The Effectiveness of Interventions to Change Six Health Behaviours: A Review of Reviews

From the abstract of this United Kingdom-based study: "This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency).... The results were discussed in a narrative synthesis.

Results: ....The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours."

The document includes details and charts, organised according to health-related behaviour, on reports of effectiveness of a variety of interventions. Interventions involving communication include: printed materials; face-to-face and telephone therapy and counselling; curricular school-based interventions; nurse-delivered interventions; group counselling; contests; and policy changes, such as those to reduce smoking in public places or increase physical activity in schools.  Interventions by specific health-related behaviour include the following:

• Specific to physical activity: For minors - printed educational materials and curricula that promoting increased physical activity during the school day; education and provision of equipment for monitoring TV or video-game use; efforts to engage parents parents in supporting and encouraging their children's physical activity; and school break activities such as taught playground games or introduced exercise equipment. For adults - telephone counselling and professional advice and guidance (with continued support).
• Specific to smoking: Interventions with a behavioural or educational component; advertising/ media campaign; and smoke-free policies.
• Specific to youth sexual risk taking: "...[T]wo conclusions can be drawn. First, in the area of risk reduction and prevention programmes, interventions are most effective in promoting the uptake of condom use, with some success in reducing the number of sexual partners and the frequency of sex. Second, interventions seeking to promote the use of contraception are more effective than interventions that promote abstinence."
• Specific to drug use: "...A positive effect of skill-based programmes in schools is demonstrated, but it is not possible to reach any conclusion about the effectiveness of non-school based programmes. There is also some evidence that the 11-13 age range may be a crucial period for intervention with vulnerable young people...."
• Specific to healthy eating: There is evidence of a positive effect of telephone-based interventions and nutritional counselling interventions. There is inconclusive evidence for motivational interviewing for changing eating behaviours and interventions such as health education, counselling, changes in environment, and changes in policy to encourage pregnant women to eat healthily.

Conclusions include the following:

"The interventions that appear to be most successful include workplace interventions to support smoking cessation, physical activity and healthy eating; school based interventions across the health behaviours; individual-level interventions drawing on physician advice to promote healthy eating, smoking cessation and responsible/safe levels of alcohol use; and counselling for tobacco and alcohol use. Pregnancy may be a point in the lifecourse when women are especially amenable to making health improving changes (particularly in smoking cessation, and physical activity). Mass media interventions are relatively effective in addressing the interconnectedness of knowledge, attitudes and behaviour within health promoting social marketing. Similarly, population-level legislative interventions (such as smoking bans and age limits for alcohol use) tend to be a part of much wider, more comprehensive campaigns to secure public support for the underlying health promoting message. Clearly, interventions at the individual and community levels should recognise the importance of changing knowledge and attitudes along with promoting healthy behaviour."