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

Eleanor R Bull,Elise Dusseldorp,Nicola Mccleary,Xinru Li,Stephan U Dombrowski,Marie Johnston

doi:10.1007/s12529-018-9734-z

Abstract

PurposeHealthy 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.MethodData 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.ResultsFor 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.ConclusionThis 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.

Highlights

People of lower socioeconomic status are less likely to eat healthily [1] or be physically active and [2] more likely to smoke [3] compared to those of higher socioeconomic status
The original review by Bull et al [12] included studies meeting the following inclusion criteria: (i) population: currently healthy adults described in the study as ‘low-income’; (ii) interventions: aiming to change healthy eating, physical activity and/or smoking behavior in any combination; (iii) study design: randomised controlled trials (RCTs) or Cluster RCTs, with no limits on control condition design; (iv) outcomes: behavioral outcomes relevant to healthy eating, physical activity or smoking; (v) date: primary search carried out January 2006 to July 2014; (vi) language: English
We explored active components of interventions (BCTs) and the context and methods of delivery associated with effectiveness in health behavior change interventions for low-income adults, applying both individual moderator analyses and meta-CART to explore combinations of components

Summary

Introduction

People of lower socioeconomic status are less likely to eat healthily [1] or be physically active and [2] more likely to smoke [3] compared to those of higher socioeconomic status These behaviors may be mediators of the well-established link between social position and morbidity and mortality outcomes [4,5,6]. Initial explorations of heterogeneity were conducted in that review but associations between specific intervention components with variation in intervention effectiveness were not examined Understanding this variability, including identifying potentially underutilised effective components with these groups, is important when health inequalities continue to widen [10]

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