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.

Social marketing benchmark criteria use in health behaviour change interventions in pacific islands populations: a systematic review

Purpose Social marketing has been widely used to effectively and voluntarily change behaviours worldwide. The social marketing benchmark criteria offer a framework to apply this approach. This paper aims to examine the extent of use and predictors of success of social marketing benchmark criteria in changing the health behaviours of Pacific Islands populations. Design/methodology/approach A systematic review of studies designed to change health behaviours among Pacific Islands populations. Studies were assessed against the social marketing benchmark criteria to determine the extent to which the reported intervention used a social marketing approach; and whether the use of the social marketing benchmark criteria led to more effective interventions. Findings In total, 22 studies were included. In total, 13 were conducted within the Pacific Islands and 9 were aimed at Pacific Islands populations living in America, New Zealand or Hawaii. The most common criteria used were behaviour change, insight and customer orientation. Theory criterion was least commonly used. There was no clear indication of which criterion or combination of criteria, resulted in more effective interventions. Research limitations/implications Further empirical evaluations of social marketing interventions within the Pacific Islands context are required to appropriately assess effective predictors of success for this population group. Studies of social marketing interventions targeting non-Pacific Islands populations in non-Pacific Island countries and territories may have limited applicability to Pacific Islanders living in Pacific Island countries and territories. Originality/value While similar studies have been conducted, this is the first study to review all behaviour change interventions by applying a social marketing lens in the Pacific Islands. While globally this may have been reviewed, the Pacific Islands has a unique context that needs to be considered, rather than assuming a one size fits all approach. This study offers a comprehensive overview of existing health behaviour change interventions in the Pacific Islands and a call to action to move social marketing forward within the Pacific Islands.

Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists

Background and purpose Recent methodological reviews of evaluations of behaviour change interventions in public health have highlighted that the decay in effectiveness over time has been mostly overlooked, potentially leading to suboptimal decision-making. While, in principle, discrete-time Markov chains—the most commonly used modelling approach—can be adapted to account for decay in effectiveness, this framework inherently lends itself to strong model simplifications. The application of formal and more appropriate modelling approaches has been supported, but limited progress has been made to date. The purpose of this paper is to encourage this shift by offering a practical guide on how to model decay in effectiveness using a continuous-time Markov chain (CTMC)-based approach. Methods A CTMC approach is demonstrated, with a contextualized tutorial being presented to facilitate learning and uptake. A worked example based on the stylized case study in physical activity promotion is illustrated with accompanying R code. Discussion The proposed framework presents a relatively small incremental change from the current modelling practice. CTMC represents a technical solution which, in absence of relevant data, allows for formally testing the sensitivity of results to assumptions regarding the long-term sustainability of intervention effects and improving model transparency. Conclusions The use of CTMC should be considered in evaluations where decay in effectiveness is likely to be a key factor to consider. This would enable more robust model-based evaluations of population-level programmes to promote behaviour change and reduce the uncertainty surrounding the decision to invest in these public health interventions.

Environmental engagement through behaviour change interventions: A case study of litter reduction in New Zealand Schools

<p>Litter has serious implications for the environment and is recognised as a significant form of marine and terrestrial pollution. A major source of litter pollution is recreational litter. Although litter is identified as an environmental problem, the propensity to litter continues within society. Behaviour change interventions have significant potential to influence the production of recreational litter. A shift in littering behaviour is necessary to reduce the environmental impact litter has on terrestrial and marine ecosystems. This research used the framework Community-Based Social Marketing to identify the barriers and benefits of littering as well as interventions to increase the reduction of littering in a school setting. The behaviour change interventions hypocrisy and goal setting were selected and separately implemented in two Intermediate schools in the Greater Wellington Region of New Zealand. Behaviour change was assessed using pre, post, and follow up litter counts on school grounds, and supported by interviews with student, teacher and parent participants. Results found both interventions to be significant in reducing the rate of recreational littering when used in conjunction with education. Goal setting was also found to be significant in reducing wrappers in school lunches. Cognitive, situational, and personal variables, as well as key stakeholders, were also recognised as influencing the litter and packaging behaviour of participants. Findings from this research can be used to support the selection and implementation of future behaviour change interventions and campaigns, specifically those targeting the behaviour of littering in a school setting.</p>

Environmental engagement through behaviour change interventions: A case study of litter reduction in New Zealand Schools

