Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review

Hana Sediva, Tina Cartwright, Claire Robertson and Deb, S. 2022. Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review. JMIR mHealth and uHealth. 10 (11) e37234. https://doi.org/10.2196/37234

TitleBehavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review
TypeJournal article
AuthorsHana Sediva, Tina Cartwright, Claire Robertson and Deb, S.
Abstract

Background:

Digital health interventions (DHIs) are efficacious in health-promoting behaviours (e.g., healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife, however, integrated evidence-based knowledge about the mechanism of change in these interventions is unclear.

Objective:

This systematic review aims to evaluate studies on behaviour change techniques (BCTs) and mechanisms of change in DHIs aimed to promote health-enhancing behaviours in midlife women (aged 40-65 years).

Methods:

A systematic literature search of electronic databases MEDLINE/PubMed, Web of Science, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were conducted. Two independent reviewers selected studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the Behaviour Change Wheel (BCW) framework. Reporting of psychological theory use within these interventions were explored using the Theory Coding Scheme (TCS). Mode of delivery, psychological theory and BCTs were presented as descriptive statistics.

Results:

Thirteen interventions (including 1308 women) reviewed used 13 ± 4.30 (range 6–21) BCTs per intervention on average. ‘Shaping knowledge’ and ‘Repetition and substitution’ behaviour change categories (BCC) were used most frequently, with 12 interventions (92%) implementing at least one of these BCTs from these two categories. Only 14% (169/1209) of the 93 available BCTs were used, with ‘Instructions on behaviour’ most frequently utilised (12 of 13 studies). The BCW mapping suggests that half of the intervention content aimed to increase ‘Capability’ (50%; 49/98), 42% ‘Motivation’ (441/98), and 8% ‘Opportunity’ (8/98). ‘Behavioural Regulation’ was the most frequently used mechanism of action (15%; 15/98), followed by increasing ‘Knowledge’ (13%; 13/98) and ‘Cognitive and Interpersonal skills’ (10%; 10/98). Seven (78%; 7/9) intervention functions were used in the studies to change behaviour, primarily through ‘Enablement’ (36%; 60/169), while no study used ‘Restriction’ or ‘Modelling’ functions. Although 69% (9/13) of the studies mentioned a psychological theory or a model, the majority (77%; 10/13) stated or suggested rather than demonstrated use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (68%; 9/47) modes of delivery, followed by phone/text (62%; 8/47) and wearables (54%; 7/47).

Conclusions:

The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions with women in midlife. Clinical Trial: PROSPERO CRD42021259246 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202125...

Article numbere37234
JournalJMIR mHealth and uHealth
Journal citation10 (11)
ISSN2291-5222
Year2022
PublisherJMIR Publications
Publisher's version
License
CC BY 4.0
File Access Level
Open (open metadata and files)
Digital Object Identifier (DOI)https://doi.org/10.2196/37234
PubMed ID36350694
Web address (URL)https://doi.org/10.2196/37234
Publication dates
Published online11 Feb 2022
Published in print09 Nov 2022

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Perkins, A., Swann, R., Woodside, J., Robertson, C.E., Dutton, S., Mulligan, A.M., Velentzis, L.S., Keshtgar, M.R., Leathem, A. and Dwek, M. 2012. DietCompLyf study: a multi-centre UK study on breast cancer. What are the dietary and lifestyle changes following diagnosis? European Journal of Cancer. 48 (5), p. S282. https://doi.org/10.1016/S0959-8049(12)71766-5

‘Getting on with life’: the experiences of older people using complementary health care
Cartwright, T. 2012. ‘Getting on with life’: the experiences of older people using complementary health care. in: Traditional, Complementary and Integrative Medicine: An International Reader London Palgrave Macmillan. pp. 53-60

Do public health messages impact on knowledge, diet and lifestyle choices of women during pregnancy?
Salisbury, C. and Robertson, C.E. 2012. Do public health messages impact on knowledge, diet and lifestyle choices of women during pregnancy? International Journal of Food, Nutrition and Public Health. 5 (4), pp. 225-247.

