Title

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

Date of this Version

7-2016

Document Type

Journal Article

Grant Number

NHMRC grant number 1044904

Publication Details

Citation only

McCullough, A. R., Ryan, C., Macindoe, C., Yii, N., Bradley, J. M., O'Neill, B., Elborn, S., Hughes, C. M. (2016). Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review. Respiratory Medicine, 116, 78-84.

Access the journal

© 2016 Elsevier Ltd. All rights reserved.

ISSN

0954-6111

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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This document has been peer reviewed.