Nutrition and Physical Activity: Worksite Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity

The CPSTF finding is based on evidence from a systematic review of eight studies with 11 study arms (search period: January 2009-June 2020).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to nutrition, physical activity, and obesity prevention and control.

Digital health interventions have the potential to reach a large number of people (Beleigoli et al., 2019). In the United States, 93% of adults use the internet (Pew Research Center, 2021a); 85% have access to a smartphone (Pew Research Center, 2021b); and 77% have home broadband (Pew Research Center, 2021a). Worksite health programs and policies provide opportunities to promote health and prevent disease. Effective worksite interventions have the potential to reduce health risks and improve the quality of life for more than 138 million workers in the United States (Centers for Disease Control and Prevention, 2018).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Physical Activity

• Physical activity increased by a median of 38.5 minutes per week (2 studies with 4 study arms). Additional measures of physical activity demonstrated favorable findings (4 studies with 5 arms).

Dietary Behaviors

• Fruit and vegetable intake increased by a median of 0.44 servings per day (2 studies with 4 study arms).
• Fat intake decreased (3 studies with 4 study arms).

Weight-related

• Body mass index results were mixed (4 studies with 5 arms); and weight decreased (2 studies with 2 arms).

Clinical

• Clinical outcomes including systolic blood pressure, diastolic blood pressure, total cholesterol, high density lipoprotein, and glucose did not change (2 studies with 2 arms).

A systematic review of economic evidence has not been conducted.

The CPSTF finding should be applicable to all working adults who are interested in improving these behaviors regardless of gender, income level, race, or ethnicity.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How effective are interventions in worksites that are small (less than 100 employees) or medium sized (100 to less than 300 employees)?
• Are these interventions effective in rural areas?
• What are the long-term effects of digital health interventions among working adults?
• What is the effect of interventions that last longer than 12 months?
• What are the effects of incorporating wearable devices or trackers in the intervention?
• What are the effects of adding social media to the intervention?
• What is the ideal level of intensity for this type of intervention?

• Included studies were conducted in the United States (6 studies), Denmark (1 study), and Germany (1 study). Only one study reported on population density, which was urban.
• All included studies recruited participants from large worksites (>300 employees). Participants included social and healthcare workers in a nursing home (1 study), shift workers with physically demanding work (1 study), government workers (1 study), management and administrative personnel (3 studies), and a mix of management, clerical, and labor workers (2 studies).
• Across all eight studies, participants had a mean age of 47.4 years. Studies reported higher proportions of females than males (on average, 70% were female). Intervention duration ranged from one month to 12 months, with a median duration of six months.
• The six U.S. studies reported racial and ethnic distributions. Studies included participants self-identified as White (median 57.3%; 6 studies), Black or African American (median 7.1%; 5 studies), Hispanic or Latino (median 4.0%; 5 studies), Asian (median: 4.0%; 4 studies), or other race/ethnicity (median 3.6%; 5 studies).
• Seven studies provided enough information to assess participants’ income. Participants represented populations considered to be lower income (1 study), higher income (3 studies), or a combination of higher, middle, and lower income (3 studies).

Effectiveness Review

• Logic Model
• Text Description

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Balk-M ller et al. Effect of a nine-month web- and app-based workplace intervention to promote healthy lifestyle and weight loss for employees in the social welfare and health care sector: a randomized controlled trial. J Med Internet Res. 2017;19(4):e108.

Bennett et al. A web-based approach to address cardiovascular risks in managers: results of a randomized trial. J Occup Environ Med. 2011;53(8):911 18.

Cook et al. A web-based health promotion program for older workers: randomized controlled trial. J Med Internet Res. 2015;17(3):e82

Hughes et al. Comparison of two health-promotion programs for older workers. Am J Public Health 2011;101(5):883-90.

Lippke et al. A computerized lifestyle application to promote multiple health behaviors at the workplace: testing its behavioral and psychological effects. J Med Internet Res. 2015;17(10):e225.

Sternfeld et al. Improving diet and physical activity with ALIVE: a worksite randomized trial. Am J Prev Med 2009;36(6):475 83.

Widmer et al. Workplace digital health is associated with improved cardiovascular risk factors in a frequency-dependent fashion: a large prospective observational cohort study. PLoS ONE 11(4): e0152657.

