C0492 - A Systematic Review of the Behavioral Change Determinants Among Patients With NAFLD Using the Theoretical Domains Framework

Megan K. Pham, BS, Maya Balakrishnan, MD
Baylor College of Medicine, Houston, TX

Introduction: Behavioral change, with the goal of clinically significant weight loss, is first line treatment for non-alcoholic fatty liver disease (NAFLD). The first step to develop suitable interventions is to identify the determinants of behavioral changes in physical activity (PA) and diet, which would serve as targets for change techniques. With that objective, we undertook a systematic review to map behavioral determinants in patients with NAFLD using the Theoretical Domains Framework (TDF).

Methods: We searched Medline, EMBASE, Cochrane, PsycINFO, and Web of Science from inception to May 6, 2021 to identify publications that reported the psychosocial determinants of PA and diet among adults with NAFLD. Two independent reviewers screened titles/abstracts, reviewed, and extracted data from included papers. Using thematic content analysis, we summarized and analyzed the data to identify behavioral determinants in patients with NAFLD.

Results: We identified 8 papers evaluating the determinants of behavioral change in adults with NAFLD: 7 addressed PA, 4 addressed diet, and 1 addressed weight loss in general. Findings were mapped to 9 out of 11 relevant TDF domains. Poor knowledge of NAFLD emerged as an important theme: most patients believed their diagnosis of NAFLD had little to no long-term health consequences; moreover, many did not recognize a causal link between their PA and dietary behaviors and NAFLD. Conversely, patients with a family history of liver disease, obesity, diabetes, and elevated transaminases were more likely to perceive NAFLD as a dangerous condition; these patients were also more likely to place greater value on NAFLD treatment. Low PA self-efficacy emerged as a second important theme: although patients perceived PA as beneficial, most were not sufficiently active at baseline, did not know how to increase their PA, and perceived many barriers to increasing PA including a lack of willpower, time, energy, and support from clinicians.

Discussion: Through a systematic review of the literature, we found that there are limited data characterizing behavioral determinants in adults with NAFLD, especially regarding diet. More research is needed, particularly addressing outcome expectations, self-efficacy, and social influences of dietary behaviors. The research so far suggests that interventions should target the following in patients: (1) their understanding of NAFLD and its relation to PA and diet, (2) teach them how to exercise, and (3) help them overcome perceived barriers to PA.




Disclosures:


Megan K. Pham, BS, Maya Balakrishnan, MD. C0492 - A Systematic Review of the Behavioral Change Determinants Among Patients With NAFLD Using the Theoretical Domains Framework, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.