文章基本信息

标题：Meta-Synthesis of Health Behavior Change Meta-Analyses
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作者：Blair T. Johnson ; Lori A.J. Scott-Sheldon ; Michael P. Carey 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：11
页码：2193-2198
DOI：10.2105/AJPH.2008.155200
语种：English
出版社：American Public Health Association
摘要：Objectives. We integrated and compared meta-analytic findings across diverse behavioral interventions to characterize how well they have achieved change in health behavior. Methods. Outcomes from 62 meta-analyses of interventions for change in health behavior were quantitatively synthesized, including 1011 primary-level investigations with 599 559 participants. Content coding suggested 6 behavioral domains: eating and physical activity, sexual behavior, addictive behaviors, stress management, female-specific screening and intervention behaviors, and behaviors involving use of health services. Results. Behavior change interventions were efficacious (mean effect sizes = 0.08–0.45). Behavior change was more evident in more recent meta-analyses; those that sampled older interventions and literatures or sampled more published articles; those that included studies that relied on self-report, used briefer interventions, or sampled fewer, older, or female participants; and in some domains (e.g., stress management) more than others (e.g., sexual behaviors). Conclusions. Interventions improved health-related behaviors; however, efficacy varied as a function of participant and intervention characteristics. This meta-synthesis provides information about the efficacy of behavioral change interventions across health domains and populations; this knowledge can inform the design and development of public health interventions and future meta-analyses of these studies. Change in health behavior remains essential for the prevention of premature morbidity and mortality. A recent review suggests that (1) 50% of premature deaths can be attributed to modifiable risk behaviors, (2) many health problems lack curative solutions, and (3) health prevention incurs lower costs and fewer iatrogenic effects than medical solutions.¹ As a consequence, public health experts have focused their efforts on health promotion to reduce negative health outcomes. Over several decades, research on change in health behavior has burgeoned, uniting many disciplines in service of promoting health and preventing disease.^{2 – 4} Given the vastness of the literature, continued development of health promotion interventions depends on the ability of researchers to extract insight from prior efforts, a major challenge for researchers and public health officials involved in the development of behavioral health programs. Public health experts share a strong interest in the efficacy of health promotion interventions. With the growing numbers of intervention studies evaluating the success of behavior change techniques and meta-analytic reviews summarizing these studies, evaluating the efficacy of behavioral interventions can be challenging. Meta-analyses often vary by targeted health domain (e.g., condom versus alcohol use), sample (e.g., adolescents versus adults), intervention setting (e.g., community versus clinic), and assessed outcomes (e.g., single versus multiple outcomes). Moreover, some meta-analyses restrict their samples to published studies whereas others include unpublished reports. Development of health interventions is likely to be challenged by the variations among meta-analytic studies. We therefore used meta-analytic procedures to examine findings from prior meta-analytic reviews of health promotion literatures. This integration may permit researchers, practitioners, and policymakers to determine the success of behavioral interventions more broadly. By focusing on study, sample, and intervention characteristics reported in meta-analyses of health behaviors, this meta-synthesis may assist researchers in the design and development of behavior change interventions, thus having the potential to improve the science of health promotion; it can serve a similar function for future meta-analyses of related literatures. In our meta-synthesis, we focus on behavioral outcomes, the most definitive gauge of the success of an intervention,⁵ and examine factors that moderate intervention efficacy.