CRD summary

The authors concluded that behavioural counselling, motivational interviewing, and education and advice could be used as effective behaviour change interventions, by primary care providers, with no apparent difference between delivery by physician or by nurse. There was some potential for bias in the review process, but other parts were adequately conducted and the research recommendations seem reasonable.

Authors' objectives

To evaluate the effects of behaviour change interventions, delivered face-to-face in primary care, to change patients' lifestyles, and which health care provider (physician or nurse) was more effective in delivering these interventions.

Searching

PubMed, EMBASE, PsycINFO, CINAHL, and The Cochrane Library were searched for published studies, in English, to October 2010. The PubMed search strategy was presented.

Study selection

Eligible for inclusion were randomised controlled trials of individual face-to-face, lifestyle change interventions, focusing on changing behaviour relating to smoking, alcohol, nutrition, weight or physical activity (primary prevention); or focusing on the secondary prevention of type II diabetes, chronic obstructive pulmonary disease, asthma, cardiovascular disease, heart disease, or kidney disease. Patients had to be aged 18 years or older. Interventions had to be delivered by at least one primary health care provider (physician, nurse practitioner, or practice nurse). The outcomes of interest were self-reported and objective measures of behaviour.

The included trials were conducted in various countries worldwide (eight in the UK); most were aimed at primary prevention, and various populations were targeted. Around half of the trials focused on a single lifestyle behaviour; others had multiple components. Where reported, the number of intervention sessions ranged from one to 15, and they lasted between 30 seconds and 60 minutes. Interventions were delivered by one provider, or a combination of health care providers. The included behaviour change techniques were behavioural counselling, motivational interviewing, education and advice, feedback, risk assessment, goal setting, self monitoring, and cognitive behavioural therapy. Control or comparison groups received usual care, no intervention, or another type of intervention (reported in the paper). Around half the trials were theory driven.

Two reviewers were involved in the selection of trials. Ten percent of full-text articles were checked by both reviewers. Disagreements were resolved by discussion.

Assessment of study quality

Trial quality was assessed using Cochrane criteria, for randomisation, allocation concealment, similarity of groups at baseline, blinding, use of co-interventions, intervention compliance, timing of outcome assessment, and use of intention-to-treat analysis. Quality was high if at least five of the 11 criteria were met; otherwise trials were classed as low quality. Evidence of an effect was considered where at least one high-quality trial was included in the analysis.

Two reviewers assessed the quality of the included trials. Disagreements were resolved by discussion.

Data extraction

The data were extracted on the direction of the effect, to show how many trials demonstrated a positive significant effect, as a percentage of the total number evaluating a particular communication technique.

These data were extracted by two independent reviewers.

Methods of synthesis

A narrative synthesis was presented, focusing on the results of the effective interventions.

Results of the review

Fifty trials (36,713 patients) were included. Thirty-seven trials were of high quality; 13 were of low quality. The authors stated that blinding, allocation concealment, and intention-to-treat analysis were the most frequent methodological weaknesses.

Twenty-six trials were deemed effective; 81% of these were of high quality, and 16 reported a theoretical basis for the intervention.

The most frequent effective techniques were behavioural counselling, motivational interviewing, and education and advice. The percentage of trials with significant improvements (as a proportion of the total number examining each technique) ranged from 33.3 to 100. Effects were observed when these techniques were part of a multi-component intervention. These techniques were also effective in lower quality studies. The results showed that there was little difference in the effectiveness of interventions delivered by nurses, compared with physicians, but the data were limited.

Authors' conclusions

Behavioural counselling, motivational interviewing, and education and advice could be used as effective behaviour change interventions, by primary care providers. It appeared that a physician was no better equipped to deliver these interventions than a nurse.

CRD commentary

The review question was clear and the inclusion criteria were clearly stated. Several data sources were searched, but publication and language bias were possible (the former was acknowledged by the authors), meaning that relevant trials might have been overlooked. The review process included attempts to minimise error and bias. Appropriate quality assessment criteria were applied; a summary of the trial quality was reported and taken into account in the presentation of the findings. Trial characteristics were presented in detail, and this confirmed the diversity of the included interventions, outcomes, and populations, as acknowledged by the authors. Given this diversity, the chosen method of synthesis was appropriate. The results were selectively reported for the most effective interventions.

Possible bias in the search and reporting of the results threatens the reliability of this review, but the remainder of the process was adequately conducted and the research recommendations seem reasonable.

Implications of the review for practice and research

Practice: The authors stated that appropriate arrangements should be made to divide tasks between physicians and nurses, for the delivery of behaviour change techniques, in primary care.

Research: The authors stated that future research should be theory based, and explore the working mechanisms of communication-related behaviour change techniques, together with their appropriateness for patients in primary care. Researchers should ensure adequate description of the intervention content. The effectiveness of goal-setting techniques should be explored, and the observation of real-life consultations in primary care was recommended.

Funding

Funded by the Dutch Ministry of Health, Welfare and Sport.

Bibliographic details

Noordman J, van der Weijden T, van Dulmen S. Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: a systematic review of the literature. Patient Education and Counseling 2012; 89(2): 227-244. [PubMed: 22878028]

Original Paper URL

http://www.pec-journal.com/article/S0738-3991(12)00295-9/abstract

Indexing Status

Subject indexing assigned by NLM

MeSH

Communication; Health Promotion /methods; Humans; Interviews as Topic; Life Style; Motivational Interviewing /methods; Patient Education as Topic; Primary Health Care /methods

AccessionNumber

12012055644

Database entry date

02/05/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.