The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis

Objectives Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers. Methods A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1). Results Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”. Conclusion There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.

Nutrition Concepts for the Treatment of Obesity in Adults

Obesity caused by a positive energy balance is a serious health burden. Studies have shown that obesity is the major risk factor for many diseases like type 2 diabetes mellitus, coronary heart diseases, or various types of cancer. Therefore, the prevention and treatment of increased body weight are key. Different evidence-based treatment approaches considering weight history, body mass index (BMI) category, and co-morbidities are available: lifestyle intervention, formula diet, drugs, and bariatric surgery. For all treatment approaches, behaviour change techniques, reduction in energy intake, and increasing energy expenditure are required. Self-monitoring of diet and physical activity provides an effective behaviour change technique for weight management. Digital tools increase engagement rates for self-monitoring and have the potential to improve weight management. The objective of this narrative review is to summarize current available treatment approaches for obesity, to provide a selective overview of nutrition trends, and to give a scientific viewpoint for various nutrition concepts for weight loss.

How Do Self-Examination Interventions For The Early Detection of Cancer Work? An Umbrella Review Protocol.

Background: Cancer is a major contributor to mortality and morbidity globally. A key prognostic factor for many cancers is early detection. Self-examination is often promoted as a method to detect cancer early for cancers that have early physical signs and symptoms. The type(s) of interventions capable of delivering behaviour change such as self-examination are complex with their description historically lacking. This umbrella review protocol sets out the methodology for summarising the evidence surrounding self-examination for four major cancers; breast, testicular, oral and skin. The review aims to answer the following question: What are the components of self-examination programmes for early detection of cancer and are they effective in bringing about actions that could lead to early detection of cancer in post pubescent people. Methods: The methodology has been informed by the PRISMA-P checklist for systematic reviews and the JBI methodology for umbrella reviews. Narrative synthesis will include detail on effectiveness of interventions alongside coding of intervention components using Intervention Taxonomy and the Behaviour Change Technique Taxonomy Version 1. AMSTAR-2 will be used to assess quality of included studies. Discussion: The review will provide a summary of the existing evidence with descriptions of interventions whilst identifying gaps for future research in this area.Registration: Prospero: CRD42021285966

Using the Behaviour Change Wheel (BCW) to Characterise Parenting Interventions to Prevent Intergenerational Child Abuse

Research shows that parents with a history of child abuse are at risk of perpetuating the cycle of abuse; however, exploration of intervention content is still a neglected area. This qualitative study identifies intervention components and corresponding mechanisms of change of parenting interventions to prevent intergenerational child abuse. Interviews with ten heads of interventions from the UK and USA were coded using deductive framework analysis. The Behaviour Change Technique (BCT) Taxonomy and Behaviour Change Wheel were used to code intervention components including BCTs and intervention functions. Mechanisms of change were coded using the Theoretical Domains Framework. Twelve BCTs and eight intervention functions were identified including education, enablement and training delivered through BCTs of instruction on how to perform a behaviour, restructuring the environment and social support. Corresponding mechanisms of change include behaviour regulation, knowledge and social influences, among others. This study offers insight into targeting and tailoring services to improve outcomes for parents with a history of child abuse. Findings suggest that there are possible mechanisms through which vulnerable parents can be helped to break the cycle of abuse including promoting social support, regulating parents’ behaviour through trauma-informed approaches and enhancing knowledge, self-esteem and confidence in parenting.

Remote delivery of alcohol and/or substance misuse interventions for adults: A systematic review protocol

Introduction Alcohol and substance misuse are a public health priority. The World Health Organisation (WHO) estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and that 35.6 million people worldwide are affected by substance misuse. The Coronavirus Disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has disrupted delivery of face-to-face alcohol and substance misuse interventions and has forced the development of alternative remote interventions or adaptation to existing ones. Although existing research on remote interventions suggests they might be as effective as face-to-face delivery, there has been a lack of systematic exploration of their content, the experience of service users, and their effectiveness for behavioural outcomes. This review will provide a narrative synthesis of the behaviour change techniques (BCT) contained in interventions for alcohol and/or substance misuse and their association with effectiveness. Methods and analysis Systematic searches will be conducted in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library. Included studies will be those reporting remote interventions focusing on alcohol and/or substance misuse among adults living in the community and which have a primary behaviour change outcome (i.e., alcohol levels consumed). Data extraction will be conducted by one author and moderated by a second, and risk of bias and behaviour change technique (BCT) coding will be conducted by two authors independently. A narrative synthesis will be undertaken focussing upon the association of BCTs with intervention effectiveness using promise ratios. Patient and Public Involvement (PPI) The Public Involvement in Research Group (PIRG), part of the NIHR-funded PHIRST, will be involved in refining the review questions, eligibility criteria, data synthesis and dissemination. Dissemination Dissemination will be through an academic peer reviewed publication, alongside other outputs to be shared with non-academic policy, professional, and public audiences, including local authorities, service users and community organisations.

