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Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review

Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review
Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review
Background: digital interventions have potential to efficiently support improved hygiene practices to reduce transmission of COVID-19.

Objective: to evaluate the evidence for digital interventions to improve hygiene practices within the community.

Methods: we reviewed articles published between 01 January 2000 and 26 May 2019 that presented a controlled trial of a digital intervention to improve hygiene behaviours in the community. We searched MEDLINE, Embase, PsycINFO, Cochrane Controlled Register of Trials (CENTRAL), China National Knowledge Infrastructure and grey literature. Trials in hospitals were excluded, as were trials aiming at prevention of sexually transmitted infections; only target diseases with transmission mechanisms similar to COVID-19 (e.g. respiratory and gastrointestinal infections) were included. Trials had to evaluate a uniquely digital component of an intervention. Study designs were limited to randomised controlled trials, controlled before-and-after trials, and interrupted time series analyses. Outcomes could be either incidence of infections or change in hygiene behaviours. The Risk of Bias 2 tool was used to assess study quality.

Results: we found seven studies that met the inclusion criteria. Six studies reported successfully improving self-reported hygiene behaviour or health outcomes, but only one of these six trials, Germ Defence, confirmed improvements using objective measures (reduced consultations and antibiotic prescriptions). Settings included kindergartens, workplaces, and service station restrooms. Modes of delivery were diverse: WeChat, website, text messages, audio messages to mobiles, electronic billboards, and electronic personal care records. Four interventions targeted parents of young children with educational materials. Two targeted the general population; these also used behaviour change techniques or theory to inform the intervention. Only one trial had low risk of bias, Germ Defence; the most common concerns were lack of information about the randomisation, possible bias in reporting of behavioural outcomes, and lack of an analysis plan and possible selective reporting of results.

Conclusion: there was only one trial that was judged to be at low risk of bias, Germ Defence, which reduced incidence and severity of illness, as confirmed by objective measures. Further evaluation is required to determine the effectiveness of the other interventions reviewed.

Trial registration
PROSPERO CRD42020189919.
Behaviour, Behaviour change, Behavioural medicine, COVID-19, Community health, Digital medicine, Handwashing, Hygiene, Infection control, Novel coronavirus, eHealth
1471-2458
1180
Gold, Natalie
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Hu, Xiaoyang
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Denford, Sarah
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Xia, Ru-yu
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Towler, Lauren
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Groot, Julia
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Gledhill, Rachel
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Willcox, Merlin
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Ainsworth, Ben
b02d78c3-aa8b-462d-a534-31f1bf164f81
Miller, Sascha, Jane
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
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Amlôt, Richard
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Chadborn, Tim
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Yardley, Lucy
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Gold, Natalie
2df992a8-1536-449f-89f0-72c5ce2c1250
Hu, Xiaoyang
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Denford, Sarah
8970b5a7-8cad-4356-ad0e-88297b67db37
Xia, Ru-yu
93e6664d-40f0-43e8-b156-e0d037404694
Towler, Lauren
6529c6fc-3dee-4a92-9b17-7808be47f737
Groot, Julia
cc29dc97-a3aa-4036-a46a-a913828f2962
Gledhill, Rachel
09cc8a7f-05cf-49cd-8d68-7a105db76afd
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Ainsworth, Ben
b02d78c3-aa8b-462d-a534-31f1bf164f81
Miller, Sascha, Jane
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Amlôt, Richard
d93f5263-ea24-4b12-b505-f51694220b8e
Chadborn, Tim
fb42e42c-cac4-46bc-8f4f-07844add4d93
Yardley, Lucy
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Gold, Natalie, Hu, Xiaoyang, Denford, Sarah, Xia, Ru-yu, Towler, Lauren, Groot, Julia, Gledhill, Rachel, Willcox, Merlin, Ainsworth, Ben, Miller, Sascha, Jane, Moore, Michael, Little, Paul, Amlôt, Richard, Chadborn, Tim and Yardley, Lucy (2021) Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review. BMC Public Health, 21 (1), 1180, [1180]. (doi:10.1186/s12889-021-11150-8).

