The reviews were screened using a three-stage process. A total of 2 reviewers (NG and AY) examined titles and discarded reviews that did not meet the inclusion criteria (Textbox 1). Each reviewer then independently screened the abstracts of 10% of the remaining reviews to identify studies that potentially met the inclusion criteria. Interreviewer agreement on inclusion was also assessed. Reviewers disagreed on 11 of 41 decisions. All disagreements were resolved through discussion. AY screened all the remaining abstracts. The relevant review articles were then obtained in full and screened independently for eligibility by NG and AY. Any disagreement over eligibility was resolved through discussion with a third reviewer (TC or BR).

Inclusion criteria

Study type: systematic reviews (whose reporting of the evidence could be either by narrative synthesis or by meta-analysis) that reported on the effectiveness of digital interventions in changing health-related behavior and/or health outcomes. We did not restrict by study design of the included studies within the systematic reviews.

Population: this included adult nonclinical populations. We aimed to assess the effectiveness of digital interventions in relation to CVD prevention relevant to the NHS Health Check program, which is offered to adults aged between 40 and 74 years (England, United Kingdom). Where populations were mixed, we included the review if the population of interest could be isolated. Where impossible to isolate the population of interest, reviews were included if ≥50% of the studies were of relevant populations.

Intervention: we included digital interventions targeting behaviors related to diet, physical activity, smoking, and/or alcohol consumption. Digital interventions include interventions delivered over the internet (web-based or websites), mobile telephone interventions (including texts and mobile apps), social media, computer-delivered interventions, and wearable technology. Interventions incorporating both digital and face-to-face components were also included.

Comparator: there were no restrictions. We extracted information about the comparators where available, allowing us to review effectiveness compared with both nondigital interventions and nonintervention controls.

Outcome: this included behavioral or health outcomes related to diet, physical activity, alcohol consumption, and smoking. Reviews that considered these areas of behavior, either individually or in combination, were included.

Time frame for follow-up: any time frame.

Exclusion criteria

Study type: reviews of reviews, conference abstracts, protocols, opinion pieces, and commentaries. We excluded reviews of reviews because we expected that most of the reviews gathered in a review of reviews would already be included in our study. Therefore, including reviews of reviews would have led to double counting of some information.

Population: reviews that only considered any of the following in ≥50% of included studies: children and adolescents, students, adults aged <40 years, pregnant women, management of existing CVD or other health conditions, and low- to middle-income countries. These criteria were selected to protect the ecological validity of this review, as relevant to the NHS Health Check.

Intervention: reviews of nondigital interventions. We did not consider television, radio, or telephone calls to be digital, as they are not often used in digital interventions for public health.

Comparator: no exclusion criteria.

Outcome: feasibility, acceptability, participation, and engagement only.

Superseded: this included reviews updated by subsequent reviews that included all the same studies as the original.

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