Bull Eleanor R, McCleary Nicola, Li Xinru, Dombrowski Stephan U, Dusseldorp Elise, Johnston Marie
Manchester Metropolitan University, Manchester, UK.
University of Manchester, Manchester, UK.
Int J Behav Med. 2018 Dec;25(6):605-616. doi: 10.1007/s12529-018-9734-z.
Healthy eating, physical activity and smoking interventions for low-income groups may have small, positive effects. Identifying effective intervention components could guide intervention development. This study investigated which content and delivery components of interventions were associated with increased healthy behavior in randomised controlled trials (RCTs) for low-income adults.
Data from a review showing intervention effects in 35 RCTs containing 45 interventions with 17,000 participants were analysed to assess associations with behavior change techniques (BCTs) and delivery/context components from the template for intervention description and replication (TIDieR) checklist. The associations of 46 BCTs and 14 delivery/context components with behavior change (measures of healthy eating, physical activity and smoking cessation) were examined using random effects subgroup meta-analyses. Synergistic effects of components were examined using classification and regression trees (meta-CART) analyses based on both fixed and random effects assumptions.
For healthy eating, self-monitoring, delivery through personal contact, and targeting multiple behaviors were associated with increased effectiveness. Providing feedback, information about emotional consequences, or using prompts and cues were associated with reduced effectiveness. In synergistic analyses, interventions were most effective without feedback, or with self-monitoring excluding feedback. More effective physical activity interventions included behavioral practice/rehearsal or instruction, focussed solely on physical activity or took place in home/community settings. Information about antecedents was associated with reduced effectiveness. In synergistic analyses, interventions were most effective in home/community settings with instruction. No associations were identified for smoking.
This study identified BCTs and delivery/context components, individually and synergistically, linked to increased and reduced effectiveness of healthy eating and physical activity interventions. The identified components should be subject to further experimental study to help inform the development effective behavior change interventions for low-income groups to reduce health inequalities.
针对低收入群体的健康饮食、体育活动和吸烟干预措施可能会产生微小的积极影响。确定有效的干预组成部分可为干预措施的制定提供指导。本研究调查了在针对低收入成年人的随机对照试验（RCT）中，干预措施的哪些内容和实施组成部分与健康行为的增加相关。
对一项综述中的数据进行分析，该综述显示了35项RCT中的干预效果，这些RCT包含45项干预措施，涉及17,000名参与者，以评估与行为改变技术（BCT）以及干预描述与复制模板（TIDieR）清单中的实施/背景组成部分之间的关联。使用随机效应亚组荟萃分析来检验46种BCT和14种实施/背景组成部分与行为改变（健康饮食、体育活动和戒烟措施）之间的关联。基于固定效应和随机效应假设，使用分类与回归树（meta-CART）分析来检验各组成部分的协同效应。
对于健康饮食，自我监测、通过个人接触实施以及针对多种行为与有效性增加相关。提供反馈、关于情绪后果的信息或使用提示与线索则与有效性降低相关。在协同分析中，无反馈或排除反馈的自我监测的干预措施最为有效。更有效的体育活动干预措施包括行为练习/排练或指导，仅专注于体育活动或在家庭/社区环境中进行。关于行为前因的信息与有效性降低相关。在协同分析中，在家庭/社区环境中进行指导的干预措施最为有效。未发现与吸烟相关的关联。
本研究确定了BCT以及实施/背景组成部分，无论是单独还是协同作用，都与健康饮食和体育活动干预措施有效性的增加或降低相关。所确定的组成部分应接受进一步的实验研究，以帮助为低收入群体开发有效的行为改变干预措施提供信息，从而减少健康不平等现象。