Alpha thalassaemia and the severity of Plasmodium falciparum infection in microcytic children from the Ashanti region of Ghana
Opoku-Okrah, C., Smith, C.L., Gordge, M.P., Parry, M., Robertson, C.E., Abgenyega, T. and Nakua, E. 2012. Alpha thalassaemia and the severity of Plasmodium falciparum infection in microcytic children from the Ashanti region of Ghana. British Society for Haematology 52nd meeting. Glasgow 16-18 April 2012

A comparison of self-reported analgesic use and detection of urinary ibuprofen and acetaminophen metabolites by means of metabonomics
Loo, R.L., Chan, Q., Brown, I.J., Robertson, C.E., Stamler, J., Nicholson, J.K., Holmes, E. and Elliott, P. 2012. A comparison of self-reported analgesic use and detection of urinary ibuprofen and acetaminophen metabolites by means of metabonomics. American Journal of Epidemiology. 175 (4), pp. 348-358. https://doi.org/10.1093/aje/kwr292

Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure
Brown, I.J., Stamler, J., Van Horn, L., Robertson, C.E., Chan, Q., Dyer, A.R., Huang, C.C., Rodriguez, B.L., Zhao, L., Daviglus, M.L., Ueshima, H. and Elliott, P. 2011. Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure. Hypertension. 57 (4), pp. 695-701. https://doi.org/10.1161/HYPERTENSIONAHA.110.165456

Abstract B76 - An overview of the DietCompLyf study - a multicentre UK study to evaluate the role of diet, lifestyle and complementary medicine use on breast cancer recurrence
Swann, R., Perkins, A., Dahya, P., Woodside, J., Dutton, S., Robertson, C.E., Velentzis, L.S., Leathem, A. and Dwek, M. 2011. Abstract B76 - An overview of the DietCompLyf study - a multicentre UK study to evaluate the role of diet, lifestyle and complementary medicine use on breast cancer recurrence. National Cancer Research Institute (NCRI) Cancer Conference 2011. BT Convention Centre, Liverpool, UK 06 - 09 Nov 2011

Men behaving well? Journeys towards constructive engagement with well-being through meditation
Lomas, T., Cartwright, T., Edginton, T.L. and Ridge, Damien T. 2011. Men behaving well? Journeys towards constructive engagement with well-being through meditation. BSA Medical Sociology Group 43rd Annual Conference 2011. University of Chester 14 - 16 Sep 2011

Men behaving well? Journeys towards constructive engagement with well-being through meditation
Lomas, T., Cartwright, T., Edginton, T.L. and Ridge, Damien T. 2011. Men behaving well? Journeys towards constructive engagement with well-being through meditation. 7th Biennial Conference of the International Society of Critical Health Psychology (ISCHP). Adelaide, South Australia 18 -20 Apr 2011

High-dose vitamin D supplements are not associated with linear growth in a large Finnish cohort
Hyppönen, E., Fararouei, M., Sovio, U., Hartikainen, A.L., Pouta, A., Robertson, C.E., Whittaker, J.C. and Jarvelin, M.R. 2011. High-dose vitamin D supplements are not associated with linear growth in a large Finnish cohort. Journal of Nutrition. 141 (5), pp. 843-848. https://doi.org/10.3945/​jn.110.133009

Maternal haemoglobin during pregnancy and offspring's educational achievement: a prospective cohort study over 30 years
Fararouei, M., Robertson, C.E., Whittaker, J.C., Sovio, U., Ruokonen, A., Pouta, A., Hartikainen, A.L., Jarvelin, M.R. and Hyppönen, E. 2010. Maternal haemoglobin during pregnancy and offspring's educational achievement: a prospective cohort study over 30 years. British Journal of Nutrition. 104 (9), pp. 1363-1368. https://doi.org/10.1017/S0007114510002175

Men behaving well? Journeys towards constructive engagement with well-being through meditation
Lomas, T., Cartwright, T., Edginton, T.L. and Ridge, Damien T. 2010. Men behaving well? Journeys towards constructive engagement with well-being through meditation. Psychology & Health. 25 (S1), p. 265. https://doi.org/10.1080/08870446.2010.502762

A new food frequency questionnaire designed to measure the intake of fatty acids and antioxidants in children
Stiegler, P., Sausenthaler, S., Buyken, A.E., Rzehak, P., Czech, D., Linseisen, J., Kroke, A., Gedrich, K., Robertson, C.E. and Heinrich, J. 2010. A new food frequency questionnaire designed to measure the intake of fatty acids and antioxidants in children. Public Health Nutrition. 13 (1), pp. 38-46. https://doi.org/10.1017/S1368980009005813

Illness perceptions, coping and quality of life in patients with alopecia
Cartwright, T., Endean, N. and Porter, A. 2009. Illness perceptions, coping and quality of life in patients with alopecia. British Journal of Dermatology. 160 (5), pp. 1034-1039. https://doi.org/10.1111/j.1365-2133.2008.09014.x

Dietary starch intake of individuals and their blood pressure: the international study of macronutrients and micronutrients and blood pressure
Brown, I.J., Elliott, P., Robertson, C.E., Chan, Q., Daviglus, M.L., Dyer, A.R., Huang, C.C., Rodriguez, B.L., Sakata, K., Ueshima, H., Van Horn, L., Zhao, L. and Stamler, J. 2009. Dietary starch intake of individuals and their blood pressure: the international study of macronutrients and micronutrients and blood pressure. Journal of Hypertension. 27 (2), pp. 231-236. https://doi.org/10.1097/HJH.0b013e32831a7294

Complementary medicine and health psychology
Cartwright, T., van Wersch, A. and Forshaw, M. 2009. Complementary medicine and health psychology. Open University Press.