Wilson et al. Effect of intensity and program delivery on the translation of diabetes prevention program to worksites a randomized controlled trial of fuel your life. J Occup Environ Med 2016;586(11):1113-20.

Effectiveness Review

The following outlines the search strategy used for systematic reviews of digital health and telephone interventions in community settings, worksites, and institutions of higher education.

Database: Ovid MEDLINE

1 exp “Physical Education and Training”/ or exp Sports/ or exp Exercise/ or exp Physical Fitness/ or exp Exercise Therapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 Evaluation Studies/ or Program Evaluation/

33 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (“controlled clinical trial” or “randomized controlled trial”).pt.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid Embase

1 exp “Physical Education”/ or exp Sport/ or exp Exercise/ or exp Fitness/ or exp Kinesiotherapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Blogging/ or exp Mobile Phone/ or exp Computer Graphics/ or Computers/ or exp Personal Digital Assistant/ or Educational Technology/ or e-mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Game/ or Webcast/ or Wireless Communication/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or ‘FB’ or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 evaluation study/ or program evaluation/

33 (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (random* or placebo* or double-blind*).ti,ab,kw.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/ or exp College student/ or exp University student/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab,kw.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid PsycINFO

1 exp Sports/ or exp Exercise/ or exp Physical Fitness/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diets/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Weight control/ or exp Weight loss/

9 ((Weight adj2 (program or change or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

10 8 OR 9

11 exp Feedback/

12 exp Health Education/

13 exp Teaching/

14 Goals/

15 Intention/

16 Mentoring/

17 Counseling/

18 Social Support/

19 OR/11-18

20 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

21 19 OR 20

22 (6 OR 7 OR 10) AND 21

23 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

24 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

25 23 OR 24

26 22 AND 25

27 Program Evaluation/

28 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

29 (double-blind or random: assigned or control).tw.

30 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

31 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

32 OR/28-31

33 26 AND 32

34 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

35 ((college adj2 student*) or (university adj2 student*)).ti,ab.

36 34 OR 35

37 33 AND 36

Cochrane Database

#1 MeSH descriptor: [Physical Education and Training] explode all trees

#2 MeSH descriptor: [Sports] this term only

#3 MeSH descriptor: [Exercise] this term only

#4 MeSH descriptor: [Physical Fitness] this term only

#5 MeSH descriptor: [Exercise Therapy] this term only

#6 MeSH descriptor: [Motor Activity] this term only

#7 ((sedentary NEAR/2 behavior*) OR (physical NEAR/2 activi*) OR (physical NEAR/2 inactivi*) OR sport* OR exercis* OR (muscle NEAR/2 stretch*) OR (resistance NEAR/2 training) OR walk* OR bicycle* OR cycling OR swim* OR running OR jogging OR gymnastic* OR yoga OR dancing OR pilates OR gardening OR (physical NEAR/2 conditioning) OR circuit-based OR endurance OR (high-intensity NEAR/2 interval) OR HIIT OR plyometric* OR resistance OR running OR jogging OR swimming OR walking OR sports OR (stair NEAR/2 climbing) OR (cardiorespiratory NEAR/2 fitness) OR (motion NEAR/2 therapy) OR (physical NEAR/2 (education OR training OR fitness)) OR (motor NEAR/2 activity) OR (active NEAR/2 living)):ab,ti

#8 {OR #1-#7}

#9 MeSH descriptor: [Diet] this term only

#10 (nutrition OR diet* OR (intake NEAR/2 (calorie OR caloric OR restriction*)) OR fasting OR (mindful NEAR/2 eating) OR (healthy NEAR/2 diet*) OR (healthy NEAR/2 eating) OR (vending NEAR/2 machine*) OR (eating NEAR/2 behavior*) OR candy OR candies OR sweet* OR fruit* OR vegetable* OR vegetarian* OR vegan* OR “sweetened drink” OR “sugar sweetened beverage*” OR soda* OR carbonated OR low-fat OR gluten-free OR water OR food* OR pop OR dessert* OR cake* OR cookie* OR brownie* OR (baked NEAR/2 goods*) OR carbohydrate* OR sugar* OR “soft drink*” OR soda):ab,ti

#11 #9 OR #10

#12 #8 AND #11

#13 MeSH descriptor: [Body Weight Maintenance] this term only

#14 MeSH descriptor: [Obesity Management] this term only

#15 MeSH descriptor: [Weight Reduction Programs] explode all trees

#16 (((Weight NEAR/2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight)):ab,ti

