Can We Identify the Active Ingredients of Behaviour Change Interventions for Coronary Heart Disease Patients? A
Laura Goodwin1, Giovanni Ostuzzi2, Nadia Khan3
1Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Insights
Behavioral interventions for coronary heart disease (CHD) patients, primarily cardiac rehabilitation, show positive impacts. While common techniques like information provision and goal setting were identified, the specific active ingredients influencing outcomes remain unclear.
Area of Science:
- Cardiology
- Behavioral Science
- Public Health
Background:
- Cardiac rehabilitation is the primary behavioral intervention for coronary heart disease (CHD) patients.
- Identifying the active components of behavioral interventions for CHD is crucial for optimizing effectiveness.
- Utilizing a behavior change technique (BCT) framework can help analyze intervention content.
Purpose of the Study:
- To systematically review the effectiveness of behavioral interventions for CHD.
- To determine if BCT content and structure explain the effectiveness of these interventions.
- To identify commonly used BCTs in CHD behavioral interventions.
Main Methods:
- Systematic literature search of Medline, EMBASE, and PsycInfo databases (2003-2015).
- Coding intervention content using the Coventry Aberdeen and London-Refined (CALO-RE) taxonomy.
- Meta-regression analyses to examine BCTs as predictors of mortality.
Main Results:
- Twenty-two studies (16,766 participants) were included.
- Commonly used BCTs included providing information and goal setting.
- Interventions significantly reduced mortality (RR = 0.82) but not CHD events.
- No specific BCT variables or number of BCTs predicted mortality.
Conclusions:
- Behavioral interventions for CHD patients demonstrate a positive impact on various outcomes.
- The study identified prevalent BCTs but could not pinpoint the active components of these complex interventions.
- Further research is needed to elucidate the specific mechanisms driving intervention effectiveness.
Background:
The main behaviour change intervention available for coronary heart disease (CHD) patients is cardiac rehabilitation. There is little recognition of what the active ingredients of behavioural interventions for CHD might be. Using a behaviour change technique (BCT) framework to code existing interventions may help to identify this. The objectives of this systematic review are to determine the effectiveness of CHD behaviour change interventions and how this may be explained by BCT content and structure.
Methods And Findings:
A systematic search of Medline, EMBASE and PsycInfo electronic databases was conducted over a twelve year period (2003-2015) to identify studies which reported on behaviour change interventions for CHD patients. The content of the behaviour change interventions was coded using the Coventry Aberdeen and London-Refined (CALO-RE) taxonomy. Meta-regression analyses examined the BCT content as a predictor of mortality. Twenty two papers met the criteria for this review, reporting data on 16,766 participants. The most commonly included BCTs were providing information, and goal setting. There was a small but significant effect of the interventions on smoking (risk ratio (RR) = 0.89, 95% CI 0.81-0.97). The interventions did not reduce the risk of CHD events (RR = 0.86, 95% CI 0.68, 1.09), but significantly reduced the risk of mortality (RR = 0.82, 95% CI 0.69, 0.97). Sensitivity analyses did not find that any of the BCT variables predicted mortality and the number of BCTs included in an intervention was not associated with mortality (β = -0.02, 95% CI -0.06-0.03).
Conclusions:
Behaviour change interventions for CHD patients appear to have a positive impact on a number of outcomes. Using an existing BCT taxonomy to code the interventions helped us to understand which were the most commonly used techniques, providing information and goal setting, but not the active components of these complex interventions.
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