Pixels or in-Person? a Comparative Systematic Review of Efficacy of Online Vs. Face-to-Face Group Treatment

Background and Purpose: The shift towards digital platforms for psychosocial interventions, especially during the COVID-19 pandemic, has heightened interest in comparing the effectiveness of online versus face-to-face (F2F) group interventions. This systematic review examines the comparative efficacy of online versus F2F group interventions and narrows the gap in the literature regarding their effectiveness for various psychosocial outcomes.

Methods: Adhering to PRISMA guidelines and registered with PROSPERO, this review focused exclusively on randomized controlled trials (RCTs) comparing similar interventions/models delivered online and F2F. A systematic search was conducted across 12 major databases, including published and unpublished scholarly works. The PICO (population, intervention, control, outcome) framework was applied to examine the study characteristics. Each study was reviewed for risk of bias by two reviewers, utilizing the Cochrane Risk of Bias Assessment Tool. Within-condition and between-conditions effect sizes were calculated using the R statistical software.

Results: The search included 15 RCTs, engaging a cumulative participant of 1,078 across various psychosocial challenges. This systematic review demonstrated group interventions delivered online and F2F offer comparable effectiveness when applied to address symptoms associated with conditions including PTSD, bulimia, cancer, and social phobias. These results underscore the broad applicability of online group interventions to improve various psychosocial health challenges. The most frequently used treatment model was Cognitive Behavioral Therapy (CBT). Additional therapeutic methods included dissonance-based prevention strategies, positive psychology, psychoeducation, nutrition, and exercise.

The effect sizes varied widely, from small to exceptionally large. The analysis of between-group effect sizes indicated no significant differences in the effectiveness of online and F2F modalities for most outcomes, with exceptions in three studies favoring F2F interventions. A comprehensive meta-analysis was not conducted due to the high heterogeneity among the studies, especially regarding intervention models and participant demographics. Notably, only two studies showed a low risk of bias, underscoring methodological variability across the reviewed studies. The lack of reporting on group treatment factors was a major limitation of all the studies, and most studies did not provide adequate information on group composition, process, and leadership.

Conclusions and Implications: The findings suggest interventions delivered online and F2F offer comparable outcomes. These results highlight the potential of online platforms to increase access to psychosocial group support and advance health equity/social justice. However, the observed heterogeneity and the relatively small number of studies meeting high methodological rigor call for cautious interpretation. This review underscores the necessity for further research, particularly studies with robust designs, to conclusively determine the modality with the strongest social impact. Future research should also consider including analyses of group factors such as cohesion. The implications for social work practice hinge on recognizing the value of online interventions while acknowledging the need for ongoing evaluation to optimize their effectiveness and ensure equitable access to psychosocial support. This study reaffirms dedication to collaborative efforts aimed at addressing health equity by recognizing the powerful impacts of group work on various platforms to foster connections and promote a sense of community.