Trinity Centre for Practice and Healthcare Innovation (TCPHI), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Ann Behav Med. 2024 May 23;58(6):432-444. doi: 10.1093/abm/kaae021.
Health behaviors play a significant role in chronic disease management. Rather than being independent of one another, health behaviors often co-occur, suggesting that targeting more than one health behavior in an intervention has the potential to be more effective in promoting better health outcomes.
We aimed to conduct a systematic review and meta-analysis of randomized trials of interventions that target more than one behavior to examine the effectiveness of multiple health behavior change interventions in patients with chronic conditions.
Five electronic databases (Web of Science, PubMed, CINAHL, EMBASE, and Cochrane) were systematically searched in November 2023, and studies included in previous reviews were also consulted. We included randomized trials of interventions aiming to change more than one health behavior in individuals with chronic conditions. Two independent reviewers screened and extracted data, and used Cochrane's Risk of Bias 2 tool. Meta-analyses were conducted to estimate the effects of interventions on change in health behaviors. Results were presented as Cohen's d for continuous data, and risk ratio for dichotomous data.
Sixty-one studies were included spanning a range of chronic diseases: cardiovascular (k = 25), type 2 diabetes (k = 15), hypertension (k = 10), cancer (k = 7), one or more chronic conditions (k = 3), and multiple conditions (k = 1). Most interventions aimed to change more than one behavior simultaneously (rather than in sequence) and most targeted three particular behaviors at once: "physical activity, diet and smoking" (k = 20). Meta-analysis of 43 eligible studies showed for continuous data (k = 29) a small to substantial positive effect on behavior change for all health behaviors (d = 0.081-2.003) except for smoking (d = -0.019). For dichotomous data (k = 23) all analyses showed positive effects of targeting more than one behavior on all behaviors (RR = 1.026-2.247).
Targeting more than one behavior at a time is effective in chronic disease management and more research should be directed into developing the science of multiple behavior change.
健康行为在慢性病管理中起着重要作用。健康行为并非彼此独立，而是经常同时发生，这表明在干预中针对多种健康行为可能更有效地促进更好的健康结果。
我们旨在对针对多种行为的干预措施进行系统评价和荟萃分析，以检查针对慢性病患者的多种健康行为改变干预措施的有效性。
2023 年 11 月，我们系统地检索了五个电子数据库（Web of Science、PubMed、CINAHL、EMBASE 和 Cochrane），并查阅了之前综述中包含的研究。我们纳入了旨在改变慢性病患者多种健康行为的干预措施的随机试验。两名独立审查员筛选并提取数据，并使用 Cochrane 的偏倚风险 2 工具。进行荟萃分析以估计干预措施对健康行为变化的影响。结果以连续数据的 Cohen's d 和二分类数据的风险比表示。
共纳入 61 项研究，涵盖多种慢性疾病：心血管疾病（k = 25）、2 型糖尿病（k = 15）、高血压（k = 10）、癌症（k = 7）、一种或多种慢性疾病（k = 3）和多种疾病（k = 1）。大多数干预措施旨在同时改变多种行为（而不是按顺序），并且大多数一次针对三种特定行为：“体力活动、饮食和吸烟”（k = 20）。对 43 项合格研究的荟萃分析显示，对于连续数据（k = 29），除吸烟外（d = -0.019），所有健康行为的行为改变均有较小到较大的积极影响（d = 0.081-2.003）。对于二分类数据（k = 23），所有分析均显示针对多种行为的目标对所有行为的积极影响（RR = 1.026-2.247）。
一次针对多种行为是有效的慢性病管理方法，应该有更多的研究致力于发展多种行为改变的科学。
