A systematic review of eHealth cancer prevention and control interventions: new technology, same methods and designs?

Abstract

There has been a recent surge of eHealth programs in cancer and other content areas, but few reviews have focused on the methodologies and designs employed in these studies. We conducted a systematic review of studies on eHealth interventions on cancer prevention and control published between 2001 and 2010 applying the Pragmatic Explanatory Continuum Indicator Summary (PRECIS) criteria and external validity components from the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. We identified 113 studies that focused on cancer prevention and control of eHealth interventions. Most studies fell midway along the explanatory/ pragmatic trial continuum, but few reported on various practical feasibility criteria for translation. Despite vast interest in cancer eHealth and the applied nature of this field, few studies considered key external validity issues. There is a need for use of alternative pragmatic study designs and transparent reporting of external validity components to produce more rapid and generalizable results.Keywords eHealth, Pragmatic trials, Systematic review, Design, PRECIS, External validity, RE-AIM framework BACKGROUND Reductions in cancer morbidity and mortality are partly attributable to interventions addressing modifiable risk factors and screening behaviors [1]. However, such advancements in cancer outcomes are not observed among all populations, specifically those with limited access to cancer care and efficacious behavior interventions [2,3]. The recent surge of eHealth interventions (EHIs) presents unique opportunities to enhance cancer prevention and control by increasing intervention reach, adapting to various contextual conditions, being readily available where users live, work, and play, and tailoring information to patients' needs [4][5][6].eHealth research is a relatively young field that is rapidly growing. EHIs have been found to be effective in promoting change in behaviors, knowledge, self-

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

“…Data extraction and quality assessment In order to rank interventions by their Brealworld^applicability [33,34], we rated each study in terms of pragmatism, as measured by PRECIS-2. PRECIS-2 contains nine domains ( Fig.…”

“…The details of the PRECIS-2 rating scale, including pragmatic and explanatory extremes of each domain, have been described extensively elsewhere [32]. We adapted an existing rating tool that was used to assess PRE-CIS domains in a prior review article [33]. Our rationale was that highly pragmatic clinical trials more closely mimic real-world circumstances in terms of design.…”

“…RE-AIM was designed with the intention of increasing reporting on the robustness, translatability, and public health impact of healthcare-related trials [33,34]. We identified important practical feasibility factors derived from the RE-AIM framework that are not represented in the PRECIS-2 domains.…”

“…We identified important practical feasibility factors derived from the RE-AIM framework that are not represented in the PRECIS-2 domains. These practical feasibility factors that we identified include reports of participant engagement, adaptation/change of intervention, program sustainability, unintended effects of intervention, and monetary costs of intervention [32][33][34]. We adapted an existing RE-AIM rating tool that was used to assess these practical feasibility factors in a prior review article [33].…”

“…In 2015, >80 international trialists, clinicians, and policy-makers revised and validated an updated version: the PRECIS-2 model [32]. The PRECIS-2 model may serve two purposes-to inform future trial design and to allow researchers to assess the Breal-world applicability^of published studies [33].…”