Centre for Outcomes Research and Effectiveness, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
Soc Sci Med. 2010 May;70(10):1618-25. doi: 10.1016/j.socscimed.2010.01.039. Epub 2010 Feb 16.
Evidence syntheses are used to inform health care policy and practice. Behaviour change theories offer frameworks for categorising and evaluating interventions and identifying likely mechanisms through which effects are achieved. Yet systematic reviews rarely explicitly classify intervention components using theory, which may result in evidence syntheses and health care practice recommendations that are less than optimal. This paper outlines a method for applying theory to evidence syntheses of behaviour change interventions. We illustrate this method with an analysis of 'audit and feedback' interventions, based on data from a Cochrane review. Our analysis is based on Control Theory, which suggests that behaviour change is most likely if feedback is accompanied by comparison with a behavioural target and by action plans, and we coded interventions for these three techniques. Multivariate meta-regression was performed on 85 comparisons from 61 studies. However, few interventions incorporated targets or action plans, and so meta-regression models were likely to be underfitted due to insufficient power. The utility of our approach could not be tested via our analysis because of the limited nature of the audit and feedback interventions. However, we show that conceptualising and categorising interventions using behaviour change theory can reveal the theoretical coherence of interventions and so point towards improvements in intervention design, evaluation and synthesis. The results demonstrate that a theory-based approach to evidence synthesis is feasible, and can prove beneficial in understanding intervention design, even where there is insufficient empirical evidence to reliably synthesise effects of specific intervention components.
证据综合用于为医疗保健政策和实践提供信息。行为改变理论为分类和评估干预措施以及确定实现效果的可能机制提供了框架。然而，系统评价很少明确使用理论对干预措施进行分类，这可能导致证据综合和医疗保健实践建议不够理想。本文概述了一种将理论应用于行为改变干预措施证据综合的方法。我们使用来自 Cochrane 综述的数据，对“审核和反馈”干预措施进行了分析。我们的分析基于控制理论，该理论表明，如果反馈伴随着与行为目标的比较和行动计划，那么行为改变最有可能发生，我们对这三种技术的干预措施进行了编码。对 61 项研究中的 85 项比较进行了多元荟萃回归。然而，很少有干预措施纳入目标或行动计划，因此由于缺乏足够的力量，荟萃回归模型可能拟合不足。由于审核和反馈干预措施的性质有限，我们的分析无法测试我们方法的实用性。但是，我们表明，使用行为改变理论来概念化和分类干预措施可以揭示干预措施的理论一致性，从而有助于改进干预措施的设计、评估和综合。结果表明，基于理论的证据综合方法是可行的，即使在缺乏可靠综合特定干预措施效果的经验证据的情况下，也可以证明对理解干预措施设计是有益的。
