The authors concluded that interventions using electronic media could improve health and safety behaviours in young people, but there was a need for higher-quality, rigorous interventions that promoted behaviour change. The authors’ conclusions reflect the data presented and their recommendation for further research reflects the limited evidence available.

To evaluate electronic media-based interventions focused on promoting health and safety behaviour change in young people.

MEDLINE and PsycINFO were searched up to September 2010 for articles published in English. Search terms were reported.

Studies of interventions using electronic media and focused on changes in behaviour related to health or safety in children or young people (aged 18 years or younger) were eligible for inclusion. Electronic media included interactive content accessed electronically including content in computer and video console games, video clips, CD-ROM, and the Internet.

Over half of the interventions in the included studies were computer games or simulations. The remaining studies used console video games, Internet programs, game or virtual reality worlds, video clips or an interactive element. Interventions were focused on physical activity or nutrition, asthma, safety behaviours, sexual risk behaviours, and diabetes mellitus. Study settings were clinical, school or home (where reported). Participant age ranged from three to 18 years (where reported).

It appeared that four reviewers independently selected studies for inclusion.

Study quality was assessed using the Jadad score which covered randomisation, blinding, and withdrawals and drop-outs (maximum score of 5). Studies with a score of 2 or more were considered excellent; those with a score of 0 to 2 were considered poor quality.

It appeared that four reviewers independently assessed study quality.

Data were extracted on changes in health and safety behaviour.

The authors did not state how many reviewers extracted data.

Data were grouped by health or safety condition and combined in a narrative synthesis.

Nineteen studies were included in the review (7,001 participants). Sample sizes ranged from 5 to 1,876 participants. Follow-up ranged from one week to 15.6 months. Five studies were rated as excellent quality, scoring 3 points for reporting adequate randomisation and withdrawals and drop-outs. Of the remaining studies, six scored 2 points, four scored 1 point, and four scored zero points. No studies reported blinding.

Nutrition and physical activity (seven studies including four RCTs): As a result of behaviour change interventions statistically significant increases were reported in fruit and vegetable consumption (two studies), fruit juice (one study), nutrition self-care behaviours (one study), daily consumption of dairy products and a decrease in daily consumption of sweets or sugars (one study) and significant improvements in dietary intake (one study). Significant improvements were also reported in increased physical activity (two studies), decreased sedentary behaviours (two studies), decreased computer use (one study), obesity reduction in girls (one study) and an improvement in systolic blood pressure (one study).

Asthma and lung function (six RCTs): Statistically significant increases as a result of behaviour change interventions were reported for asthma self-management skills (two RCTs) and more successful spirometric performance (one study). Statistically significant decreases were reported for asthma symptom scores, clinical appointment return rate, hospitalisations in children under 12 years old (one RCT), and use of oral steroids (one RCT). One RCT reported no significant changes in asthma symptoms between groups.

Safety behaviours (three studies including two controlled studies): Significant improvements were found as a result of behaviour change interventions for driving skills of younger, inexperienced drivers (one study), but no statistically significant differences were reported for fire and safety skills (two studies).

Sexual risk behaviours (two RCTs): There were statistically significantly fewer condom failures, lower reporting of sexually transmitted infection diagnosis (one RCT) as a result of a behaviour change intervention. Fewer participants in an intervention group were likely to report having initiated oral, vaginal or anal sex compared with a control group by the 9th grade (one RCT).

Diabetes mellitus (one RCT): There were no statistically significant differences between intervention and control groups for self-efficacy ratings for diabetes self-care and urgent visits to physicians or for increase in glycated haemoglobin (HbA_1c) levels.

Interventions using electronic media could improve health and safety behaviours in young people, but there was a need for higher-quality, rigorous interventions that promoted behaviour change.

The review question was clear with broadly defined inclusion criteria. Only two databases were searched; this, together with restriction to English language studies, meant that there was potential for language and publication bias and relevant studies may have been missed. Appropriate methods were used to reduce the risk of reviewer error and bias for the selection of studies, but it was unclear whether similar methods were used for quality assessment and data extraction.

Study quality was assessed using a published scale for RCTs, and summary scores were reported. A narrative synthesis was appropriate given the variation between studies of interventions, study designs, and outcomes. Full details of studies were provided in an online appendix. Most of the outcomes were reported in single studies and most outcome measures were self-reported (liable to over-estimation).

The authors’ conclusions reflect the data presented and their recommendation for further research reflects the limited evidence available.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research was needed to assess the effectiveness of electronic media-based interventions in different settings. These studies should focus on developing, rigorously evaluating and implementing electronic media-based interventions.

Eunice Kenedy Shriver National Institute of Child Health and Human Development, USA; Yale Robert Wood Johnson Foundation Clinical Scholars Program, USA; US Department of Veterans Affairs.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.