Relationship of dietary linoleic acid to blood pressure: the international study of macro-micronutrients and blood pressure study
Miura, K., Stamler, J., Nakagawa, H., Elliott, P., Ueshima, H., Chan, Q., Brown, I.J., Tzoulaki, I., Saitoh, S., Dyer, A.R., Daviglus, M.L., Kesteloot, H., Okayama, A., Curb, J.D., Rodriguez, B.L., Elmer, P.J., Steffen, L.M., Robertson, C.E. and Zhao, L. 2008. Relationship of dietary linoleic acid to blood pressure: the international study of macro-micronutrients and blood pressure study. Hypertension. 52 (2), pp. 408-414. https://doi.org/10.1161/HYPERTENSIONAHA.108.112383

Dietary and supplemental iron, red meat, and blood pressure: INTERMAP study
Tzoulaki, I., Brown, I.J., Chan, Q., van Horn, L., Robertson, C.E., Stamler, J. and Elliott, P. 2008. Dietary and supplemental iron, red meat, and blood pressure: INTERMAP study. 48th Cardiovascular Disease Epidemiology and Prevention Conference. The Broadmoor Hotel - Colorado Springs, CO 13 - 15 Mar 2008

A thematic analysis of childrens' experiences of living with thalassemia major in Pakistan
Mufti, G.E.R., Cartwright, T. and Towell, A. 2008. A thematic analysis of childrens' experiences of living with thalassemia major in Pakistan. Psychology & Health. 23 (S1), p. 189. https://doi.org/10.1080/08870440802299543

The application of post-market monitoring to novel foods
Hepburn, P., Boeing, H., Cockburn, A., Constable, A., Davi, A., de Jong, N., Howlett, J., Moseley, B., Oberdorfer, R., Robertson, C.E., Wal, J.M., Samuels, F. and de Sesmaisons, A. 2008. The application of post-market monitoring to novel foods. Food and Chemical Toxicology. 46 (1), pp. 9-33. https://doi.org/10.1016/j.fct.2007.09.008

Relationship of glycaemic index with cardiovascular risk factors: analysis of the National Diet and Nutrition Survey for people aged 65 and older
Milton, J.E., Briche, B., Brown, I.J., Hickson, M., Robertson, C.E. and Frost, G.S. 2007. Relationship of glycaemic index with cardiovascular risk factors: analysis of the National Diet and Nutrition Survey for people aged 65 and older. Public Health Nutrition. 10 (11), pp. 1321-1335. https://doi.org/10.1017/S1368980007702914

Dietary carbohydrate intake of individuals (total, starch, total sugar) and their blood pressure: INTERMAP study
Brown, I.J., Elliott, P., Chan, Q., Daviglus, M.L., Dyer, A.R., Huang, S., Rodriguez, B.L., Sakata, K., Ueshima, H., Van Horn, L., Stamler, J. and Robertson, C.E. 2007. Dietary carbohydrate intake of individuals (total, starch, total sugar) and their blood pressure: INTERMAP study. 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in association with the Council on Nutrition, Physical Activity, and Metabolism. Buena Vista Palace - Orlando, FL 28 Feb - 03 Mar 2007 Nature Publishing Group.

'Getting on with life': the experiences of older people using complementary health care
Cartwright, T. 2007. 'Getting on with life': the experiences of older people using complementary health care. Social Science & Medicine. 64 (8), pp. 1692-1703. https://doi.org/10.1016/j.socscimed.2006.11.034

Post-market monitoring: Why? What? How?
Robertson, C.E. 2006. Post-market monitoring: Why? What? How? FoodInfo: the newsletter of the International Food Information Service.

Biomarkers for nutrient-gene interactions
Robertson, C.E. and Vineis, P. 2006. Biomarkers for nutrient-gene interactions. in: Choi, S.W. and Friso, S. (ed.) Nutrient-gene interactions in cancer London, UK CRC Press, Taylor & Francis. pp. 37-55

Attainment of precision in implementation of 24 h dietary recalls: INTERMAP UK
Robertson, C.E., Conway, R., Dennis, B.H., Yarnell, J., Stamler, J. and Elliott, P. 2005. Attainment of precision in implementation of 24 h dietary recalls: INTERMAP UK. British Journal of Nutrition. 94 (4), pp. 588-594. https://doi.org/10.1079/BJN20051543

Salt intake and cardiovascular health in adults: analysis of INTERMAP study and NDNS
Robertson, C.E., Hurley, J. and Elliott, P. 2005. Salt intake and cardiovascular health in adults: analysis of INTERMAP study and NDNS. London, UK Food Standards Agency. https://doi.org/N02032

Post-market surveillance of novel foods
Robertson, C.E. 2005. Post-market surveillance of novel foods. Food Science & Technology. 19 (2), pp. 35-37.

