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Hawkins LK, Burns L, Swancutt D, Moghadam S, Pinkney J, Tarrant M. Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews. Obes Rev 2024:e13798. [PMID: 38952041 DOI: 10.1111/obr.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/10/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.
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Affiliation(s)
- Lily K Hawkins
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Lorna Burns
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Dawn Swancutt
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Shokraneh Moghadam
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Jonathan Pinkney
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
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2
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Bryant AL, Hirschey R, Caiola CE, Chan YN, Cho Y, Plassman BL, Wu B, Anderson RA, Bailey DE. Care partners experience of an oral health intervention for individuals with mild cognitive impairment and mild dementia using behavior change technique: A qualitative study. Geriatr Nurs 2024; 56:40-45. [PMID: 38237339 PMCID: PMC10990823 DOI: 10.1016/j.gerinurse.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024]
Abstract
Oral health declines in older adults with cognitive impairment. We aimed to improve oral hygiene outcomes for individuals with mild cognitive impairment (MCI) or mild dementia (MD) by fostering behavior changes among carepartners assisting them. We used qualitative data of verbatim transcripts of coaching sessions with carepartners (n = 17 dyads:10 dyads for MCI, 7 dyads for MD). Directed and emergent coding were used to understand behavior change techniques (BCTs). BCTs were compared with carepartners of participants with MCI and MD. Most frequently used BCTs in both groups: prompts and cues, instruction on how to perform the behavior, review behavioral goal, and problem solving. Different BCTs emerged in study: social support-unspecified of the MCI group and credible source for MD group. Findings clarified active intervention components, common BCTs used by carepartners, and different BCT approaches for both participants. Findings help to elucidate the mechanisms of changes in individuals' behaviors in these interventions.
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Affiliation(s)
- Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ya-Ning Chan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Youngmin Cho
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brenda L Plassman
- Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York City, New York, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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3
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Stoeckel LE, Hunter C, Onken L, Green P, Nielsen L, Aklin WM, Simmons JM. The NIH Science of Behavior Change Program: Looking Toward the Future. Behav Ther 2023; 54:714-718. [PMID: 37330260 PMCID: PMC10331559 DOI: 10.1016/j.beth.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
The National Institutes of Health established the Science of Behavior Change (SOBC) program to promote basic research on the initiation, personalization, and maintenance of health behavior change. The SOBC Resource and Coordinating Center now leads and supports activities to maximize the creativity, productivity, scientific rigor, and dissemination of the experimental medicine approach and experimental design resources. Here, we highlight those resources, including the Checklist for Investigating Mechanisms in Behavior-change Research (CLIMBR) guidelines introduced in this special section. We describe the ways in which SOBC can be applied across a range of domains and contexts, and end by considering ways to extend SOBC's perspective and reach, so as to best promote behavior change linked with health, quality of life, and well-being.
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Affiliation(s)
| | - Christine Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health
| | - Lisa Onken
- National Institute on Aging, National Institutes of Health
| | - Paige Green
- National Cancer Institute, National Institutes of Health
| | | | - Will M Aklin
- National Institute on Drug Abuse, National Institutes of Health
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Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England. Vaccines (Basel) 2023; 11:vaccines11020288. [PMID: 36851166 PMCID: PMC9962700 DOI: 10.3390/vaccines11020288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.
