Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
National Institute of Health Research Behavioural Science Policy Research Unit, Population Health Sciences, Baddiley-Clark Building, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4AX, UK.
Implement Sci. 2021 Jan 7;16(1):8. doi: 10.1186/s13012-020-01072-1.
Healthcare workers perform clinical behaviours which impact on patient diagnoses, care, treatment and recovery. Some methods of supporting healthcare workers in changing their behaviour make use of social norms by exposing healthcare workers to the beliefs, values, attitudes or behaviours of a reference group or person. This review aimed to evaluate evidence on (i) the effect of social norms interventions on healthcare worker clinical behaviour change and (ii) the contexts, modes of delivery and behaviour change techniques (BCTs) associated with effectiveness.
Systematic review and meta-analysis of randomised controlled trials. Searches were undertaken in seven databases. The primary outcome was compliance with a desired healthcare worker clinical behaviour and the secondary outcome was patient health outcomes. Outcomes were converted into standardised mean differences (SMDs). We performed meta-analyses and presented forest plots, stratified by five social norms BCTs (social comparison, credible source, social reward, social incentive and information about others' approval). Sources of variation in social norms BCTs, context and mode of delivery were explored using forest plots, meta-regression and network meta-analysis.
Combined data from 116 trials suggested that social norms interventions were associated with an improvement in healthcare worker clinical behaviour outcomes of 0.08 SMDs (95%CI 0.07 to 0.10) (n = 100 comparisons), and an improvement in patient health outcomes of 0.17 SMDs (95%CI 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I of 85.4% (healthcare worker clinical behaviour) and 91.5% (patient health outcomes). Credible source was more effective on average, compared to control conditions (SMD 0.30, 95%CI 0.13 to 0.47, n = 7). Social comparison also appeared effective, both on its own (SMD 0.05, 95%CI 0.03 to 0.08, n = 33) and with other BCTs, and seemed particularly effective when combined with prompts/cues (0.33, 95%CI 0.22 to 0.44, n = 5).
Social norms interventions appeared to be an effective method of changing the clinical behaviour of healthcare workers and have a positive effect on patient health outcomes in a variety of health service contexts. Although the overall result is modest and variable, there is the potential for social norms interventions to be applied at large scale.
PROSPERO CRD42016045718 .
医疗保健工作者实施的临床行为会影响患者的诊断、护理、治疗和康复。一些支持医疗保健工作者改变行为的方法利用社会规范，使医疗保健工作者接触到参考群体或个人的信念、价值观、态度或行为。本综述旨在评估以下方面的证据：（i）社会规范干预对医疗保健工作者临床行为改变的影响；（ii）与有效性相关的背景、交付模式和行为改变技术（BCT）。
对随机对照试验进行系统评价和荟萃分析。在七个数据库中进行了检索。主要结局是医疗保健工作者遵守期望的临床行为，次要结局是患者健康结局。将结局转换为标准化均数差（SMD）。我们进行了荟萃分析，并呈现了森林图，按五个社会规范 BCT（社会比较、可信来源、社会奖励、社会激励和他人认可的信息）进行分层。使用森林图、元回归和网络荟萃分析探索了社会规范 BCT、背景和交付模式中的变异来源。
来自 116 项试验的综合数据表明，社会规范干预与医疗保健工作者临床行为结局的改善相关，平均为 0.08 SMD（95%CI 0.07 至 0.10）（n=100 项比较），以及患者健康结局的改善，平均为 0.17 SMD（95%CI 0.14 至 0.20）（n=14）。异质性很高，总体 I 为 85.4%（医疗保健工作者临床行为）和 91.5%（患者健康结局）。与对照条件相比，可信来源平均更有效（SMD 0.30，95%CI 0.13 至 0.47，n=7）。社会比较本身似乎也很有效（SMD 0.05，95%CI 0.03 至 0.08，n=33），并且与其他 BCT 一起似乎也很有效，并且当与提示/线索结合使用时，效果似乎特别好（0.33，95%CI 0.22 至 0.44，n=5）。
社会规范干预似乎是改变医疗保健工作者临床行为的有效方法，并在各种卫生服务环境中对患者健康结局产生积极影响。尽管总体结果是适度且多变的，但社会规范干预有可能大规模应用。
PROSPERO CRD42016045718。
