Electronic Media–Based Health Interventions Promoting Behavior Change in Youth A Systematic Review.

Kimberly Hieftje, PhD; E. Jennifer Edelman, MD, MHS; Deepa R. Camenga, MD, MHS; Lynn E. Fiellin, MD

Importance  Little research has been done on the efficacy of electronic media–based interventions, especially on their effect on health or safety behavior. The current review systematically identified and evaluated electronic media–based interventions that focused on promoting health and safety behavior change in youth.
Objective  To assess the type and quality of the studies evaluating the effects of electronic media–based interventions on health and safety behavior change.
Evidence Review  Studies were identified from searches in MEDLINE (1950 through September 2010) and PsycINFO (1967 through September 2010). The review included published studies of interventions that used electronic media and focused on changes in behavior related to health or safety in children aged 18 years or younger.
Findings  Nineteen studies met the criteria and focused on at least 1 behavior change outcome. The focus was interventions related to physical activity and/or nutrition in 7 studies, on asthma in 6, safety behaviors in 3, sexual risk behaviors in 2, and diabetes mellitus in 1. Seventeen studies reported at least 1 statistically significant effect on behavior change outcomes, including an increase in fruit, juice, or vegetable consumption; an increase in physical activity; improved asthma self-management; acquisition of street and fire safety skills; and sexual abstinence. Only 5 of the 19 studies were rated as excellent.
Conclusions and Relevance  Our systematic review suggests that interventions using electronic media can improve health and safety behaviors in young persons, but there is a need for higher-quality, rigorous interventions that promote behavior change.
More established forms of electronic media, such as television and radio, have been shown to encourage behavior change. Previous studies have demonstrated that their use can increase physical activity1 and reduce disruptive behavioral problems.2 However, other types of media, such as computer or video games, may be more effective in producing behavior change because they encourage active engagement and processing of information from the child. On any given day, 60% of young persons play video games, including 47% who play on a handheld player or a cell phone and 39% who play on a console player. Moreover, 99% of teenage boys and 94% of teenage girls play video games.3 Given their widespread use and interactive capabilities, computer and video games are an increasingly popular type of electronic media used in health interventions and have been a successful tool for health promotion and management of chronic medical conditions in children and adolescents.45 Although they did not meet the strict criteria for the present review, 2 articles67 describe how video game interventions target smoking cessation and asthma in adolescents.
Electronic media–based interventions lend themselves to experiential learning and, when created according to established health promotion and instructional design principles, offer distinct advantages over conventional methods of health education.4 Because of their repetitive nature, these interventions can better expose individuals to educational content and reinforce learning. Furthermore, electronic media–based interventions can be personalized through the creation of avatars and virtual identities. Finally, these interventions have interactive capability that can provide immediate feedback and increase player engagement. Accordingly, they may be an ideal platform for improving health outcomes for adolescents. However, little research has been done on the efficacy of electronic media–based interventions, especially on their effect on health or safety behavior.
The aim of this study is to systematically review the literature to identify and evaluate electronic media–based interventions focused on promoting health and safety behavior change in youth. Although several recent systematic reviews810 have been conducted to evaluate the effectiveness of electronic media–based interventions on health outcomes, these reviews were limited to video games as the only form of intervention1112 or to only a single specific health outcome. In addition, many reviews did not include safety behavior outcomes,810,1213 or youth populations.8 The present review expands on previous reviews by including studies that specifically focus on youth, use electronic media–based interventions as part of the study, and examine both health and safety behavior outcomes.