Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities

ABSTRACT

Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.

KEYWORDS:

• Health disparities
• behavioral interventions
• psychosocial
• health risk behaviors
• social determinants
• heterogeneity of treatment effects

Disclosure statement

No potential conflict of interest was reported by the author(s).

ORCID

Carmela Alcántara http://orcid.org/0000-0002-6460-3842

Additional information

Funding

This work was supported by the National Heart and Lung and Blood Institute under grants HL125748 and HL125939; the Agency for Healthcare Research and Quality under grant HS024274, and by the National Institute of Health (NIH) Science Behavior Change Common Fund Program through an awarded administered by the National Center for Complementary and Integrative Health under grants UH3AT009145 and UH2AT00915. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.