Effectiveness of Behavior Change Wheel-based health education for cancer pain: A systematic review of randomized controlled trials

ObjectiveTo evaluate the effectiveness and implementation characteristics of health education interventions based on the Behavior Change Wheel for adults with cancer pain.MethodsTen databases (CNKI, VIP, Wanfang, CBM, PubMed, Embase, Web of Science, Cochrane Library, CINAHL, and Scopus) were searched from inception to January 2025. Randomized controlled trials evaluating Behavior Change Wheel- or Capability-Opportunity-Motivation-Behavior-informed health education for patients with cancer pain were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias 2 tool. Because of substantial heterogeneity in intervention content, duration, delivery mode, and outcome measures, no meta-analysis was performed. Findings were synthesized narratively according to the Synthesis Without Meta-analysis reporting guidance. Between-group differences were calculated or extracted from individual studies and summarized as ranges across trials.ResultsOf 367 records identified, seven randomized controlled trials involving 954 patients met the inclusion criteria. All interventions were explicitly designed around Behavior Change Wheel/Capability-Opportunity-Motivation-Behavior principles. Behavior Change Wheel based health education was associated with reduced pain intensity, improved medication adherence, and better quality of life. For secondary outcomes, favorable effects on sleep quality and self-management ability were reported in a subset of trials, but the evidence was less consistent. Interpretation of these findings is limited by short follow-up, considerable heterogeneity in intervention content and outcome measures, and an overall moderate risk of bias.ConclusionBehavior Change Wheel based health education appears to be a promising adjunct for cancer pain management, plausibly by strengthening patients' capability, opportunity, and motivation. However, the current evidence is limited to a small number of trials with methodological concerns. Larger multicenter trials with standardized core outcomes and follow-up of at least 3-6 months are needed to confirm these findings.