Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review

Amanda R McCullough, Crístín Ryan, Christopher Macindoe, Nathan Yii, Judy M Bradley, Brenda O'Neill, J. Stuart Elborn, Carmel M Hughes

Research output: Contribution to journalArticle

Abstract

Background We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease.Methods We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p <0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results 12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2–5 sessions (n = 26,45%) for 1–3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies. Conclusions Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.
LanguageEnglish
Pages78-84
JournalRespiratory Medicine
Volume116
Early online date24 May 2016
DOIs
Publication statusPublished - Jul 2016

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Chronic Disease
Self Care
Decision Making
Research Design
Randomized Controlled Trials
Databases
Psychology
Education
Therapeutics

Keywords

  • Adherence
  • Respiratory
  • Systematic review
  • Behavior
  • Theory

Cite this

McCullough, Amanda R ; Ryan, Crístín ; Macindoe, Christopher ; Yii, Nathan ; Bradley, Judy M ; O'Neill, Brenda ; Elborn, J. Stuart ; Hughes, Carmel M. / Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review. 2016 ; Vol. 116. pp. 78-84.
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abstract = "Background We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease.Methods We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p <0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results 12,488 articles screened; 46 included studies (n = 42,91{\%} in OSA or asthma) testing 58 interventions (n = 27, 47{\%} were effective). Nineteen (33{\%}) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41{\%}) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47{\%}). They were commonly delivered by a doctor (n = 20,23{\%}), in face-to-face (n = 48,70{\%}), one-to-one (n = 45,78{\%}) outpatient settings (n = 46,79{\%}) across 2–5 sessions (n = 26,45{\%}) for 1–3 months (n = 26,45{\%}). Doctors delivered a lower proportion (n = 7,18{\%} vs n = 13,28{\%}) and pharmacists (n = 6,15{\%} vs n = 1,2{\%}) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93{\%}) in most studies. Conclusions Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.",
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Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review. / McCullough, Amanda R; Ryan, Crístín; Macindoe, Christopher; Yii, Nathan; Bradley, Judy M; O'Neill, Brenda; Elborn, J. Stuart; Hughes, Carmel M.

Vol. 116, 07.2016, p. 78-84.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review

AU - McCullough, Amanda R

AU - Ryan, Crístín

AU - Macindoe, Christopher

AU - Yii, Nathan

AU - Bradley, Judy M

AU - O'Neill, Brenda

AU - Elborn, J. Stuart

AU - Hughes, Carmel M

PY - 2016/7

Y1 - 2016/7

N2 - Background We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease.Methods We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p <0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results 12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2–5 sessions (n = 26,45%) for 1–3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies. Conclusions Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.

AB - Background We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease.Methods We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p <0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results 12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2–5 sessions (n = 26,45%) for 1–3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies. Conclusions Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.

KW - Adherence

KW - Respiratory

KW - Systematic review

KW - Behavior

KW - Theory

U2 - 10.1016/j.rmed.2016.05.021

DO - 10.1016/j.rmed.2016.05.021

M3 - Article

VL - 116

SP - 78

EP - 84

ER -