Digital and community-based health interventions for exercise and education in the management of musculoskeletal- and lifestyle-related health conditions in rural communities in low- and middle-income countries: a scoping review

Early Abstract:

Introduction: Musculoskeletal and lifestyle related health conditions often co-occur, which presents a major physical and psychological burden on individuals and may have socioeconomic implications in society. Rural communities in low- and middle-income countries often have limited access to regular, in-person health and healthy lifestyle supportive services and facilities. As an alternative, digital and community-based interventions should be considered. A scoping review was conducted to investigate digital and community-based health interventions for exercise and education in the management of musculoskeletal and lifestyle related health conditions in rural communities in low- and middle-income countries.
Methods: The JBI methodology for scoping reviews was utilised. A three-step search strategy was implemented to identify articles. Following an initial exploratory search, the strategy was adapted. The full search was conducted using PubMed, Scopus, Web of Science, and EBSCO host. Reference lists of included articles and grey literature searches were also performed. Titles and abstracts were screened followed by full text evaluations against the eligibility criteria by two independent reviewers. Studies in the past 20 years involving digital or community-based health interventions aimed at the management of musculoskeletal and/or lifestyle related health conditions through exercise or education for participants over 18 years of age and conducted in rural settings in low or middle-income countries were included in the review.
Results: The search identified 1323 articles (following removal of duplicates). Nineteen studies meeting the eligibility criteria were included. Most studies (n = 16) focused on community-based interventions with (n = 8) or without (n = 8) digital components, with one study involving a digital intervention only for lifestyle related health conditions. Only two studies focused on musculoskeletal conditions. All interventions included a health education component and some studies included screening, monitoring, and exercise components. Digital health components included mobile health messages and apps, videos, and websites to assist health practitioners and patients. Many studies relied on community health workers for the implementation of interventions. Improvements in various health parameters were reported following the interventions. Barriers related to the digital components such as technical faults and message content related concerns were reported. Community engagement during development and implementation of interventions and finding cost-saving strategies may be important to assist with the feasibility of interventions in rural under-resourced settings.
Conclusion: The findings of the review demonstrate that community-based health interventions with and without digital components for the management of lifestyle related health conditions appear to have a positive impact and are feasible to implement in rural communities in low- and middle-income countries. The type of interventions utilised as well as associated facilitators and barriers should be considered during the development of future interventions to increase the likelihood of the value and feasibility thereof in rural, under-resourced settings. Community involvement should be encouraged during the development and implementation of interventions to ensure the appropriateness thereof to local communities. 
Keywords: community-based interventions, digital interventions, lifestyle health conditions, musculoskeletal conditions, remote health, review, rural health.