Lifestyle eHealth and mHealth Interventions for Children and Adolescents: Systematic Umbrella Review and Meta–Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: eHealth and mobile health (mHealth) interventions are promising in promoting healthy behaviors among children and adolescents. OBJECTIVE: This systematic umbrella review and meta-meta-analysis aimed to evaluate the effectiveness of eHealth and mHealth interventions in promoting healthy behaviors among children and adolescents. METHODS: Nine databases were searched for systematic reviews and meta-analyses of randomized controlled trials of eHealth and mHealth interventions targeting physical activity, sedentary behavior, sleep, and dietary outcomes in children and adolescents aged below 18 years. Screening, data extraction, and all assessments were completed by 2 reviewers. Study quality was assessed using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) checklist, and meta-analyses were conducted to combine effect sizes using random effects models. Subgroup analyses examined participant and intervention characteristics. RESULTS: A total of 25 systematic reviews comprising 440 randomized controlled trials and 133,501 participants, mostly involving healthy children and adolescents (n=18, 72%) or those who were overweight or with obesity (n=4, 16%), were included. Interventions mostly included active video games or serious games (n=8, 32%), various mHealth interventions (n=6, 24%), various eHealth interventions (n=5, 20%), combined eHealth and mHealth interventions (n=4, 16%), wearables (n=1, 4%), and computer-based interventions (n=1, 4%). Most studies (n=18, 72%) had critically low AMSTAR-2 scores. Meta-analyses based on standardized mean difference (SMD) showed significant effects (all P<.05) for moderate to vigorous physical activity (SMD 0.18, 95% CI 0.09-0.27), total physical activity (SMD 0.24, 95% CI 0.13-0.35), fat intake (SMD 0.10, 95% CI 0.02-0.18), fruit and vegetable intake (SMD 0.11, 95% CI 0.00-0.22), BMI (SMD 0.19, 95% CI 0.11-0.27), and body weight (SMD 0.15, 95% CI 0.01-0.30). No effects were found for sedentary behavior (SMD 0.12, 95% CI -0.11 to 0.35) or sleep (SMD 0.27, 95% CI -0.09 to 0.63). Shorter interventions (lasting <8 weeks) had a greater effect on moderate to vigorous physical activity than longer interventions (lasting ≥8 weeks), while longer interventions (lasting ≥12 weeks) had a greater effect on BMI compared with shorter interventions. CONCLUSIONS: eHealth and mHealth interventions offer modest but meaningful improvements in physical activity, diet, and weight management in children and adolescents, with important implications for integrating digital tools into health promotion strategies. TRIAL REGISTRATION: PROSPERO CRD42024537019; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537019.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.053 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.040 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".