#17 {OR #13-#16}

#18 MeSH descriptor: [Feedback] explode all trees

#19 MeSH descriptor: [Health Education] this term only

#20 MeSH descriptor: [Teaching] explode all trees

#21 MeSH descriptor: [Reminder Systems] explode all trees

#22 MeSH descriptor: [Goals] explode all trees

#23 MeSH descriptor: [Intention] explode all trees

#24 MeSH descriptor: [Mentoring] explode all trees

#25 MeSH descriptor: [Counseling] explode all trees

#26 MeSH descriptor: [Social Support] explode all trees

#27 (self-monitor* OR (goal* NEAR/2 setting) OR intention* OR track* OR behavior OR behaviour OR coach* OR mentor* OR counsel* OR (social NEAR/2 support*) OR feedback OR educat* OR (teach* NEAR/2 skill*) OR monitor* OR (health NEAR/2 educat*) OR reminder):ab,ti

#28 {OR #18-#27}

#29 #11 OR #12 OR #17

#30 #28 AND #29

#31 MeSH descriptor: [Telemedicine] explode all trees

#32 MeSH descriptor: [Computer-Assisted Instruction] explode all trees

#33 MeSH descriptor: [Blogging] explode all trees

#34 MeSH descriptor: [Cell Phone] explode all trees

#35 MeSH descriptor: [Computer Graphics] explode all trees

#36 MeSH descriptor: [Computers] explode all trees

#37 MeSH descriptor: [Computers, Handheld] explode all trees

#38 MeSH descriptor: [Educational Technology] explode all trees

#39 MeSH descriptor: [Internet] explode all trees

#40 MeSH descriptor: [Multimedia] explode all trees

#41 MeSH descriptor: [Technology] explode all trees

#42 MeSH descriptor: [Text Messaging] explode all trees

#43 MeSH descriptor: [User-Computer Interface] explode all trees

#44 MeSH descriptor: [Videoconferencing] explode all trees

#45 MeSH descriptor: [Video Games] explode all trees

#46 MeSH descriptor: [Webcasts as Topic] explode all trees

#47 MeSH descriptor: [Wireless Technology] explode all trees

#48 ((instant NEAR/2 messag*) OR IM OR (Interactive NEAR/2 voice NEAR/2 response) OR IVR OR (personal NEAR/2 digital NEAR/2 assistant) OR PDA OR (social NEAR/2 network*) OR (text NEAR/2 messag*) OR SMS OR (world NEAR/2 wide NEAR/2 web) OR website* OR (apple NEAR/2 watch) OR automated OR blog* OR Bluetooth OR chat OR (chat NEAR/2 room) OR (communication NEAR/2 network) OR (computer NEAR/2 assisted) OR (computer NEAR/2 interface) OR computer* OR computer-based OR computerized OR laptop* OR (digital NEAR/2 assistant*) OR ecoach* OR (educational NEAR/2 technolog*) OR edutainment OR e-health OR ehealth OR (electronic NEAR/2 feedback) OR (electronic NEAR/2 health) OR e-mail OR (electronic NEAR/2 mail) OR Facebook OR FB OR fitbit* OR (fitness NEAR/2 tracker*) OR graphic* OR (handheld NEAR/2 computer*) OR (health NEAR/2 information*) OR technolog* OR hypermedia OR individualized OR Instagram OR interactive OR (internet NEAR/2 based) OR internet OR iOTA OR mhealth OR m-health OR (mobile NEAR/2 app*) OR (mobile NEAR/2 technolog*) OR (mobile NEAR/2 health) OR mobile OR (mobile NEAR/2 phone*) OR android* OR smartphone* OR (smart NEAR/2 phone*) OR (cell* NEAR/2 phone*) OR (mobile NEAR/2 device*) OR iphone OR multimedia OR (new NEAR/2 technolog*) OR online OR on-line OR (personal NEAR/2 electronic NEAR/2 device*) OR podcast* OR programmed OR prompt* OR (remote NEAR/2 consultation*) OR remote OR (short NEAR/2 message NEAR/2 service*) OR (social NEAR/2 media) OR software OR tablet* OR tailored OR telecare OR telehealth OR telemonitoring OR twitter OR tweet OR (video NEAR/2 conferenc*) OR (video NEAR/2 game*) OR (virtual NEAR/2 reality) OR web-based OR webcast* OR wireless* OR apps OR iOs OR (digital NEAR/2 health)):ab,ti

