Translational Behavioral Medicine

, Volume 3, Issue 4, pp 392–401 | Cite as

A systematic review of eHealth cancer prevention and control interventions: new technology, same methods and designs?

  • Michael A Sanchez
  • Borsika A Rabin
  • Bridget Gaglio
  • Michelle Henton
  • M Khair Elzarrad
  • Peyton Purcell
  • Russell E Glasgow
systematic review


There has been a recent surge of eHealth programs in cancer and other content areas, but few reviews have focused on the methodologies and designs employed in these studies. We conducted a systematic review of studies on eHealth interventions on cancer prevention and control published between 2001 and 2010 applying the Pragmatic Explanatory Continuum Indicator Summary (PRECIS) criteria and external validity components from the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. We identified 113 studies that focused on cancer prevention and control of eHealth interventions. Most studies fell midway along the explanatory/pragmatic trial continuum, but few reported on various practical feasibility criteria for translation. Despite vast interest in cancer eHealth and the applied nature of this field, few studies considered key external validity issues. There is a need for use of alternative pragmatic study designs and transparent reporting of external validity components to produce more rapid and generalizable results.


eHealth Pragmatic trials Systematic review Design PRECIS External validity RE-AIM framework 


  1. 1.
    Eheman C et al. Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. 2012; 118(9): 2338-66.PubMedCrossRefGoogle Scholar
  2. 2.
    Chu, K.C., B.A. Miller, and S.A. Springfield, Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status. J Natl Med Assoc, 2007. 99(10): p. 1092–100, 1102–4.Google Scholar
  3. 3.
    Saldana-Ruiz, N., et al., Fundamental causes of colorectal cancer mortality in the United States: understanding the importance of socioeconomic status in creating inequality in mortality. Am J Public Health, 2012.Google Scholar
  4. 4.
    Noar SM, H.N., eHealth Applications: Promising Strategies for Behavior Change, Routledge, NY, 2012.Google Scholar
  5. 5.
    Bennett GG, Glasgow RE. The delivery of public health interventions via the internet: actualizing their potential. Annu Rev Public Health. 2009; 30: 273-92.PubMedCrossRefGoogle Scholar
  6. 6.
    Strecher V. Internet methods for delivering behavioral and health-related interventions (eHealth). Annu Rev Clin Psychol. 2007; 3: 53-76.PubMedCrossRefGoogle Scholar
  7. 7.
    Wantland DJ et al. The effectiveness of web-based vs. non-web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2004; 6(4): e40.PubMedCrossRefGoogle Scholar
  8. 8.
    Murray E et al. Interactive health communication applications for people with chronic disease. Cochrane Database Syst Rev. 2005; 4: CD004274.PubMedGoogle Scholar
  9. 9.
    Glasgow RE. eHealth evaluation and dissemination research. Am J Prev Med. 2007; 32(5 Suppl): S119-26.PubMedCrossRefGoogle Scholar
  10. 10.
    Eysenbach G. CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions. J Med Internet Res. 2011; 13(4): e126.PubMedCrossRefGoogle Scholar
  11. 11.
    Zwarenstein M et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008; 337: a2390.PubMedCrossRefGoogle Scholar
  12. 12.
    Thorpe KE et al. A pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009; 62(5): 464-75.PubMedCrossRefGoogle Scholar
  13. 13.
    Riddle DL et al. The pragmatic–explanatory continuum indicator summary (PRECIS) instrument was useful for refining a randomized trial design: experiences from an investigative team. J Clin Epidemiol. 2010; 63(11): 1271-5.PubMedCrossRefGoogle Scholar
  14. 14.
