Abstract
ObjectivesThe question-behavior effect (QBE) refers to whether asking people questions can result in changes in behavior. Such changes in behavior can lead to bias in trials. This study aims to update a systematic review of randomized controlled trials investigating the QBE, in light of several large preregistered studies being published. Study Design and SettingA systematic search for newly published trials covered 2012 to July 2018. Eligible trials randomly allocated participants to measurement vs. non-measurement control conditions or to different forms of measurement. Studies that reported health-related behavior as outcomes were included. ResultsForty-three studies (33 studies from the original systematic review and 10 new studies) compared measurement vs. no measurement. An overall small effect was found using a random effect model: standardized mean difference = 0.06 (95% CI: 0.02–0.09), n = 104,388. Statistical heterogeneity was substantial (I2 = 54%). In an analysis restricted to studies with a low risk of bias, the QBE remained small but significant. There was positive evidence of publication bias. ConclusionThis update shows a small but significant QBE in trials with health-related outcomes but with considerable unexplained heterogeneity. Future trials with lower risk of bias are needed, with preregistered protocols and greater attention to blinding.
Highlights
Existing systematic reviews have supported the idea that measurement can affect behavior [1e5]
The question-behavior effect’ (QBE) is a specific, well-recognized example of measurement reactivity (MR), which describes the phenomenon where any type of measurement can affect the people being measured in terms of cognition, emotion, and behavior [6]
Data from each of these 10 studies were suitable to add to the meta-analysis presented in the original systematic review
Summary
Existing systematic reviews have supported the idea that measurement can affect behavior [1e5] Much of this evidence derives from studies where people who were asked to complete a questionnaire showed changes in behavior relative to a control group. This phenomenon is often called the ‘question-behavior effect’ (QBE). Theoretical explanations of how asking questions can produce changes in people include by increasing awareness of own behavior; providing information about consequences of behavior; or attentional effects through increasing the salience of components of health, behavior, or the link between the two. The QBE is a specific, well-recognized example of measurement reactivity (MR), which describes the phenomenon where any type of measurement (including objective and subjective measures) can affect the people being measured in terms of cognition, emotion, and behavior [6]
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