#49 {OR #31-#48}

#50 #30 AND #49

#51 MeSH descriptor: [Program Evaluation] explode all trees

#52 (effectiveness or intervention or (program* NEAR/2 evaluat*)):ab,ti

#53 ((pre NEAR/5 post) OR (pretest NEAR/5 posttest)):ab,ti

#54 ((control* or before or (before and after stud*) or follow up assessment)):ab,ti

#55 {OR #51-#54}

#56 #50 AND #55

#57 MeSH descriptor: [Adult] explode all trees

#58 MeSH descriptor: [Young Adult] explode all trees

#59 ((college NEAR/2 student*) OR (university NEAR/2 student)):ab,ti

#60 (geriatric* OR senior* OR adult* OR m?n OR wom?n or participant*):ab,ti

#61 {OR #57-#60}

Abbreviations: exp, explode; mp, multi-purpose; ti; title; ab, abstract; adj, adjacency; pt, publication type; kw, keyword heading; sh, MESH subject headings; *, unlimited suffix variations

Beleigoli AM, Andrade AQ, Cancado AG, Paulo MNI, Diniz MFH, et al. Web-based digital health interventions for weight loss and lifestyle habit changes in overweight and obese adults: systematic review and meta-analysis. Journal of Medical Internet Research 2019;21(1):e298.

Centers for Disease Control and Prevention. Workplace Health Strategies. Date accessed 3/1/2021. February 2018. Available at: https://www.cdc.gov/workplacehealthpromotion/health-strategies/index.html.

Pew Research Center. Internet/Broadband Fact Sheet, 2021a. Date Accessed 7/2/2021. Available at: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/.

Pew Research Center. Mobile Fact Sheet, 2021b. Date Accessed 12/1/2021. Available at https://www.pewresearch.org/internet/fact-sheet/mobile/.

Carter MC, Burley VJ, Nykjaer C, & Cade JE. Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res. 2013:15(4), e32.

Roess A. The promise, growth, and reality of mobile health another data-free zone. N Engl J Med 2017:2010-2011.

Svetkey LP, Batch BC, Lin P-H, Intille SS, Corsino L, et al. Cell phone intervention for you CITY): a randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology. Obesity (Silver Spring) 2015:23(11):2133-41.

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion, as noted below. It is important to note that these interventions were conducted among working adults; therefore, not all populations would benefit to the same degree. Additionally, the CPSTF does not endorse any specific digital health intervention.

• Interventions incorporating digital health are a convenient way to reach individuals in worksites. They have the potential for broad dissemination and scalability (Carter et al., 2013; Roess, 2017; Svetkey et al., 2015).
• Interventions aiming to help adults lose weight may require greater intensity, longer durations, or both. Implementers might consider their population of interest to determine reasonable expectations.
• Populations may respond differently to varying levels of intensity. For example, younger adults may be more comfortable tracking their daily behaviors on mobile devices than older adults would be.
• Programs may want to consider participants’ electronic literacy. The CPSTF suggests worksites consider tailoring interventions to the electronic and literacy levels of their employees.
• CPSTF suggests implementers make these programs accessible to workers of all types of jobs and all races/ethnicities.
• The digital divide needs to be considered when using technology other than telephones to implement programs. Key issues include participants’ access to affordable internet networks or mobile devices and digital readiness. Worksite programs may be able to provide employees with resources and opportunities that address this concern.
• Programs may want to consider the built environment. It is important for participants to have access to healthier foods and safe places where they can be physically active.
• CPSTF suggests implementers incorporate behavior change theories into program designs.
• Data security and privacy issues need to be considered when individuals enter personal information electronically.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of adults who do no physical activity in their free time — PA-01
• Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA-02
• Increase the proportion of adults who do enough muscle-strengthening activity — PA-04
• Increase fruit consumption by people aged 2 years and over — NWS-06
• Increase vegetable consumption by people aged 2 years and older — NWS-07
• Increase consumption of dark green vegetables, red and orange vegetables, and beans and peas by people aged 2 years and over — NWS-08
• Increase whole grain consumption by people aged 2 years and over — NWS-09
• Reduce consumption of saturated fat by people aged 2 years and over — NWS-11
• Increase the proportion of worksites that offer an employee physical activity program — ECBP-D04