Date of Award

2021

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Jacob Shabani

Second Supervisor/Advisor

Dr. Anthony Ngugi

Third Supervisor/Advisor

Dr. Catherine Gathu

Department

Family Medicine (East Africa)

Abstract

Objectives: This systematic review and meta-analysis aimed (1) to determine the effectiveness of digital health intervention (DHI) components on weight loss in postpartum women, (2) to determine the effect of DHIs on body mass index and (3) to determine the attrition rates within DHIs.

Methods: Electronic searches were conducted on PubMed (MEDLINE), Cochrane Library, Google Scholar, and Web of Science from inception to 22nd April 2020. Studies included were; (1) randomized controlled trials (RCT), quasi-experimental trials, and controlled before-after studies (2) of weight loss interventions delivered by either website, Internet, email, computer, Apps, SMS, phone call, or video player (3) for postpartum women. Interventions involving medicines or surgeries for weight loss were excluded. Primary outcome was weight mean difference (MD), while secondary outcomes were BMI MD and attrition rates. Cochrane Collaboration’s tool for assessing the risk of bias and the Quality Assessment Tool for Quantitative Studies were used to judge the quality of the primary outcome. Narrative summary tables were generated for descriptive analysis. Random-effects model analysis was conducted to generate weight and BMI mean differences and 95% CIs.

Results: Twenty studies (19 RCTs and 1 Non-RCT) were included. A total of 3228 women were included for analysis of body weight change, while 458 women were included for BMI change. DHIs significantly reduced body weight (mean difference, -1.41 Kg; 95% CI: -2.04 to -0.77 Kg) and BMI (-0.94 Kg/m2; 95% CI: -1.37 to -0.52 Kg/m2 ). All classifications of DHIs were effective, but the biggest weight loss was with on-demand information services (-2.4 Kg, 95% CI: -3.4 to -1.41 Kg). Mixed-site interventions had more weight loss (-1.62 Kg; 95% CI: -2.99 to -0.25 Kg) compared to home-based interventions (-1.35 Kg; 95% CI: -2.13 to -0.57 Kg). Mixed-target interventions had more weight loss (-1.67 Kg; 95% CI: -2.89 to -0.46 Kg) compared to individual-only targeted interventions (-1.30 Kg; 95% CI: -2.11 to -0.49 Kg). Attrition within intervention groups ranged from 0% to 85%. Ten studies (out of 20) were judged to be at high risk of bias with 1 having “some concerns” mostly due to missing outcome data and attrition.

Conclusion: Digital health interventions lead to weight loss in postpartum women irrespective of type or mode of delivery and are a good recommendation as a scalable weight loss v promotion option. The most effective interventions had components catering to continuous support, group interaction and convenience.

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