Health behaviour change in cardiovascular disease prevention and management: meta-review of behaviour change techniques to affect self-regulation

ABSTRACT

Self-regulation processes assume a major role in health behaviour theory and are postulated as important mechanisms of action in behavioural interventions to improve health prevention and management. The need to better understand mechanisms of behaviour change interventions for cardiovascular diseases (CVD) called for conducting a meta-review of meta-analyses for interventions targeting self-regulation processes. The protocol, preregistered on Open Science Framework (OSF), found 15 eligible meta-analyses, published between 2006 and August 2019, which quantitatively assessed the role of self-regulatory mechanisms and behaviour change techniques (BCTs). Quality of the meta-analyses varied widely according to AMSTAR-2 criteria. Several BCTs, assumed to engage self-regulatory mechanisms, were unevenly represented in CVD meta-analytic reviews. Self-monitoring, the most frequently studied self-regulatory BCT, seemed to improve health behaviour change and health outcomes but these results merit cautious interpretation. Findings for other self-regulatory BCTs were less promising. No studies in the CVD domain directly tested engagement of self-regulation processes. A general challenge for this area stems from reliance on post-hoc tests of the effects of BCTs in multiple-component interventions. Recent advances in BCT taxonomies and the experimental medicine approach to engaging self-regulation mechanisms, however, provide opportunities to improve CVD prevention and management behavioural interventions.

KEYWORDS:

• Meta-review
• self-regulation
• prevention
• intervention
• behaviour change techniques
• cardiovascular disease

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Jerry Suls http://orcid.org/0000-0002-8436-7488

Jazmin N. Mogavero http://orcid.org/0000-0001-7921-0606

Louise Falzon http://orcid.org/0000-0002-9449-6056

Emily A. Hennessy http://orcid.org/0000-0002-5146-5823

Karina W. Davidson http://orcid.org/0000-0002-9162-477X

Notes

1 Michie et al. (2013) instructed 18 experts to ‘ … group together (93) BCTs which have similar active ingredients, i.e., by the mechanism of change’ (p. 85). Hierarchical clustering analysis found a 16-cluster solution was the best fit with a Dunn index value of .57 (see Table 5, pp. 92–93). BCT clusters #8, 9, 14, and 16 included these 11 strategies.

2 The health outcome, all-cause mortality, is quite different from the vast majority of health outcomes (e.g., BP; increased fitness; improved medical adherence) described in this meta-review, but it was included in the Goodwin et al. (2016) meta-analysis. We reported results for all-cause mortality in the interest of comprehensiveness.

Additional information

Funding

This study was supported by the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Institute on Aging (U24AG052175). The authors acknowledge Jennifer Holmes, ELS, for copy editing.