Book review: When food kills: BSE, E coli and disaster science
Robertson, C.E. 2005. Book review: When food kills: BSE, E coli and disaster science. Journal of Epidemiology & Community Health. 59 (3), p. 250.

Making sense of illness: the experiences of users of complementary medicine
Cartwright, T. and Torr, R. 2005. Making sense of illness: the experiences of users of complementary medicine. Journal of Health Psychology. 10 (4), pp. 559-572. https://doi.org/10.1177/1359105305053425

Standardised coding of diet records: experiences from INTERMAP UK
Conway, R., Robertson, C.E., Dennis, B.H., Stamler, J. and Elliott, P. 2004. Standardised coding of diet records: experiences from INTERMAP UK. British Journal of Nutrition. 91 (5), pp. 765-771. https://doi.org/10.1079/BJN20041095

Surveillance and post market monitoring of potential health effects of novel (including GM) foods: feasibility study
Elliott, P., Robertson, C.E., Diamond, J. and Best, N. 2004. Surveillance and post market monitoring of potential health effects of novel (including GM) foods: feasibility study. London, UK Food Standards Agency. https://doi.org/G01021

INTERMAP: the dietary data - process and quality control
Dennis, B.H., Stamler, J., Buzzard, M., Conway, R., Elliott, P., Moag-Stahlberg, A., Okayama, A., Okuda, N., Robertson, C.E., Robinson, F., Schakel, S.F., Stevens, M., Van Heel, N., Zhao, L. and Zhou, B.F. 2003. INTERMAP: the dietary data - process and quality control. Journal of Human Hypertension. 17 (9), pp. 609-622. https://doi.org/10.1038/sj.jhh.1001604

Enhancing data on nutrient composition of foods eaten by participants in the INTERMAP study in China, Japan, the United Kingdom, and the United States
Schakel, S.F., Dennis, B.H., Wold, A.C., Conway, R., Zhao, L., Okuda, N., Okayama, A., Moag-Stahlberg, A., Robertson, C.E., Van Heel, N., Buzzard, M. and Stamler, J. 2003. Enhancing data on nutrient composition of foods eaten by participants in the INTERMAP study in China, Japan, the United Kingdom, and the United States. Journal of Food Composition and Analysis. 16 (3), pp. 395-408. https://doi.org/10.1016/S0889-1575(03)00043-7

Tracing ingestion of 'novel' foods in UK diets for possible health surveillance: a feasibility study
Robertson, C.E., Best, N., Diamond, J. and Elliott, P. 2003. Tracing ingestion of 'novel' foods in UK diets for possible health surveillance: a feasibility study. Public Health Nutrition. 7 (2), pp. 345-352. https://doi.org/10.1079/PHN2003528

Book review: McCance and Widdowson's the composition of foods - sixth summary edition
Robertson, C.E. 2003. Book review: McCance and Widdowson's the composition of foods - sixth summary edition. Nutrition Bulletin. 28 (1), pp. 81-83. https://doi.org/10.1046/j.1467-3010.2003.00292.x

Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study
Zhou, B.F., Stamler, J., Dennis, B.H., Moag-Stahlberg, A., Okuda, N., Robertson, C.E., Zhao, L., Chan, Q. and Elliott, P. 2003. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. Journal of Human Hypertension. 17 (9), pp. 623-630. https://doi.org/10.1038/sj.jhh.1001605

Higher blood pressure in middle-aged American adults with less education - role of multiple dietary factors: the INTERMAP study
Stamler, J., Elliott, P., Appel, L.J., Chan, Q., Buzzard, M., Dennis, B.H., Dyer, A.R., Elmer, P.J., Greenland, P., Jones, D., Kesteloot, H., Kuller, L., Labarthe, D., Liu, K., Moag-Stahlberg, A., Nichaman, M., Okayama, A., Okuda, N., Robertson, C.E., Rodriguez, B.L., Stevens, M., Ueshima, H., Van Horn, L. and Zhou, B.F. 2003. Higher blood pressure in middle-aged American adults with less education - role of multiple dietary factors: the INTERMAP study. Journal of Human Hypertension. 17 (9), pp. 655-664. https://doi.org/10.1038/sj.jhh.1001608

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