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International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 6/2018

Open Access 01-12-2018 | Systematic Review

Interventions to Promote Healthy Eating, Physical Activity and Smoking in Low-Income Groups: a Systematic Review with Meta-Analysis of Behavior Change Techniques and Delivery/Context

Authors: Eleanor R. Bull, Nicola McCleary, Xinru Li, Stephan U. Dombrowski, Elise Dusseldorp, Marie Johnston

Published in: International Journal of Behavioral Medicine | Issue 6/2018

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Abstract

Purpose

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.

Method

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.

Results

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.

Conclusion

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.
Appendix
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Literature
1.
Drewnowski A, Specter S. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79:6–16.CrossRef
2.
Stamatakis E. Obesity, eating and physical activity. In: Bajekal M, Osborne V, Yar M, Meltzer M, editors. Focus on health London. London: Office for National Statistics/Palgrave Macmillan; 2006. p. 47–61.
3.
Scottish Government. Equally well: report of the ministerial task force on health inequalities. Edinburgh: The Stationery Office; 2008.
4.
Whitley E, Batty GD, Hunt K, Popham F, Benzeval M. The role of health behaviors across the life course in the socioeconomic patterning of all-cause mortality: the west of Scotland twenty-07 prospective cohort study. Ann Behav Med. 2014;47:148–57.CrossRef
5.
Hart C, Gruer L, Watt G. Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study. BMJ. 2011;342:d3785.CrossRef
6.
Gruer L, Hart CL, Gordon DS, et al. Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study. BMJ. 2009;338:480.CrossRef
7.
Hiscock R, Judge K, Bauld L. Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation? J Public Health. 2011;33:39–47.CrossRef
8.
Niederdeppe J, Fiore MC, Baker TB, Smith SS. Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations. Am J Public Health. 2008;98:916–24.CrossRef
9.
Chesterman J, Judge K, Bauld L, Ferguson J. How effective are the English smoking treatment services in reaching disadvantaged smokers? Addiction. 2005;100:36–45.CrossRef
10.
White M, Adams J, Heywood P. How and why do interventions that increase health overall widen inequalities within populations? In: Barbones S, editor. Health, inequality and public health. Bristol: Policy Press; 2009. p. 65–81.CrossRef
11.
Michie S, Jochelson K, Markham WA, Bridle C. Low-income groups and behavior change interventions: a review of intervention content, effectiveness and theoretical frameworks. J Epidemiol Community Health. 2009;63:610–22.CrossRef
12.
Bull ER, Dombrowski SU, McCleary N, Johnston M. Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviors? A systematic review and meta-analysis. BMJ Open. 2014;4(11):e006046.CrossRef
13.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.CrossRef
14.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.CrossRef
15.
Dusseldorp E, van Genugten L, van Buuren S, Verheijden MW, van Empelen P. Combinations of techniques that effectively change health behavior: evidence from Meta-CART analysis. Health Psychol. 2014;33(12):1530–40.CrossRef
16.
Li X, Dusseldorp E, Meulman JJ. Meta-CART: a tool to identify interactions between moderators in meta-analysis. Br J Math Stat Psychol. 2017;70(1):118–36.CrossRef
17.
Boutron I, Moher D, Altman D, et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295–309.CrossRef
18.
Peters GJY, Ruiter RA, Kok G. Threatening communication: a critical re-analysis and a revised meta-analytic test of fear appeal theory. Health Psychol Rev. 2013;7(sup1):S8–S31.CrossRef
19.
Davidson K, Goldstein M, Kaplan R, et al. Evidence-based behavioural medicine: what is it and how do we achieve it? Ann Behav Med. 2003;26:161–71.CrossRef
20.
Avenell A, Broom J, Brown T, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8:1–182.CrossRef
21.
Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46(5):423–9.CrossRef
22.
Orwin RG. Evaluating coding decisions. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 150–1.
23.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–48.PubMed
24.
Dombrowski SU, Sniehotta F, Avenell A, et al. Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review. Health Psychol Rev. 2010;6(1):7–32.CrossRef
25.
Borenstein M, Hedges LV, Higgins J, Rothstein HR. Introduction to meta-analysis. Chichester: John Wiley & Sons, Ltd; 2009.CrossRef
26.
Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. California: Wadsworth & Brooks. Monterey; 1984.
27.
Keyserling TC, Samuel Hodge CD, Jilcott SB, Johnston LF, Garcia BA, Gizlice Z, et al. Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project. Prev Med. 2008;46:499–510.CrossRef
28.
Emmons K, Stoddard A, Flotcher R, et al. Cancer prevention among working class, multiethnic adults: results of the healthy directions-health centers study. Am J Public Health. 2005;95:1200–5.CrossRef
29.
Jackson RA, Stotland NE, Caughey AB, Gerbert B. Improving diet and exercise in pregnancy with video doctor counseling: a randomized trial. Patient Educ Couns. 2011;83:203–9.CrossRef
30.
Tessaro I, Rye S, Parker L, Mangone C, McCrone S. Effectiveness of a nutrition intervention with rural low-income women. Am J Health Behav. 2007;31:35–43.CrossRef