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5
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Corker E, Marques MM, Johnston M, West R, Hastings J, Michie S. Behaviour change techniques taxonomy v1: Feedback to inform the development of an ontology. Wellcome Open Res 2023; 7:211. [PMID: 37745778 PMCID: PMC10511844 DOI: 10.12688/wellcomeopenres.18002.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 09/26/2023] Open
Abstract
Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety of behaviours. The BCTTv1 was intentionally named version 1 to allow for further revisions to the taxonomy. This study aimed to gather data to improve the BCTTv1 and provide recommendations for developing it into a more elaborated knowledge structure, an ontology. Methods: Feedback from users of BCTTv1 about limitations and proposed improvements was collected through the BCT website, user survey, researchers and experts involved in the Human Behaviour-Change Project, and a consultation. In addition, relevant published research reports and other classification systems of BCTs were analysed. These data were synthesised to produce recommendations to inform the development of an ontology of BCTs. Results: A total of 282 comments from six sources were reviewed and synthesised into four categories of suggestions: additional BCTs, amendments to labels and definitions of specific BCTs, amendments to the groupings, and general improvements. Feedback suggested some lack of clarity regarding understanding and identifying techniques from labels, definitions, and examples; distinctions and relations between BCTs; and knowing what they would look like in practice. Three recommendations to improve the BCTTv1 resulted from this analysis: to review the label and definition of each BCT, the 16 groupings of BCTs, and the examples illustrating BCTs. Conclusions : This review of feedback about BCTTv1 identified the need to improve the precision and knowledge structure of the current taxonomy. A BCT ontology would enable the specification of relationships between BCTs, more precise definitions, and allow better interoperability with other ontologies. This ontology will be developed as part of the Human Behaviour-Change Project.
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Affiliation(s)
- Elizabeth Corker
- Centre for Behaviour Change, University College London, London, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Marta M. Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM,) Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, Scotland, UK
| | - Robert West
- Centre for Behaviour Change, University College London, London, UK
| | - Janna Hastings
- Centre for Behaviour Change, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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6
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Corker E, Marques MM, Johnston M, West R, Hastings J, Michie S. Behaviour change techniques taxonomy v1: Feedback to inform the development of an ontology. Wellcome Open Res 2023; 7:211. [PMID: 37745778 PMCID: PMC10511844 DOI: 10.12688/wellcomeopenres.18002.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety of behaviours. The BCTTv1 was intentionally named version 1 to allow for further revisions to the taxonomy. This study aimed to gather data to improve the BCTTv1 and provide recommendations for developing it into a more elaborated knowledge structure, an ontology. Methods: Feedback from users of BCTTv1 about limitations and proposed improvements was collected through the BCT website, user survey, researchers and experts involved in the Human Behaviour-Change Project, and a consultation. In addition, relevant published research reports and other classification systems of BCTs were analysed. These data were synthesised to produce recommendations to inform the development of an ontology of BCTs. Results: A total of 282 comments from six sources were reviewed and synthesised into four categories of suggestions: additional BCTs, amendments to labels and definitions of specific BCTs, amendments to the groupings, and general improvements. Feedback suggested some lack of clarity regarding understanding and identifying techniques from labels, definitions, and examples; distinctions and relations between BCTs; and knowing what they would look like in practice. Three recommendations to improve the BCTTv1 resulted from this analysis: to review the label and definition of each BCT, the 16 groupings of BCTs, and the examples illustrating BCTs. Conclusions : This review of feedback about BCTTv1 identified the need to improve the precision and knowledge structure of the current taxonomy. A BCT ontology would enable the specification of relationships between BCTs, more precise definitions, and allow better interoperability with other ontologies. This ontology will be developed as part of the Human Behaviour-Change Project.
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Affiliation(s)
- Elizabeth Corker
- Centre for Behaviour Change, University College London, London, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Marta M. Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM,) Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, Scotland, UK
| | - Robert West
- Centre for Behaviour Change, University College London, London, UK
| | - Janna Hastings
- Centre for Behaviour Change, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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7
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Burkhart G, Tomczyk S, Koning I, Brotherhood A. Environmental Prevention: Why Do We Need It Now and How to Advance It? JOURNAL OF PREVENTION (2022) 2022; 43:149-156. [PMID: 35258809 PMCID: PMC8902843 DOI: 10.1007/s10935-022-00676-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Samuel Tomczyk
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Ina Koning
- Interdisciplinary Social Science: Youth Studies, Utrecht University, Utrecht, Netherlands
| | - Angelina Brotherhood
- Addiction Competence Centre, Austrian National Public Health Institute, Vienna, Austria
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Richards R, Jones RA, Whittle F, Hughes CA, Hill AJ, Lawlor ER, Bostock J, Bates S, Breeze PR, Brennan A, Thomas CV, Stubbings M, Woolston J, Griffin SJ, Ahern AL. Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy-Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach. JMIR Form Res 2022; 6:e31801. [PMID: 34994698 PMCID: PMC8783282 DOI: 10.2196/31801] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.
