quality assessments also indicate that there have been few scientifically rigorous evaluations of such interventions in this age group," they concluded. They also cautioned that access to electronic media for computer interventions may be limited in some populations.
The authors also noted that their study was limited by a small number of randomized clinical trials, variability of study quality, and lack of blinding.
Primary source: JAMA Pediatrics
Source reference: Hieftje K, et al "Electronic media-based health interventions promoting behavior change in youth" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.1095.