Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada.
School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada.
Lifestyle Genom. 2018;11(1):49-63. doi: 10.1159/000488086. Epub 2018 Apr 10.
Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours.
This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research.
Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB.
Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of "poor" quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be "fair"). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition.
It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided.
近年来，研究遗传检测干预对生活方式行为改变的影响一直是研究的重点领域。该文献的结果和结论存在很大的异质性，尚未使用经过验证的行为改变理论和遗传干预质量评估来解释。计划行为理论（TPB）有助于解释行为改变的关键因素。有人假设，可以在该理论中添加个性化内容，以帮助预测健康行为的变化。
本系统评价详细、全面地确定、评估和总结了与遗传检测干预导致的生活方式行为改变（营养、身体活动、睡眠和吸烟）相关的主要研究文章。本评价还旨在深入分析迄今为止在 TPB 背景下进行的研究，并评估向参与者提供的遗传干预措施的质量，同时确定遗传检测是否有助于改变生活方式习惯。鉴于最近发表的一篇强调需要将 TPB 纳入个性化医疗行为改变研究的“行动呼吁”论文，本评价是及时的。
为了查找相关的主要研究文章，我们检索了三个书目数据库、一个主要网站和文章参考文献列表。PRISMA 流程图和 PRISMA 清单用于指导搜索策略和手稿准备。在 32783 个标题中，有 26 项研究符合纳入标准。进行了三项质量评估，包括：（1）偏倚风险，（2）遗传干预措施的质量，以及（3）理论基础的考虑，主要是 TPB。
总体而言，研究的偏倚风险被评为“中等”。对 TPB 的考虑是“差”，没有研究提到这一经过验证的理论。虽然有些研究（n=11；42%）提到了其他行为改变理论，但这些理论通常只是简单提及，并未深入纳入研究设计或分析。向参与者提供的遗传干预措施总体质量较差。然而，对使用对照干预研究方法的研究进行单独分析表明，使用了更高质量的遗传干预措施（总体评为“中等”）。提供基于遗传检测的可操作建议比提供没有可操作生活方式建议的遗传信息更有可能促进行为改变。一些高质量的研究表明，提供遗传干预措施会导致生活方式习惯的改变。最有希望的生活方式改变是营养方面的改变。
使用遗传检测作为催化剂促进行为改变是可能的。未来的研究应确保向参与者提供高质量的遗传干预措施，并在研究设计和分析中考虑经过验证的理论，如 TPB。为未来的研究提供了进一步的建议。
