Laughter-inducing therapies: Systematic review and meta-analysis.

RATIONALE: Laughter-inducing therapies are being applied more regularly in the last decade, and the number of scientific reports of their beneficial effects is growing. Laughter-inducing therapies could be cost-effective treatments for different populations as a complementary or main therapy. A systematic review and meta-analysis has not yet been performed on these therapies for different populations and outcomes, but is needed to examine their potential benefits. This research aims to broadly describe the field of laughter-inducing therapies, and to estimate their effect on mental and physical health for a broad range of populations and conditions. METHOD: A systematic review of the field was undertaken, followed by a meta-analysis of RCTs and quasi-experimental studies. The systematic review included intervention studies, one-session therapies, lab studies and narrative reviews to provide a broad overview of the field. The meta-analysis included RCTs or quasi-experimental studies that assessed multi-session laughter or humor therapies compared to a control group, performed on people of any age, healthy or with a mental or physical condition. English and non-English articles were searched using PubMed, Web of Science, EBSCO and EMBASE. Search terms included laugh(ing), laughter, humo(u)r, program, therapy, yoga, exercise, intervention, method, unconditional, spontaneous, simulated, forced. Studies were classified as using humor ('spontaneous' laughter) or not using humor ('simulated' laughter). RESULTS: This systematic review and meta-analysis suggests that (1) 'simulated' (non-humorous) laughter is more effective than 'spontaneous' (humorous) laughter, and (2) laughter-inducing therapies can improve depression. However, overall study quality was low, with substantial risk of bias in all studies. With rising health care costs and the increasing elderly population, there is a potential for low-cost, simple interventions that can be administered by staff with minimal training. Laughter-inducing therapies show a promise as an addition to main therapies, but more methodologically rigorous research is needed to provide evidence for this promise.

Persuasive system design does matter: a systematic review of adherence to web-based interventions.

BACKGROUND: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. OBJECTIVE: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. METHODS: We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. RESULTS: We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p=.004), setup (p<.001), updates (p<.001), frequency of interaction with a counselor (p<.001), the system (p=.003) and peers (p=.017), duration (F=6.068, p=.004), adherence (F=4.833, p=.010) and the number of primary task support elements (F=5.631, p=.005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. CONCLUSIONS: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere.