(303) A Systematic Review of Behavioral Change Techniques in Mobile Health Interventions for Adherence or Self-Management: Application to People with CF

Thursday, November 3, 2022

12:45 PM – 1:25 PM ET

Presenting Author(s)

Emma McWilliams (she/her/hers)

Clinical Research Specialist
Boston Children's Hospital, United States

Co-Author(s)

DY

Dana Yablon

United States
RK

Remi Kesim

United States
RG

Renee Ge

United States
AD

Alfred Donkoh

United States
MA

Melanie Abdelnour

United States
Cynthia George, MSN, FNP

Sr. Director
Cystic Fibrosis Foundation, Maryland, United States
Emily F. Muther, PhD (she/her/hers)

Associate Professor; Licensed Psychologist
University of Colorado School of Medicine
Aurora, Colorado, United States
GO

Gabriela Oates

Assistant Professor
University of Alabama at Birmingham, United States
Kristin A. Riekert, PhD

Professor
Johns Hopkins School of Medicine, Division of Pulmonary & Critical Care Medicine
Baltimore, Maryland, United States
Meghana Sathe, MD

Co-Director Cystic Fibrosis Clinic and Co-Director TDC
University of Texas Southwestern and Children's Medical Center Dallas
Dallas, Texas, United States
GS

Gregory Sawicki, MD MPH

CF Center Director
Boston Children's Hospital, United States
Carolyn Snell, PhD

Psychologist
Boston Children's Hospital
Boston, Massachusetts, United States
MP

Mary-Leigh Phillips

United States
CE

Cyd Eaton

United States

Background: The Success with Therapies Research Consortium (STRC) surveyed the CF community about areas to prioritize in future research. A mobile health (mHealth) app to promote CF self-management was the top rated idea on this survey. However, little is known about which behavior change strategies [Michie et al., 2013] in mHealth interventions could help people manage their CF. Hence, the STRC conducted a registered systematic review to characterize the specific behavior change techniques (BCTs) in empirically evaluated mHealth interventions for promotion of self-management or adherence to treatments (CRD42021224407).

Methods: The research team developed the search strategy and study eligibility criteria and queried databases (e.g., PubMed, Scopus) to identify potentially eligible articles published from 2015 to 2020. Non-CF chronic disease groups were included based on relevance to people with CF. Results were screened via blinded double review, and articles were excluded based on established criteria. A standardized data abstraction form was applied to all meeting inclusion criteria articles. The primary outcome for studies selected for full abstraction was self-management/adherence. The review team coded behavior change techniques, such as prompts/cues, self-monitoring of behavior, and others [Michie et al, 2013] used in each study.

Results: Following removal of duplicates and preliminary screening, 122 manuscripts were included in the final data abstraction, of which 6 involved people with CF. The most common chronic disease groups were Diabetes (n=61, 46.92%), asthma (n=27, 20.77%), and HIV (n=11, 8.46%). The majority of interventions targeted adherence to taking medications (n=68, 33%), followed by diet (n=32, 15%), exercise/physical activity (n=27, 13%), and airway clearance (n=1, 0.5%). The most frequently observed behavior change technique were prompts/cues (e.g., reminders to take medicine; n=85, 70%), followed by self-monitoring of outcomes of behavior (e.g., self-tracking HbA1c using an app; n=73, 60%), feedback on outcomes of behavior (e.g., graph showing daily blood pressure readings; n=60, 49%), and self-monitoring of behavior (e.g., self-tracking when medicine is taken using an app; n=56, 46%). Outcomes of behavior, feedback on behavior, and self-monitoring of behavior were frequently associated with studies classified as having ‘positive’ adherence/self-management outcomes (see Table 1).

Conclusions: There is a small but growing literature examining mHealth interventions to help self-management in CF. Review of broader literature indicates that feedback on outcomes of behavior, feedback on behavior, and self-monitoring of behavior are likely important BCTs to include in interventions aimed at promoting self-management in people with a chronic disease, and potentially for people with CF. The most commonly used BCT, prompts and cues, did not appear to be associated with positive outcomes. These findings will help to plan and conduct future studies evaluating mHealth interventions in CF and other chronic diseases.

Acknowledgements:

References: Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81-95. doi: 10.1007/s12160-013-9486-6.