Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation : a scoping review

Background: Evidence suggests that unhealthy lifestyle behaviours are modifiable risk factors for postoperativecomplications. Digital behaviour change interventions (DBCIs), for instance text messaging programs and smartphoneapps, have shown promise in achieving lifestyle behaviour change in a wide range of clinical populations, and it maytherefore be possible to reduce postoperative complications by supporting behaviour change perioperatively usingdigital interventions. This scoping review was conducted in order to identify existing research done in the area ofperioperative DBCIs for reducing alcohol consumption, improving dietary intake, increasing physical activity andsmoking cessation.Main text: This scoping review included eleven studies covering a range of surgeries: bariatric, orthopaedic, cancer,transplantation and elective surgery. The studies were both randomised controlled trials and feasibility studies andinvestigated a diverse set of interventions: one game, three smartphone apps, one web-based program and five textmessage interventions. Feasibility studies reported user acceptability and satisfaction with the behaviour changesupport. Engagement data showed participation rates ranged from 40 to 90%, with more participants being activelyengaged early in the intervention period. In conclusion, the only full-scale randomised controlled trial (RCT), textmessaging ahead of bariatric surgery did not reveal any benefits with respect to adherence to preoperative exerciseadvice when compared to a control group. Two of the pilot studies, one text message intervention, one game,indicated change in a positive direction with respect to alcohol and tobacco outcomes, but between groupcomparisons were not done due to small sample sizes. The third pilot-study, a smartphone app, found between groupchanges for physical activity and alcohol, but not with respect to smoking cessation outcomes. Conclusion: This review found high participant satisfaction, but shows recruitment and timing-delivery issues, as wellas low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcomemeasures prevent the synthesis of results and makes generalisation difficult. Future research should focus on definingstandardised outcome measures, enhancing patient engagement and improving adherence to behaviour change priorto scheduled surgery.Funding: Region Ostergotland (Strategiomradet Sjukvard och Valfard) [LIO-858631]; Swedish Research Council for Health, Working Life and Welfare (FORTE) [2018-01410]; Swedish Research Council for Health, Working Life and Welfare (FORTE) [2018-01410; Swedish Cancer Society (Cancerfonden)Swedish Cancer Society [20 0883]; Linkoping University