Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review

Natalie Gold*, Xiao-Yang Hu, Sarah Denford, Ru-Yu Xia, Lauren Towler, Julia Groot, Rachel Gledhill, Merlin Willcox, Ben Ainsworth, Sascha Miller, Michael Moore, Paul Little, Richard Amlôt, Tim Chadborn, Lucy Yardley

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
45 Downloads (Pure)


Digital interventions have potential to efficiently support improved hygiene practices to reduce transmission of COVID-19.

To evaluate the evidence for digital interventions to improve hygiene practices within the community.

We reviewed articles published between 01 January 2000 and 26 May 2019 that presented a controlled trial of a digital intervention to improve hygiene behaviours in the community. We searched MEDLINE, Embase, PsycINFO, Cochrane Controlled Register of Trials (CENTRAL), China National Knowledge Infrastructure and grey literature. Trials in hospitals were excluded, as were trials aiming at prevention of sexually transmitted infections; only target diseases with transmission mechanisms similar to COVID-19 (e.g. respiratory and gastrointestinal infections) were included. Trials had to evaluate a uniquely digital component of an intervention. Study designs were limited to randomised controlled trials, controlled before-and-after trials, and interrupted time series analyses. Outcomes could be either incidence of infections or change in hygiene behaviours. The Risk of Bias 2 tool was used to assess study quality.

We found seven studies that met the inclusion criteria. Six studies reported successfully improving self-reported hygiene behaviour or health outcomes, but only one of these six trials, Germ Defence, confirmed improvements using objective measures (reduced consultations and antibiotic prescriptions). Settings included kindergartens, workplaces, and service station restrooms. Modes of delivery were diverse: WeChat, website, text messages, audio messages to mobiles, electronic billboards, and electronic personal care records. Four interventions targeted parents of young children with educational materials. Two targeted the general population; these also used behaviour change techniques or theory to inform the intervention. Only one trial had low risk of bias, Germ Defence; the most common concerns were lack of information about the randomisation, possible bias in reporting of behavioural outcomes, and lack of an analysis plan and possible selective reporting of results.

There was only one trial that was judged to be at low risk of bias, Germ Defence, which reduced incidence and severity of illness, as confirmed by objective measures. Further evaluation is required to determine the effectiveness of the other interventions reviewed.

Trial registration
PROSPERO CRD42020189919.
Original languageEnglish
Article number1180
JournalBMC Public Health
Issue number1
Publication statusPublished - 21 Jun 2021

Bibliographical note

Funding Information:
We would like to thank other members of the Germ Defence team for input: Jennifer Bostock, James Denison-Day, Kate Morton, Cathy Rice and Beth Stuart.

Funding Information:
Lucy Yardley is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC).

Funding Information:
MLW’s salary is funded by the National Institute of Health Research (NIHR), under grant CL-2016-26-005.

Publisher Copyright:
© 2021, The Author(s).


  • Behaviour
  • Behaviour change
  • Behavioural medicine
  • Community health
  • COVID-19
  • Digital medicine
  • eHealth
  • Hygiene
  • Handwashing
  • Infection control
  • Novel coronavirus


Dive into the research topics of 'Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: a rapid systematic review'. Together they form a unique fingerprint.

Cite this