Persuasive design principle of social support in digital interventions targeting mental health symptoms: a systematic review and meta-analysis

Abstract

Objective This systematic review and meta-analysis evaluates the available evidence on efficacy of social support strategies, as defined by the persuasive system design framework, in internet-based and mobile-based interventions (IMI) targeting mental health.Design Systematic review and meta-analysis.Data sources PubMed, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials.Eligibility criteria for selecting studies Randomised controlled trials comparing IMI implementing a social support strategy for mental health symptoms to various control conditions. Publications up to June 2023 (date of search 6 June 2023) were considered.Data extraction and synthesis Two independent reviewers screened and extracted data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Risk of Bias Tool V.2.0. Data were pooled based on a random-effects model.Results After screening 6484 records, a total of 45 studies met our inclusion criteria. At 96%, social support was predominantly implemented through the strategy of social facilitation, by which users recognising others using the intervention (eg, discussion forum). IMI implementing social support strategies showed moderate effect sizes of Hedges’ g=−0.34 (95% CI −0.47 to −0.21, p<0.001) in comparison to different control conditions. Heterogeneity was considerable (I2=73.6%; 95% CI 64.8 to 80.3). Subgroup analyses revealed a significant influence of targeted psychological condition (p<0.001), type of social support (p<0.001) and control condition (p<0.001). In k=11 component studies (ie, comparison to a disentangled version of the same intervention), IMI with social support strategies were not significantly more effective in comparison to the same IMI without social support (Hedges’ g=−0.08 (95% CI −0.22 to 0.05, p=0.19, I2=0%). 64% (k=7) of component studies reported higher adherence rates in IMI with social support.Conclusions Based on a small number of component studies, implementing social support strategies in IMI that target mental health symptoms has no significant incremental benefit on effectiveness. To draw more robust conclusions, the potential of other social support strategies besides social facilitation should be exploited in future component studies.PROSPERO registration number CRD42020222810.