Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review

Background: The prevalence of chronic health conditions in
childhood is increasing, and behavioral interventions can support
the management of these conditions. Compared with face-to-face
treatment, the use of digital interventions may be more
cost-effective, appealing, and accessible, but there has been
inadequate attention to their use with younger populations
(children aged 5-12 years). Objective: This systematic review aims
to (1) identify effective digital interventions, (2) report the
characteristics of promising interventions, and (3) describe the
user’s experience of the digital intervention. Methods: A total
of 4 databases were searched (Excerpta Medica Database [EMBASE],
PsycINFO, Medical Literature Analysis and Retrieval System Online
[MEDLINE], and the Cochrane Library) between January 2014 and
January 2019. The inclusion criteria for studies were as follows:
(1) children aged between 5 and 12 years, (2) interventions for
behavior change, (3) randomized controlled trials, (4) digital
interventions, and (5) chronic health conditions. Two researchers
independently double reviewed papers to assess eligibility, extract
data, and assess quality. Results: Searches run in the databases
identified 2643 papers. We identified 17 eligible interventions.
The most promising interventions (having a beneficial effect and
low risk of bias) were 3 targeting overweight or obesity, using
exergaming or social media, and 2 for anxiety, using web-based
cognitive behavioral therapy (CBT). Characteristics of promising
interventions included gaming features, therapist support, and
parental involvement. Most were purely behavioral interventions
(rather than CBT or third wave), typically using the behavior
change techniques (BCTs) feedback and monitoring, shaping
knowledge, repetition and substitution, and reward. Three papers
included qualitative data on the user’s experience. We developed
the following themes: parental involvement, connection with a
health professional is important for engagement, technological
affordances and barriers, and child-centered design. Conclusions:
Of the 17 eligible interventions, digital interventions for anxiety
and overweight or obesity had the greatest promise. Using
qualitative methods during digital intervention development and
evaluation may lead to more meaningful, usable, feasible, and
engaging interventions, especially for this underresearched younger
population. The following characteristics could be considered when
developing digital interventions for younger children: involvement
of parents, gaming features, additional therapist support,
behavioral (rather than cognitive) approaches, and particular BCTs
(feedback and monitoring, shaping knowledge, repetition and
substitution, and reward). This review suggests a model for
improving the conceptualization and reporting of behavioral
interventions involving children and parents.

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Digital Behavior Change Interventions for Younger Children
With Chronic Health Conditions: Systematic Review