Effectiveness of mHealth for modification of dietary habits and physical activity among individuals at risk or suffering from noncommunicable diseases in primary healthcare settings in South East Asian Region countries – A systematic review and meta-analysis

Background: Noncommunicable diseases (NCDs) are increasing, for which some behavioral risk factors are major concerns. mHealth has been found to be effective in changing these behavioral patterns. Objective: To assess effectiveness of mHealth technology in modification of dietary habits and physical activity, among individuals having NCDs or their risk factors, in primary healthcare settings in South East Asian Region Countries. Materials and Methods: A systematic review and meta-analysis was done with the primary outcome as effectiveness of mHealth for improving dietary practices and increasing physical activity. Articles were retrieved from PubMed, Cochrane Central, Google Scholar, and Pre-print servers followed by forward and backward searching. Quality and risk of bias of included studies were assessed. Meta-analysis was performed using RevMan v. 5.4.1 software. Heterogeneity was tested using χ2 test and measured using I2 statistic, with Forest plots as the final outcome. Results: Nine publications from seven studies, of which seven were conducted in India and two in Bangladesh, qualified for the review. All studies used varied mHealth interventions. Most studies reported beneficial effects in reducing inadequate/improper diet and insufficient/improving physical activity, at community/workplace settings, except two studies reporting no apparent impact, both being from Bangladesh. Meta-analysis revealed statistically significant differences between intervention and control groups for pooled estimates of reduced dietary energy and increased fruits/vegetables. Although heterogeneity is absent between studies considered for fruits/vegetables, both studies were compromised in quality and bias. Studies on dietary energy intake had high statistical heterogeneity, in addition to having high risk of bias. Hence, the results need to be interpreted with caution. No effect was observed on increasing physical activity. Conclusion: mHealth interventions have huge potential to facilitate behavior change. However, more research is needed before its potential scale-up.