31.
Marcus BH, Dunsiger SI, Pekmezi DW, Larsen BA, Bock BC, Gans KM, et al. The seamos saludables study: a randomized controlled physical activity trial of Latinas. Am J Prev Med. 2013;45:598–605.CrossRef
32.
Dangour AD, Albala C, Allen E, Grundy E, Walker DG, Aedo C, et al. Effect of a nutrition supplement and physical activity program on pneumonia and walking capacity in Chilean older people: a factorial cluster randomized trial. PLoS Med. 2011;8:e1001023.CrossRef
33.
Olvera NN, Bush JA, Sharma SV, Knox BB, Scherer RL, Butte NF. BOUNCE: a community-based mother-daughter healthy lifestyle intervention for low-income Latino families. Obesity. 2010;18(Suppl 1):S102–4.CrossRef
34.
Dutton GR, Davis MP, Welsch MA, et al. Promoting physical activity for low-income minority women in primary care. Am J Health Behav. 2007;31:622–31.CrossRef
35.
Chang MW, Nitzke S, Brown R. Design and outcomes of a mothers in motion behavioral intervention pilot study. J Nutr Educ Behav. 2010;42(3 Suppl):S11–21.CrossRef
36.
37.
Gans KM, Risica PM, Strolla LO, Fournier L, Kirtania U, Upegui D, et al. Effectiveness of different methods for delivering tailored nutrition education to low-income, ethnically diverse adults. Int J Behav Nutr Phys Act. 2009;6:24.CrossRef
38.
Elder J, Ayala G, Campbell N, et al. Long-term effects of a communication intervention for Spanish-dominant Latinas. Am J Prev Med. 2006;31:159–66.CrossRef
39.
Norman GJ, Zabinski MF, Adams MA, Rosenberg DE, Yaroch AL, Atienza AA. A review of eHealth interventions for physical activity and dietary behavior change. Am J Prev Med. 2007;33(4):336–45.CrossRef
40.
Carver C, Sheier M. Control theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychol Bull. 1982;92(1):111–35.CrossRef
41.
Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701.CrossRef
42.
Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res. 2011;26(2):308–22.CrossRef
43.
Gardner B. A review and analysis of the use of ‘habit’ in understanding, predicting and influencing health-related behaviour. Health Psychol Rev. 2014:1–19.
44.
Pothoff S, Presseau J, Sniehotta FF, Johnston M, Elovainio M, Avery L. Planning to be routine: habit as a mediator of the planning-behaviour relationship in healthcare professionals. Implement Sci. 2011;12(1):24.CrossRef
45.
46.
Dombrowski SU, Sniehotta FF, Avenell A, Johnston M, MacLennan G, Araújo-Soares V. Identifying active ingredients in complex behavioral interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review. Health Psychol Rev. 2012;6(1):7–32.CrossRef
47.
van Genugten L, Dusseldorp E, Webb TL, van Empelen P. Which combinations of techniques and modes of delivery in internet-based interventions effectively change health behavior? A meta-analysis. J Med Internet Res. 2016;18(6):e155.CrossRef
48.
Bartlett YK, Sheeran P, Hawley MS. Effective behaviour change techniques in smoking cessation interventions for people with chronic obstructive pulmonary disease: a meta-analysis. Br J Health Psychol. 2014;19(1):181–203.CrossRef
49.
Lorencatto F, West R, Michie S. Specifying evidence-based behavior change techniques to aid smoking cessation in pregnancy. Nicotine Tob Res. 2012;14(9):1019–26.CrossRef
50.
Lorencatto F, West R, Stavri Z, Michie S. How well is intervention content described in published reports of smoking cessation interventions? Nicotine Tob Res. 2013;15(7):1273–82.CrossRef
51.
Webb TL, Sniehotta FF, Michie S. Using theories of behavior change to inform interventions for addictive behaviors. Addiction. 2010;105(11):1879–92.CrossRef
52.
Prestwich A, Sniehotta FF, Whittington C, Dombrowski SU, Rogers L, Michie S. Does theory influence the effectiveness of health behavior interventions? Meta-analysis. Health Psychol. 2014;33(5):465–74.CrossRef
53.
Dombrowski SU, Sniehotta FF, Avenell A, Coyne JC. Towards a cumulative science of behavior change: do current conduct and reporting of behavioral interventions fall short of best practice. Psychol Health. 2007;22:869–74.CrossRef
54.
McCleary N, Duncan EM, Stewart F, Francis JJ. Active ingredients are reported more often for pharmacologic than non-pharmacologic interventions: an illustrative review of reporting practices in titles and abstracts. Trials. 2013;14:146.CrossRef
55.
Hoffman TC, Erueti C, Glasziou PP. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. BMJ. 2013;347:f3755.CrossRef
56.
The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: update a U.S. public health service report. Am J Prev Med. 2008;35(2):158–76.
57.
Foster C, Hillsdon M, Throrogood M, et al. Interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;1:14651858.
58.
Lemmens V, Oenema A, Knut I, et al. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008;17:535–44.CrossRef
59.
deBruin M, Viechtbauer W, Hospers HJ, et al. Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects. Health Psychol. 2009;28:668–74.CrossRef
Metadata
Title
Interventions to Promote Healthy Eating, Physical Activity and Smoking in Low-Income Groups: a Systematic Review with Meta-Analysis of Behavior Change Techniques and Delivery/Context
Authors
Eleanor R. Bull
Nicola McCleary
Xinru Li
Stephan U. Dombrowski
Elise Dusseldorp
Marie Johnston
Publication date
01-12-2018
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 6/2018
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-018-9734-z

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