A systematic literature review of computer-based behaviouralchange interventions to inform the design of an online VBACintervention for the OptiBIRTH European randomised trial(project HEALTH – F3 – 2012-305208)

Aim. To systematically review computer-based, behaviour change interventions during pregnancy and their design componentsin order to determine their best application within the context of the OptiBIRTH intervention.Design. A systematic literature review was undertaken using the Cochrane Collaboration Guidelines for Systematic Reviewsof Health Promotion and Public Health Interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed,Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied toassess the methodological quality and a taxonomy of behaviour change techniques was used to appraise the interventions.PICO. Participants: included healthy pregnant women who were ≥18 years old. Types of Intervention: Computer-basedinterventions designed to facilitate a behaviour change approach in a sample of pregnant women. Comparison: routineantenatal care. Outcomes: The primary outcome included improved health behaviour(s), as an indicator of the intentionbehind the intervention design.Results. A total of 343 papers were identified through database searching and hand searching methods; 80 duplicates wereremoved. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full textarticles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a totalof three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011 and Tsoh et al, 2010). Thecomputer-based interventions were designed to bring about behavioural change in relation to alcohol consumption, smokingor diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer-delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011, Tsoh et al, 2010). Techniques usedincluded motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomesvaried but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes wereseen in the interventions by Jackson et al, (2011) and Tsoh et al, (2010) but not Tzilos et al (2011). The GRADE analysisidentified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.Conclusion. This systematic review reports on the best available evidence and theory to design an online component of acomplex intervention for use in a RCT to enhance women’s shared-decision making experience about VBAC. The reviewreports the differences between the observed behavioural change approach and that of a decision-making approach: BCTsare applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a morehealthy option. As a result, techniques designed to create dissonance are considered appropriate. Shared decision-making,however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel forher as a person. Therefore, the authors argue that it is crucial for health care professionals designing complex healthcareinterventions (either BCTs or SDMs) to ensure that a person’s self-determination is respected through having access torelevant and understandable information and health care professionals’ who understand a woman’s motivation. However,it is not possible to draw firm conclusions from three studies and there is a requirement for further research.