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Abstract
Background It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness.
Methods The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects.
Results We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was −1.86 (95% CI −3.17 to −0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), −1.53 (−2.43 to −0.62; p=0.001) mm Hg; body mass index (14 trials), −0.13 (−0.26 to −0.01; p=0.04) kg/m2; serum total cholesterol (14 trials), −0.13 (−0.19 to −0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes.
Conclusions MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions’ rationale, content and delivery is essential to understanding their effectiveness.
- Cardiovascular Diseases
- Health Behaviour
- Primary Health Care
- Meta-analysis
- Primary Prevention
- Risk Factors.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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Footnotes
Contributors SA, AJW and MCG conceptualised and designed the study. SA and MCG performed the paper search. SA and LM performed the coding. SA wrote the first draft and all authors have read and made improvements of the contents and the wordings.
Funding MCG was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. SA was supported by the Government of Saudi Arabia.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected theseerrors and the correct publishers have been inserted into the references.