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

  1. Natalie Gold
  2. Xiao-Yang Hu
  3. Sarah Denford
  4. Ru-Yu Xia
  5. Lauren Towler
  6. Julia Groot
  7. Rachel Gledhill
  8. Merlin Willcox
  9. Ben Ainsworth
  10. Sascha Miller
  11. Michael Moore
  12. Paul Little
  13. Richard Amlôt
  14. Tim Chadborn
  15. Lucy Yardley

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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 .

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  1. Version published to 10.1186/s12889-021-11150-8
  2. ScreenIT

    SciScore for 10.1101/2020.09.07.20164947: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy: We conducted a systematic literature search in five databases: MEDLINE, Embase, PsycINFO, Cochrane Controlled Register of Trials (CENTRAL), and China National Knowledge Infrastructure (CNKI).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)
    Cochrane Controlled Register of Trials
    suggested: (Cochrane Central Register of Controlled Trials, RRID:SCR_006576)
    We assessed the following types of bias as outlined in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions [11]: bias arising from the randomisation process, bias due to deviations from the intended interventions, bias due to missing outcome data, bias in measurement of the outcome, and bias in selection of the reported result.
    Cochrane Handbook
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: We were able to search a wide range of papers because we did not have a language restriction and we specifically searched Chinese-language repositories, finding three Chinese-language papers. However, because we conducted a rapid review we searched a limited number of databases, so we may have missed papers. In particular, we may have missed papers that were in languages other than English or Chinese. Our search terms were in English and Chinese, and the English-language databases would only have recorded foreign-language papers if their abstracts had been translated into English. Other major limitations relate to the studies themselves. The interventions and outcome measures were heterogeneous, which precluded a meta-analysis. Only one was deemed to be at low risk of bias, Little 2015 [5]. The most common faults were that the studies lacked information about the randomisation process, that they did not give information about an analysis plan and had the potential for selective reporting of results, and that there was risk of bias in the measurement of outcomes in behavioural studies. In many of the trials either participants or personnel were aware of the assignment to conditions, which the RoB 2 tool rates as being at some concern of bias from deviation from intended interventions. Arguably, being aware of the assignment is not a source of risk in digital interventions, especially those where the intervention is completely fixed in advance, so par...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.07.20164947v1 on medRxiv