Tailoring in eHealth lifestyle interventions targeting people with cardiometabolic conditions and lower socioeconomic position: A scoping review.

Abstract

eHealth interventions can support healthy lifestyle change for preventing and managing cardiometabolic conditions. While most eHealth interventions are designed for the general population, these conditions are more prevalent in people from lower socioeconomic backgrounds. Tailoring interventions to the needs and characteristics of this population can increase adherence and engagement, thereby enhancing the overall intervention effectiveness. However, evidence on how to tailor eHealth interventions to users from low socioeconomic backgrounds remains limited. Therefore, this scoping review examines the tailoring approaches implemented within eHealth lifestyle interventions targeting people with cardiometabolic conditions and low socioeconomic position (SEP). We focus on what is being tailored, the tailoring variables, the algorithms used for tailoring, and how the tailoring approaches are evaluated. Using keywords related to low SEP, cardiometabolic conditions, eHealth interventions, lifestyle, and tailoring, we searched electronic databases including Scopus, Web of Science, PubMed, and PsycINFO. We identified 43 eligible articles, with 27 unique eHealth lifestyle interventions targeting primarily diet and exercise. The literature shows a variety of tailoring approaches, albeit with a trend towards tailoring to socioeconomic factors at the design stage. Most interventions (n = 26/27, 96%) used rule-based algorithms for tailoring, primarily through functions such as feedback selection (n = 17/27, 63%) or variable substitution (n = 16/27, 59%). Although evaluation of tailoring was missing from most studies (n = 15/27, 55%), the importance of sociocultural relevance, appropriate language, and health literacy-sensitive design was highlighted. These findings suggest that while tailoring is present in many interventions, the current approaches remain limited in the facilitating technology and dynamic adaptations to SEP-specific needs. Thus, future research should investigate the application of more advanced, but reproducible tailoring algorithms and rigorously evaluate the impact of different tailoring methods on intervention effectiveness. To synthesize our findings, we assembled a framework that encapsulates the key concepts from our review, in combination with envisioned future work.