Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis

Abstract

Background With the large amount of material that is readily available on the internet, there are endless opportunities for electronic health–literate patients to obtain and learn new information. Although novel, a Web- or mobile-based program can be a powerful way to engage adolescents and young adults (AYAs). The ongoing engagement of AYAs with chronic disease is vital not only to empower them but also to ensure a smooth transition from pediatric to adult health care. Objective This study aimed to evaluate the current evidence on Web- or mobile-based interventions designed for AYAs. Methods This review was registered with PROSPERO: CRD42018096487. A systematic search of MEDLINE Complete, EMBASE, and CINAHL Complete was conducted on April 10, 2019, for studies that examined the perspectives of transition-age patients about technology-based interventions, the process involved in intervention development, or the evaluation of intervention efficacy. For each study, the comprehensiveness of reporting was appraised. The Downs and Black checklist was used for intervention efficacy trials, the Standards for Reporting Qualitative Research checklist was used for qualitative work, and a 16-item tool developed by Tong et al was used for questionnaire research. Results The search uncovered 29 relevant studies, which included qualitative studies (n=14), intervention efficacy studies (n=7), questionnaire studies (n=4), mixed qualitative and questionnaire studies (n=2), and a mixed qualitative and pilot randomized controlled trial study (n=1). The reporting comprehensiveness score of questionnaires was rated considerably lower (n=6, 13%-57% [2/16-8/14]) than the scores of intervention efficacy trials (n=8, 48%-85% [13/27-23/27]) and qualitative research (n=17, 40%-93% [8.5/21-19.5/21]). AYAs were receptive to obtaining information via a website or mobile app. An intervention was more likely to be perceived as useful by AYAs when there was a concerted effort to involve AYAs and subject matter experts in the process of intervention design, as opposed to relying solely on the AYAs or the experts alone. The preferred medium of intervention delivery varied greatly for AYAs, ranging from static text to audiovisual materials. However, AYAs considered being concise was the most important aspect. Across different conditions, AYAs were interested in receiving information on diverse topics, such as anxiety and stress management, dealing with insurance, and having social relationships. Patients also requested for disease-specific information, such as weather forecasts and pollen levels for patients with asthma and information related to the pretransplant period for organ transplant recipients. Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management. Conclusions Owing to the lack of intervention efficacy trials, no conclusion can be drawn if an ...

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

“…Furthermore, a substantial number of IMIs (8 out of 19) are older than ten years, presumably not representative to the mobile technology and platforms available today. Second, although we were able to include substantially more studies than prior reviews ( Low and Manias, 2019 ; Thabrew et al, 2018 ), single meta-analytic comparisons might be still underpowered to detect significant effects ( Cuijpers et al, 2014 ; Harrer et al, 2019 ; Hedges and Pigott, 2001 ) – which might be in addition (very) small for single-component interventions, but clinically relevant for patients nonetheless ( Domhardt et al, 2019 ). Third (and clinically most relevant), given the high strain and specific needs of youth with CC, it might be that this particular group of patients is not responsive to IMIs to the same extent than other patient populations ( Andersson et al, 2019 ; Bendig et al, 2018 ; Domhardt et al, 2020b ).…”

“…Next to these efforts toward precision medicine ( Cohen and DeRubeis, 2018 ) and “ precision digital health ” ( Domhardt et al, accepted ), important future directions for forthcoming research are on how to best improve interventions and maximize treatment outcomes. At that, involving the patients` perspective into intervention development ( Geirhos et al, submitted ; Holmes et al, 2018 ; Low and Manias, 2019 ) and disentangling the active ingredients of interventions by means of component and mediation studies ( Domhardt et al, 2020c ) might be key avenues, to increase the potential benefits of digital health interventions for youth with CC and other underserved populations.…”

“…Furthermore, Fedele et al (2017) found a small effect for mobile-based interventions for various health outcomes in youth with or without CC (SMD, 0.22; 95% CI, 0.14 to 0.29), reporting only an overall estimate with high clinical heterogeneity and neglecting fine-grained analyses on specific outcomes and subgroups. Other meta-analyses were constrained by a small number of included trials ( Low and Manias, 2019 ; Thabrew et al, 2018 ), focusing either on specific control conditions (i.e., treatment-as-usual; Low and Manias, 2019 ) or psychological outcomes (i.e., symptoms of depression and anxiety; Thabrew et al, 2018 ), evincing non-significant findings for QoL, self-efficacy, and self-management ( Low and Manias, 2019 ), as well as depression and anxiety symptom severity ( Thabrew et al, 2018 ). Altogether, important research questions in regard to the efficacy and effect-modifying factors of IMIs for youth with CC are unsettled to date.…”

Use and preferences regarding internet-based health care delivery in patients with chronic kidney disease

“…In addition, mobile health apps are gaining popularity and more patients are supposed to use mobile technologies and informational websites to receive information about certain diseases and treatment opportunities [ 29 – 31 ]. It is also anticipated that a variety of new internet-based approaches will flood the market in the near future especially with adolescents and younger adults as the target group [ 32 ]. However, despite the fact that in our study not many CKD patients were using internet-based health care technologies, the majority of patients are willing to consider the use within a medical context of consultation or treatment.…”

Adherence to Medication During Transition to Adult Services

“…The few studies that have addressed this topic have yielded mixed findings [ 50 ], and published materials frequently describe the methods rather than yet being able to share actual study results [ 52 – 55 ]. Two very recent comprehensive reviews concluded that, although adolescents and young adults were receptive to the technology, efficacy data were lacking [ 51 , 56 ]. Given the potential (although not yet realized) benefit of technological advances, we review some of the relevant studies here.…”