Record type: Article

Abstract

Background: digital interventions have potential to efficiently support improved hygiene practices to reduce transmission of COVID-19.

Objective: to evaluate the evidence for digital interventions to improve hygiene practices within the community.

Methods: we reviewed articles published between 01 January 2000 and 26 May 2019 that presented a controlled trial of a digital intervention to improve hygiene behaviours in the community. We searched MEDLINE, Embase, PsycINFO, Cochrane Controlled Register of Trials (CENTRAL), China National Knowledge Infrastructure and grey literature. Trials in hospitals were excluded, as were trials aiming at prevention of sexually transmitted infections; only target diseases with transmission mechanisms similar to COVID-19 (e.g. respiratory and gastrointestinal infections) were included. Trials had to evaluate a uniquely digital component of an intervention. Study designs were limited to randomised controlled trials, controlled before-and-after trials, and interrupted time series analyses. Outcomes could be either incidence of infections or change in hygiene behaviours. The Risk of Bias 2 tool was used to assess study quality.

Results: we found seven studies that met the inclusion criteria. Six studies reported successfully improving self-reported hygiene behaviour or health outcomes, but only one of these six trials, Germ Defence, confirmed improvements using objective measures (reduced consultations and antibiotic prescriptions). Settings included kindergartens, workplaces, and service station restrooms. Modes of delivery were diverse: WeChat, website, text messages, audio messages to mobiles, electronic billboards, and electronic personal care records. Four interventions targeted parents of young children with educational materials. Two targeted the general population; these also used behaviour change techniques or theory to inform the intervention. Only one trial had low risk of bias, Germ Defence; the most common concerns were lack of information about the randomisation, possible bias in reporting of behavioural outcomes, and lack of an analysis plan and possible selective reporting of results.

Conclusion: there was only one trial that was judged to be at low risk of bias, Germ Defence, which reduced incidence and severity of illness, as confirmed by objective measures. Further evaluation is required to determine the effectiveness of the other interventions reviewed.

Trial registration
PROSPERO CRD42020189919.

Text
s12889-021-11150-8 - Version of Record
Available under License Creative Commons Attribution.
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More information

Accepted/In Press date: 26 May 2021
e-pub ahead of print date: 21 June 2021
Published date: 21 June 2021
Additional Information: Lucy Yardley is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). MLW’s salary is funded by the National Institute of Health Research (NIHR), under grant CL-2016-26-005. XYH is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR).
Keywords: Behaviour, Behaviour change, Behavioural medicine, COVID-19, Community health, Digital medicine, Handwashing, Hygiene, Infection control, Novel coronavirus, eHealth

Identifiers

Local EPrints ID: 450377
URI: http://eprints.soton.ac.uk/id/eprint/450377
ISSN: 1471-2458
PURE UUID: f775bf55-371b-4fd1-81eb-4963ddad11d8
ORCID for Xiaoyang Hu: ORCID iD orcid.org/0000-0002-3143-7999
ORCID for Lauren Towler: ORCID iD orcid.org/0000-0002-6597-0927
ORCID for Merlin Willcox: ORCID iD orcid.org/0000-0002-5227-3444
ORCID for Ben Ainsworth: ORCID iD orcid.org/0000-0002-5098-1092
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 26 Jul 2021 16:33
Last modified: 06 May 2022 01:49

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Contributors

Author: Natalie Gold
Author: Xiaoyang Hu ORCID iD
Author: Sarah Denford
Author: Ru-yu Xia
Author: Lauren Towler ORCID iD
Author: Julia Groot
Author: Rachel Gledhill
Author: Merlin Willcox ORCID iD
Author: Ben Ainsworth ORCID iD
Author: Michael Moore ORCID iD
Author: Paul Little
Author: Richard Amlôt
Author: Tim Chadborn
Author: Lucy Yardley ORCID iD

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