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Affiliation(s)
- Rebecca Richards
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rebecca A Jones
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Fiona Whittle
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Andrew J Hill
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Emma R Lawlor
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jennifer Bostock
- Patient and Public Involvement Representative, Kent, United Kingdom
| | - Sarah Bates
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Penny R Breeze
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Alan Brennan
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Chloe V Thomas
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Marie Stubbings
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jennifer Woolston
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Simon J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Amy L Ahern
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Marteau TM, Fletcher PC, Munafò MR, Hollands GJ. Beyond choice architecture: advancing the science of changing behaviour at scale. BMC Public Health 2021; 21:1531. [PMID: 34376159 PMCID: PMC8356415 DOI: 10.1186/s12889-021-11382-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
Addressing the global threats to population and planetary health requires changing many behaviours at scale. This demands consideration not only of the effect size of an intervention but also its reach - the proportion of the population exposed to the intervention.We propose that a relatively under-researched and generally poorly specified set of interventions involving changes to physical micro-environments - often referred to as Choice Architecture - has the potential to make a significant contribution to meeting this urgent challenge.Realising the potential of Choice Architecture interventions requires integration of basic - i.e. laboratory-based - and applied - i.e. field-based - research, generating interventions that can be delivered at scale alongside advancing theory. We illustrate this with examples to highlight the complementarity of laboratory and field studies informed by and in turn updating the results of evidence synthesis. The examples comprise two sets of interventions - changing the relative availability of products and changing their size - to reduce consumption of meat, energy from food and alcohol across populations.
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Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marcus R Munafò
- University of Bristol, School of Psychological Science, Bristol, UK
| | - Gareth J Hollands
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Johnston M. Progress in conducting and reporting behaviour change intervention studies: a prospective retrospection. Health Psychol Behav Med 2021; 9:567-581. [PMID: 34211803 PMCID: PMC8218683 DOI: 10.1080/21642850.2021.1939701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND ehaviour change is a key to addressing many health and healthcare problems and interventions have been designed to improve health outcomes. These behaviour change interventions have been evaluated in many ways, including randomised controlled trials, and over recent decades there has been considerable progress in the conduct and reporting these studies. This paper is a personal retrospection on the changes occurring that have resulted in our current improved methods and their potential for future advancement. ADVANCES There has been steady development of methods for conducting trials, including advances in statistical methods enabled by increase computing power and programmes, greater attention to the recruitment of participants and in the specification of outcomes. Trial reporting has improved, largely due to publication of guidelines for reporting interventions and trials, but until recently the reporting of behaviour change interventions has been quite limited. Developments in the specification of active ingredients of these interventions, the behaviour change techniques, has transformed our ability to report interventions in a manner that facilitates evidence synthesis and enables replication and implementation. However, further work using ontological approaches is needed to adequately represent the evidence contained in the mass of accumulated studies. Meanwhile, attention is gradually being paid to the comparator groups in trials leading to better reporting but with continuing challenges about how control groups are selected. CONCLUSIONS These developments are important for the advancements of behavioural science - but also in consolidating the expertise needed to address global social, environmental and health challenges.
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Affiliation(s)
- Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, Aberdeen, UK
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11
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Humphreys G, Evans R, Makin H, Cooke R, Jones A. Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review. J Med Internet Res 2021; 23:e22694. [PMID: 33560243 PMCID: PMC7902193 DOI: 10.2196/22694] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change. OBJECTIVE This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling. METHODS This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions. RESULTS Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count. CONCLUSIONS This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas.
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Affiliation(s)
| | - Rebecca Evans
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Harriet Makin
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Richard Cooke
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Jones
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
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