scholarly journals How effective are social norms interventions in changing the clinical behaviours of healthcare workers? A systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mei Yee Tang ◽  
Sarah Rhodes ◽  
Rachael Powell ◽  
Laura McGowan ◽  
Elizabeth Howarth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Norms ◽  
Health Outcomes ◽  
Social Comparison ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Meta Analysis ◽  
Clinical Behaviour ◽  
Patient Health ◽  
Credible Source

Abstract Background Healthcare workers perform clinical behaviours which impact on patient diagnoses, care, treatment and recovery. Some methods of supporting healthcare workers in changing their behaviour make use of social norms by exposing healthcare workers to the beliefs, values, attitudes or behaviours of a reference group or person. This review aimed to evaluate evidence on (i) the effect of social norms interventions on healthcare worker clinical behaviour change and (ii) the contexts, modes of delivery and behaviour change techniques (BCTs) associated with effectiveness. Methods Systematic review and meta-analysis of randomised controlled trials. Searches were undertaken in seven databases. The primary outcome was compliance with a desired healthcare worker clinical behaviour and the secondary outcome was patient health outcomes. Outcomes were converted into standardised mean differences (SMDs). We performed meta-analyses and presented forest plots, stratified by five social norms BCTs (social comparison, credible source, social reward, social incentive and information about others’ approval). Sources of variation in social norms BCTs, context and mode of delivery were explored using forest plots, meta-regression and network meta-analysis. Results Combined data from 116 trials suggested that social norms interventions were associated with an improvement in healthcare worker clinical behaviour outcomes of 0.08 SMDs (95%CI 0.07 to 0.10) (n = 100 comparisons), and an improvement in patient health outcomes of 0.17 SMDs (95%CI 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I2 of 85.4% (healthcare worker clinical behaviour) and 91.5% (patient health outcomes). Credible source was more effective on average, compared to control conditions (SMD 0.30, 95%CI 0.13 to 0.47, n = 7). Social comparison also appeared effective, both on its own (SMD 0.05, 95%CI 0.03 to 0.08, n = 33) and with other BCTs, and seemed particularly effective when combined with prompts/cues (0.33, 95%CI 0.22 to 0.44, n = 5). Conclusions Social norms interventions appeared to be an effective method of changing the clinical behaviour of healthcare workers and have a positive effect on patient health outcomes in a variety of health service contexts. Although the overall result is modest and variable, there is the potential for social norms interventions to be applied at large scale. Trial registration PROSPERO CRD42016045718.

scholarly journals Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis

2020 ◽  
Vol 8 (41) ◽  
pp. 1-138
Author(s):  
Sarah Cotterill ◽  
Mei Yee Tang ◽  
Rachael Powell ◽  
Elizabeth Howarth ◽  
Laura McGowan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Social Norms ◽  
Social Comparison ◽  
Health Worker ◽  
Behaviour Change ◽  
Health Workers ◽  
Meta Analysis ◽  
Clinical Behaviour ◽  
Mean Differences ◽  
Credible Source

Background A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These low-cost interventions can be used to encourage health workers to follow recommended professional practice. Objective To summarise evidence on whether or not social norms interventions are effective in encouraging health worker behaviour change, and to identify the most effective social norms interventions. Design A systematic review and meta-analysis of randomised controlled trials. Data sources The following databases were searched on 24 July 2018: Ovid MEDLINE (1946 to week 2 July 2018), EMBASE (1974 to 3 July 2018), Cumulative Index to Nursing and Allied Health Literature (1937 to July 2018), British Nursing Index (2008 to July 2018), ISI Web of Science (1900 to present), PsycINFO (1806 to week 3 July 2018) and Cochrane trials (up to July 2018). Participants Health workers took part in the study. Interventions Behaviour change interventions based on social norms. Outcome measures Health worker clinical behaviour, for example prescribing (primary outcome), and patient health outcomes, for example blood test results (secondary), converted into a standardised mean difference. Methods Titles and abstracts were reviewed against the inclusion criteria to exclude any that were clearly ineligible. Two reviewers independently screened the remaining full texts to identify relevant papers. Two reviewers extracted data independently, coded for behaviour change techniques and assessed quality using the Cochrane risk-of-bias tool. We performed a meta-analysis and presented forest plots, stratified by behaviour change technique. Sources of variation were explored using metaregression and network meta-analysis. Results A total of 4428 abstracts were screened, 477 full texts were screened and findings were based on 106 studies. Most studies were in primary care or hospitals, targeting prescribing, ordering of tests and communication with patients. The interventions included social comparison (in which information is given on how peers behave) and credible source (which refers to communication from a well-respected person in support of the behaviour). Combined data suggested that interventions that included social norms components were associated with an improvement in health worker behaviour of 0.08 standardised mean differences (95% confidence interval 0.07 to 0.10 standardised mean differences) (n = 100 comparisons), and an improvement in patient outcomes of 0.17 standardised mean differences (95% confidence interval 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I 2 of 85.4% (primary) and 91.5% (secondary). Network meta-analysis suggested that three types of social norms intervention were most effective, on average, compared with control: credible source (0.30 standardised mean differences, 95% confidence interval 0.13 to 0.47); social comparison combined with social reward (0.39 standardised mean differences, 95% confidence interval 0.15 to 0.64); and social comparison combined with prompts and cues (0.33 standardised mean differences, 95% confidence interval 0.22 to 0.44). Limitations The large number of studies prevented us from requesting additional information from authors. The trials varied in design, context and setting, and we combined different types of outcome to provide an overall summary of evidence, resulting in a very heterogeneous review. Conclusions Social norms interventions are an effective method of changing clinical behaviour in a variety of health service contexts. Although the overall result was modest and very variable, there is the potential for social norms interventions to be scaled up to target the behaviour of a large population of health workers and resulting patient outcomes. Future work Development of optimised credible source and social comparison behaviour change interventions, including qualitative research on acceptability and feasibility. Study registration This study is registered as PROSPERO CRD42016045718. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 41. See the NIHR Journals Library website for further project information.