Systematic Review of RCTs Assessing the Effectiveness of mHealth Interventions to Improve Statin Medication Adherence: Using the Behaviour-Change Technique Taxonomy to Identify the Techniques that Improve Adherence

Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000–17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were “Goal setting (behaviour)”, “Instruction on how to perform a behaviour”, and “Credible source”. Other effective techniques were “Information about health consequences”, “Feedback on behaviour”, and “Social support (unspecified)”. This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source, provide instructions on taking statins, and set adherence goals with patients. Further research should assess the optimal frequency of intervention delivery and investigate the generalisability of these interventions across settings and demographics.

Gambling Prevention Mobile Applications: Understanding the Inclusion and Use of Behaviour Change Techniques

Online gambling is emerging as a significant health behaviour of concern at a population level. Mobile applications (apps) are a popular tool to target change in health behaviour. Behaviour change techniques (BCTs) can be included within such apps to change relevant psychological mechanisms along established pathways, yet the content of apps targeting gambling problems specifically is not currently known. The purpose of the review was to identify the BCTs included in gambling prevention apps. Apps were downloaded from the Apple App Store and Google Play Store in October 2020. Apps were included if they related to gambling problems, were freely downloadable, and available in English. Once downloaded, two researchers independently coded the apps in November 2020 using the behaviour change technique taxonomy version 1 (Michie et al., 2013). The screening led to forty apps meeting the inclusion criteria (12 Apple App Store, 28 Google Play). The analyses identified 32 BCTs (20 Apple apps, 28 Google Play apps), with apps including between 0 and 9 BCTs (mean = 2.82, median = 2). The BCTs included most frequently were “3.1. Social support (unspecified),” “2.3. Self-monitoring of behaviour,” and “7.4. Remove access to the reward.” The review provides important information on the BCTs used in apps developed to reduce gambling-related problems. A limited number of BCTs were adopted within apps. Developers of apps seeking to develop effective gambling reduction products should draw upon a greater variety of BCTs.

Supporting medicines management for older people at care transitions – a theory-based analysis of a systematic review of 24 interventions

Background Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. Method This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. Results Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. Conclusion This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.

Are behaviour change techniques and intervention features associated with effectiveness of digital cardiac rehabilitation programmes? A systematic review protocol

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Cardiac rehabilitation (CR) is a complex intervention that aims to stabilise, slow, or reverse the progression of CVD and improve patients’ functional status and quality of life. Digitally delivered CR has been shown to be effective and can overcome many of the access barriers associated with traditional centre-based delivered CR programmes. However, there is a limited understanding of the behaviour change techniques (BCTs) and intervention features that maximise the effectiveness of digital programmes. Therefore, this systematic review will aim to identify the BCTs that have been used in digital CR programmes and to determine which BCTs and intervention features are associated with programme effectiveness. Methods: PubMed, MEDLINE (Ovid), EMBASE, CINHAL, PsycINFO and Cochrane Central Register of Controlled Trials will be searched from inception to June 2021 for randomised controlled trials of digital CR with CVD patients. Screening, data extraction, intervention coding and risk of bias will be performed by one reviewer with a second reviewer independently verifying a random 20% of the articles. Intervention content will be coded using the behaviour change technique taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) checklist and intervention features will be identified. A meta-analysis will be conducted to calculate the pooled effect size of each outcome, and meta-regression analyses will investigate whether intervention features and the presence and absence of individual BCTs in interventions are associated with intervention effectiveness. Discussion: The review will identify BCTs and intervention features that are associated with digital CR programmes and adopt a systematic approach to describe the content of these programmes using the BCT taxonomy (v1) and TIDieR checklist. The results will provide key insights into the content and design of successful digital CR programmes, providing a foundation for further development, testing and refinement.