What do cost-effective health behaviour-change interventions contain? A comparison of six domains.

Fabiana Lorencatto,Lesley Owens,Emma Beard,Lion Shahab,Susan Michie,Ben Gardner,Robert West,Fernando A. Wilson

doi:10.1371/journal.pone.0213983

Abstract

ObjectivesTo help implement behaviour change interventions (BCIs) in practice it is important to be able to characterize their key components. This study compared broad features of cost-effective BCIs that addressed smoking, diet, physical activity, alcohol and sexual health. It also assessed the association of these with the magnitude of the cost-effectiveness estimates.MethodsA content analysis of 79 interventions based on 338 intervention descriptions was conducted, using the Behaviour Change Wheel (BCW) to classify intervention content in terms of intervention functions, and the BCT taxonomy to identify and categorise component Behaviour Change Techniques (BCT). Regression analysis identified the association of these with upper (pessimistic) and lower (optimistic) cost-effectiveness estimates.ResultsThe most and least common functions and BCT clusters were education (82.3%) and shaping knowledge (79.7%), and coercion (3.8%) and covert learning (2.5%). Smoking interventions contained the largest ( = 12) number of BCTs and were most cost-effective. Several other factors were associated with worse (coercionfunction βupper = 36551.24; shaping knowledgeBCT βlower = 2427.78; comparison of outcomesBCT βupper = 9067.32; repetition and substitutionBCT βupper = 7172.47) and better (modellingfunction βlower = -2905.3; environmental restructuringfunction βupper = -8646.28; reward and threatBCT βupper = -5577.59) cost-effectiveness (p<0.05).DiscussionCost-effective BCIs rely heavily on education with smoking interventions exhibiting the most comprehensive range of BCTs. Providing an example to aspire to, restructuring the environment and rewarding positive behaviour may be associated with greater cost-effectiveness.

Highlights

Physical inactivity, smoking, excessive alcohol consumption, unprotected sex and poor diet cost the National Health Service (NHS) in England more than £14 billion per year [1,2,3,4]
Several other factors were associated with worse and better cost-effectiveness (p
Nineteen National Institute for Health and Care Excellence (NICE) guidance documents which included economic modelling and cost-effectiveness reviews and which assessed behaviour change in at least one of six behavioural domains were identified in November/December 2012 through a systematic search conducted by NICE

Summary

Introduction

Physical inactivity, smoking, excessive alcohol consumption, unprotected sex and poor diet cost the National Health Service (NHS) in England more than £14 billion per year [1,2,3,4]. There is good evidence for the effectiveness of some BCIs in some contexts, including the provision of behavioural support for smoking cessation [10], brief advice in primary care for excessive alcohol consumption [11], school based programmes to raise physical activity levels [12], interactive digital interventions for sexual health promotion [13], and behavioural support to reduce calorie intake [14] These BCIs have been found to be cost-effective in yielding quality-adjusted life years [15,16,17]

Objectives

Methods

Results