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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 and Hughes, Carmel M (2016) Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review. Respiratory Medicine, 116 . pp. 78-84. [Journal article]

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DOI: 10.1016/j.rmed.2016.05.021


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.

Item Type:Journal article
Keywords:Adherence, Respiratory, Systematic review, Behavior, Theory
Faculties and Schools:Faculty of Life and Health Sciences
Faculty of Life and Health Sciences > School of Health Sciences
Research Institutes and Groups:Institute of Nursing and Health Research > Centre for Health and Rehabilitation Technologies
Institute of Nursing and Health Research
ID Code:35251
Deposited By: Wendy Aiken (Admin)
Deposited On:09 Aug 2016 10:00
Last Modified:26 May 2017 10:25

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