    Selby P et al. How pragmatic or explanatory is the randomized, controlled trial? The application and enhancement of the PRECIS tool to the evaluation of a smoking cessation trial. BMC Med Res Methodol. 2012; 12: 101.PubMedCrossRefGoogle Scholar
  15. 15.
    Glasgow RE et al. Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Serv Res. 2012; 47(3 Pt 1): 1051-67.PubMedCrossRefGoogle Scholar
  16. 16.
    Koppenaal T et al. Pragmatic vs. explanatory: an adaptation of the PRECIS tool helps to judge the applicability of systematic reviews for daily practice. J Clin Epidemiol. 2011; 64(10): 1095-101.PubMedCrossRefGoogle Scholar
  17. 17.
    Eng TR. The eHealth Landscape: A Terrain Map of Emerging Information and Communication Technologies in Health and Health Care. Princeton: Robert Wood Johnson Foundation; 2001.Google Scholar
  18. 18.
    Rabin BA, G.R., Dissemination of interactive health communication programs, in Interactive Health Communication Technologies: Promising Strategies for Health Behavior Change: Routledge, NY, 2012.Google Scholar
  19. 19.
    Khoury MJ, Gwinn M, Ioannidis JP. The emergence of translational epidemiology: from scientific discovery to population health impact. Am J Epidemiol. 2010; 172(5): 517-24.PubMedCrossRefGoogle Scholar
  20. 20.
    Hiatt RA, Rimer BK. A new strategy for cancer control research. Cancer Epidemiol Biomarkers Prev. 1999; 8(11): 957-64.PubMedGoogle Scholar
  21. 21.
    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999; 89(9): 1322-7.PubMedCrossRefGoogle Scholar
  22. 22.
    Pagliari C. Design and evaluation in eHealth: challenges and implications for an interdisciplinary field. J Med Internet Res. 2007; 9(2): e15.PubMedCrossRefGoogle Scholar
  23. 23.
    Glasgow RE, Chambers D. Developing robust, sustainable, implementation systems using rigorous, rapid and relevant science. Clin Transl Sci. 2012; 5(1): 48-55.PubMedCrossRefGoogle Scholar
  24. 24.
    Glasgow RE et al. Disseminating effective cancer screening interventions. Cancer. 2004; 101(5 Suppl): 1239-50.PubMedCrossRefGoogle Scholar
  25. 25.
    Bennett, G., eHealth and D&I research: what next?, in Training Institute for Dissemination and Implementation Research in Health. July 9–13, 2012.Google Scholar
  26. 26.
    Greene SM, Reid RJ, Larson EB. Implementing the learning health system: from concept to action. Ann Intern Med. 2012; 157(3):207-10.PubMedCrossRefGoogle Scholar
  27. 27.
    Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007; 32(5 Suppl): S112-8PubMedCrossRefGoogle Scholar
  28. 28.
    Riley WT et al. Health behavior models in the age of mobile interventions: are our theories up to the task? Transl Behav Med. 2011; 1(1): 53-71.PubMedCrossRefGoogle Scholar
  29. 29.
    West JH et al. There's an app for that: content analysis of paid health and fitness apps. J Med Internet Res. 2012; 14(3): e72.PubMedCrossRefGoogle Scholar
  30. 30.
    Abroms LC et al. iPhone apps for smoking cessation: a content analysis. Am J Prev Med. 2011; 40(3): 279-85.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2013

Authors and Affiliations

  • Michael A Sanchez
    • 1
  • Borsika A Rabin
    • 2
  • Bridget Gaglio
    • 3
  • Michelle Henton
    • 2
  • M Khair Elzarrad
    • 1
    • 4
  • Peyton Purcell
    • 5
  • Russell E Glasgow
    • 1
  1. 1.National Cancer InstituteBethesdaUSA
  2. 2.CRN Cancer Communication Research Center, Kaiser Permanente ColoradoDenverUSA
  3. 3.Mid-Atlantic Permanente Research Institute Kaiser Permanente Mid-Atlantic StatesRockvilleUSA
  4. 4.Food and Drug Administration, Interagency Oncology Task Force (IOTF) Fellowship-Cancer Prevention Fellow, National Cancer InstituteBethesdaUSA
  5. 5.Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., National Laboratory for Cancer ResearchFrederickUSA

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