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, Cristin
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. (C) 2016 Elsevier Ltd. All rights reserved.
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. (C) 2016 Elsevier Ltd. All rights reserved.
UR - http://www.scopus.com/inward/record.url?scp=84971441919&partnerID=8YFLogxK
U2 - 10.1016/j.rmed.2016.05.021
DO - 10.1016/j.rmed.2016.05.021
M3 - Article
SN - 0954-6111
VL - 116
SP - 78
EP - 84
JO - Respiratory Medicine
JF - Respiratory Medicine
ER -
