TY - JOUR
T1 - Combinations of techniques that effectively change health behavior
T2 - Evidence from Meta-CART analysis
AU - Dusseldorp, Elise
AU - van Genugten, Lenneke
AU - van Buuren, Stef
AU - Verheijden, Marieke W.
AU - van Empelen, Pepijn
PY - 2014
Y1 - 2014
N2 - Objective: Many health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available metaanalyses have not been able to identify specific combinations of techniques that provide synergistic effects. This study overcomes some of the shortcomings in the current methodology by applying classification and regression trees (CART) to meta-analytic data in a special way, referred to as Meta-CART. The aim was to identify particular combinations of BCTs that explain intervention success. Method: A reanalysis of data from Michie, Abraham, Whittington, McAteer, and Gupta (2009) was performed. These data included effect sizes from 122 interventions targeted at physical activity and healthy eating, and the coding of the interventions into 26 BCTs. A CART analysis was performed using the BCTs as predictors and treatment success (i.e., effect size) as outcome. A subgroup meta-analysis using a mixed effects model was performed to compare the treatment effect in the subgroups found by CART. Results: Meta-CART identified the following most effective combinations: Provide information about behavior- health link with Prompt intention formation (mean effect size g = 0.46), and Provide information about behavior- health link with Provide information on consequences and Use of follow-up prompts (g = 0.44). Least effective interventions were those using Provide feedback on performance without using Provide instruction (g- = 0.05). Conclusions: Specific combinations of BCTs increase the likelihood of achieving change in health behavior, whereas other combinations decrease this likelihood. Meta-CART successfully identified these combinations and thus provides a viable methodology in the context of meta-analysis.
AB - Objective: Many health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available metaanalyses have not been able to identify specific combinations of techniques that provide synergistic effects. This study overcomes some of the shortcomings in the current methodology by applying classification and regression trees (CART) to meta-analytic data in a special way, referred to as Meta-CART. The aim was to identify particular combinations of BCTs that explain intervention success. Method: A reanalysis of data from Michie, Abraham, Whittington, McAteer, and Gupta (2009) was performed. These data included effect sizes from 122 interventions targeted at physical activity and healthy eating, and the coding of the interventions into 26 BCTs. A CART analysis was performed using the BCTs as predictors and treatment success (i.e., effect size) as outcome. A subgroup meta-analysis using a mixed effects model was performed to compare the treatment effect in the subgroups found by CART. Results: Meta-CART identified the following most effective combinations: Provide information about behavior- health link with Prompt intention formation (mean effect size g = 0.46), and Provide information about behavior- health link with Provide information on consequences and Use of follow-up prompts (g = 0.44). Least effective interventions were those using Provide feedback on performance without using Provide instruction (g- = 0.05). Conclusions: Specific combinations of BCTs increase the likelihood of achieving change in health behavior, whereas other combinations decrease this likelihood. Meta-CART successfully identified these combinations and thus provides a viable methodology in the context of meta-analysis.
KW - Behavior change techniques
KW - Classification and regression trees
KW - Intervention effectiveness
KW - Meta-analysis
KW - Subgroup
KW - Synergistic effects
UR - http://www.scopus.com/inward/record.url?scp=84925872920&partnerID=8YFLogxK
U2 - 10.1037/hea0000018
DO - 10.1037/hea0000018
M3 - Article
C2 - 24274802
AN - SCOPUS:84925872920
SN - 0278-6133
VL - 33
SP - 1530
EP - 1540
JO - Health Psychology
JF - Health Psychology
IS - 12
ER -