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

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

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)

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. (C) 2016 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)78-84
Number of pages7
JournalRespiratory Medicine
Volume116
DOIs
Publication statusPublished - Jul 2016

Cite this

McCullough, Amanda R. ; Ryan, Cristin ; 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. In: Respiratory Medicine. 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. (C) 2016 Elsevier Ltd. All rights reserved.",
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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, Cristin; Macindoe, Christopher; Yii, Nathan; Bradley, Judy M.; O'Neill, Brenda; Elborn, J. Stuart; Hughes, Carmel M.

In: Respiratory Medicine, Vol. 116, 07.2016, p. 78-84.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Ryan, Cristin

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