Factors Associated with Healthcare Worker Acceptance of Vaccination: A Systematic Review and Meta-analysis

2014 ◽  
Vol 35 (6) ◽  
pp. 699-708 ◽  
Author(s):  
Marija Vasilevska ◽  
Jennifer Ku ◽  
David N. Fisman
Keyword(s):  
Systematic Review ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Disease Risk ◽  
Meta Analysis ◽  
Vaccine Uptake ◽  
Future Research ◽  
Vaccine Acceptance ◽  
Factors Influencing ◽  
Self Protection

Background and objective.Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.Design.Systematic review and meta-analysis.Methods.We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.Results.Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42–4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10–9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30–0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.Conclusions.Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers’ decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.Infect Control Hosp Epidemiol2014;35(6):699–708

Prevalence of Depression, Anxiety, and Insomnia Among Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sofia Pappa ◽  
Vasiliki Ntella ◽  
Timoleon Giannakas ◽  
Vassilis G. Giannakoulis ◽  
Eleni Papoutsi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Healthcare Workers ◽  
Meta Analysis ◽  
Prevalence Of Depression

COVID-19 in Healthcare Workers: A Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes

2020 ◽  
Author(s):  
Sergio Alejandro Gómez-Ochoa ◽  
Oscar H. Franco ◽  
Lyda Z. Rojas ◽  
Sandra Lucrecia Romero Guevara ◽  
Luis Eduardo Echeverría ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Healthcare Workers ◽  
Clinical Characteristics ◽  
Meta Analysis

scholarly journals Healthcare Workers’ (HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis

Vaccine ◽  
2021 ◽  
Vol 39 (6) ◽  
pp. 901-914
Author(s):  
Maria Rosaria Gualano ◽  
Alessio Corradi ◽  
Gianluca Voglino ◽  
Dario Catozzi ◽  
Elena Olivero ◽  
...  
Keyword(s):  
Systematic Review ◽  
Influenza Vaccination ◽  
Healthcare Workers ◽  
Meta Analysis

scholarly journals Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3406
Author(s):  
Beatriz Olaya ◽  
María Pérez-Moreno ◽  
Juan Bueno-Notivol ◽  
Patricia Gracia-García ◽  
Isabel Lasheras ◽  
...  
Keyword(s):  
Systematic Review ◽  
Healthcare Workers ◽  
Mental Health Problems ◽  
Meta Analysis ◽  
Medical Doctors ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Pooled Prevalence ◽  
Prevalence Of Depression ◽  
Common Mental Health Problems

Background: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. Methods: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. Results: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20%−28%), 25% for nurses (95% CI: 18%−33%), 24% for medical doctors (95% CI: 16%−31%), and 43% for frontline professionals (95% CI: 28%−59%). Conclusions: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

Health Outcomes of Parents of Children with Chronic Illness: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 218 ◽  
pp. 166-177.e2 ◽  
Author(s):  
Liel N. Cohn ◽  
Petros Pechlivanoglou ◽  
Yuna Lee ◽  
Sanjay Mahant ◽  
Julia Orkin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Illness ◽  
Health Outcomes ◽  
Meta Analysis

scholarly journals Updated systematic review and meta-analysis of studies examining the relationship between reported racism and health and well-being for children and youth: a protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e043722
Author(s):  
Naomi Priest ◽  
Kate Doery ◽  
Mandy Truong ◽  
Shuaijun Guo ◽  
Ryan Perry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Research Policy ◽  
Meta Analysis ◽  
Well Being ◽  
Children And Youth ◽  
Effect Sizes ◽  
Future Research ◽  
Critical Determinant ◽  
Health And Well Being

IntroductionRacism is a critical determinant of health and health inequities for children and youth. This protocol aims to update the first systematic review conducted by Priest et al (2013), including a meta-analysis of findings. Based on previous empirical data, it is anticipated that child and youth health will be negatively impacted by racism. Findings from this review will provide updated evidence of effect sizes across outcomes and identify moderators and mediators of relationships between racism and health.Methods and analysisThis systematic review and meta-analysis will include studies that examine associations between experiences of racism and racial discrimination with health outcomes of children and youth aged 0–24 years. Exposure measures include self-reported or proxy reported systemic, interpersonal and intrapersonal racism. Outcome measures include general health and well-being, physical health, mental health, biological markers, healthcare utilisation and health behaviours. A comprehensive search of studies from the earliest time available to October 2020 will be conducted. A random effects meta-analysis will examine the average effect of racism on a range of health outcomes. Study-level moderation will test the difference in effect sizes with regard to various sample and exposure characteristics. This review has been registered with the International Prospective Register of Systematic Reviews.Ethics and disseminationThis review will provide evidence for future research within the field and help to support policy and practice development. Results will be widely disseminated to both academic and non-academic audiences through peer-review publications, community summaries and presentations to research, policy, practice and community audiences.PROSPERO registration numberCRD42020184055.

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