<p>Litter has serious implications for the environment and is recognised as a significant form of marine and terrestrial pollution. A major source of litter pollution is recreational litter. Although litter is identified as an environmental problem, the propensity to litter continues within society. Behaviour change interventions have significant potential to influence the production of recreational litter. A shift in littering behaviour is necessary to reduce the environmental impact litter has on terrestrial and marine ecosystems. This research used the framework Community-Based Social Marketing to identify the barriers and benefits of littering as well as interventions to increase the reduction of littering in a school setting. The behaviour change interventions hypocrisy and goal setting were selected and separately implemented in two Intermediate schools in the Greater Wellington Region of New Zealand. Behaviour change was assessed using pre, post, and follow up litter counts on school grounds, and supported by interviews with student, teacher and parent participants. Results found both interventions to be significant in reducing the rate of recreational littering when used in conjunction with education. Goal setting was also found to be significant in reducing wrappers in school lunches. Cognitive, situational, and personal variables, as well as key stakeholders, were also recognised as influencing the litter and packaging behaviour of participants. Findings from this research can be used to support the selection and implementation of future behaviour change interventions and campaigns, specifically those targeting the behaviour of littering in a school setting.</p>

Behavioural economics and health

Human behaviour is an important determinant of health outcomes around the world. Understanding how people make health-related decisions is therefore essential for explaining health outcomes globally and for developing solutions to leading challenges in global health. Behavioural economics blends theories from economics and psychology to uncover key insights about human decision-making. This chapter describes several prominent theories from behavioural economics and reviews examples of how these theories can be useful in efforts to improve global health outcomes. We begin by reviewing the theory of rational decision-making that features prominently in economics and discuss important policy implications that follow from this theory. We then turn to theories and principles from behavioural economics and draw upon empirical evidence from around the world to highlight actionable behaviour change interventions that can be useful for students of global health and practitioners alike.

The Development of Theory-Informed Participant-Centred Interventions to Maximise Participant Retention in Randomised Controlled Trials

BackgroundA failure of clinical trials to retain participants can influence the trial findings and significantly impact the potential of the trial to influence clinical practice. Retention of participants involves people, often the trial participants themselves, performing a behaviour (e.g. returning a questionnaire or attending a follow-up clinic as part of the research). Most existing interventions that aim to improve the retention of trial participants fail to describe any theoretical basis for the potential effect (on behaviour) and also whether there was any patient and/or participant input during development. The aim of this study was to address these two problems by developing theory- informed, participant-centred, interventions to improve trial retention. MethodsThis study used a multi-phase sequential mixed methods approach informed by the Theoretical Domains Framework and Behaviour Change Techniques Taxonomy to match participant reported determinants of trial retention to theoretically informed behaviour change strategies. The prototype interventions based on participant accounts were described and developed in a co-design workshop with trial participants. We then assessed acceptability and feasibility of two of the prioritised retention interventions during a focus group, which also included a questionnaire, involving a range of trial stakeholders (e.g. trial participants, trial managers, research nurses, trialists, research ethics committee members). ResultsEight trial participants contributed to the co-design of the retention interventions. Four behaviour change interventions were designed based on suggestions provided by trial participants: 1. Incentives and rewards for follow-up clinic attendance; 2. Goal setting for improving questionnaire return; 3. Self-monitoring to improve questionnaire return and/or clinic attendance; and 4. Motivational information to improve questionnaire return and clinic attendance. Seventeen trial stakeholders (participants, trialists, ethics committee members) contributed to the evaluation of acceptability and feasibility of the retention interventions, which were generally positive with some areas for consideration highlighted. ConclusionsThis is the first study to develop interventions to improve trial retention that are based on the accounts of trial participants and also conceptualised and developed as behaviour change interventions (to encourage attendance at trial research visit or return a trial questionnaire). Further testing of these interventions is required to assess their effectiveness and assess resource implications.

Understanding behaviour change to promote regular dental attendance

Regular dental attendance is a key oral health behaviour. Behaviour change interventions are increasingly being used to promote positive oral health behaviours. A systematic approach to understanding behaviour has led to the development of frameworks which aim to guide the process of designing behaviour change interventions. One such framework is the Behaviour Change Wheel (BCW). This article aims to explore and identify barriers to regular dental attendance which may be targeted using behaviour change interventions based on the Capability, Opportunity and Motivation Behaviour model (COM-B) and the BCW, and suggests potential behaviour change techniques which could be utilised into a behaviour change intervention with the aim to promote regular dental attendance.