Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities

Alcántara, Carmela; Diaz, Sarah Valentina; Cosenzo, Luciana Giorgio; Loucks, Eric B.; Penedo, Frank J.; Williams, Natasha

doi:10.1080/17437199.2020.1718527

Cited by 45 publications

(40 citation statements)

References 59 publications

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“…In primary care studies, there are multiple ways in which social determinants of health are increasingly being addressed (e.g., screening for social risk factors, linking patients with local resources) [69]. In addition, it is important to consider social determinants as potential moderators of health behavior change [70].…”

Section: Improving the Evidence Base Link Social Determinants With Hementioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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Section: Improving the Evidence Base Link Social Determinants With Hementioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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“…Key moderators flagged in the current set of reviews include social environmental factors and methodological artifacts. Alcántara et al's (2020) review, in particular, suggested that systematic reviews and meta analyses of behavior change interventions generally tended to focus on a narrow set of moderators of intervention effects including individual demographic factors like gender and ethnicity/race, but not occupation and unemployment status, and intervention location. However, few accounted for socio-ecological and structural factors such as neighbourhood characteristics (e.g., levels of crime and violence, environmental presence of health-promoting factors), rural or urban setting, access to healthcare, and exposure to discrimination/racism.…”

Section: Reviews and Meta-analyses Do Not Routinely Account For Key Mmentioning

confidence: 99%

“…Primary studies examining effects of behavior change interventions in minority groups and populations with health disparities are needed (Alcántara et al, 2020). In addition, studies that test intervention efficacy and mechanisms of action when other methodological artifacts like delivery mode, intervention dose, and training level of delivery staff are varied are also needed.…”

Section: Reviews and Meta-analyses Do Not Routinely Account For Key Mmentioning

confidence: 99%

Known knowns and known unknowns on behavior change interventions and mechanisms of action

Hagger

Moyers

McAnally

et al. 2020

Health Psychology Review

139

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Systematic reviews and meta-analyses play an important role in summarizing current research on the efficacy of behavior change interventions and their mechanisms of action. The reviews in this special issue represent a 'step change' in evaluating current evidence on behavior change interventions and mechanisms. This article outlines the findings and emerging issues identified in the reviews ('known knowns'), and summarizes evidence gaps to be addressed in future research ('known unknowns'). Findings indicate that tests of mechanisms of behavior change interventions are not routinely conducted in primary studies and research syntheses; reviews and studies do not sufficiently account for study quality; substantive variability exists in descriptions of intervention content and putative mediators implicated in their mechanisms of action; limited data is available on the efficacy of many behavior change techniques; and moderators of intervention effects and mechanisms are seldom taken into account. Possible solutions include testing effects of isolated behavior change techniques and mechanisms of action; routine evaluation of study quality in behavioral intervention research; development of an evidence base linking behavior change techniques with theory-based constructs that comprise mechanisms of action; adoption of fit-for-purpose methods for synthesizing behavioral intervention mechanisms of action; and routine testing of moderators in intervention research.

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“…10 Accordingly, all these factors fall under the notion on social determinants of health that have been known to lead health inequities within and between countries. 11 As such, these determinants are likely to risk for a disease such as cancer, or vulnerability to disease or injury for people of lower socioeconomic status. 12 This is true for Lebanon, as studies have shown that social determinants of health had lead disparities across gender, income, educational level, governorates, physical environments and employment/working conditions.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Malignancies in Pediatric Population: Results of A Population-Based Case-Control Study

Saab¹,

Naccache²,

Zeenny³

et al. 2021

Preprint

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Cancer is the most common cause of disease-related deaths in childhood. Many sociodemographic, socioeconomic, environmental and genetic risk factors have been associated with a childhood cancer risk. However, few to no such studies have been conducted in the Middle East including Lebanon. This is a population-based case-control study that was conducted in the Lebanese pediatric population. Data was collected through face- to-face interviews, using a questionnaire, with parents of children with cancer in Lebanese pediatric cancer centers over a two-year period. In total, the sample consisted of 322 participants. Results showed that there are several sociodemographic, socioeconomic, environmental factors, in addition to consanguinity between parents, level of education and occupation of the parents , area of residence of the child (location and proximity to high-voltage electrical networks, garbage disposal areas, industrial factories and high-ways) as well as sibling history of cancer are risk factors for childhood cancers in Lebanon. Conclusion: This study informs policy makers on the risk factors in order to find solution as well as policies to decrease and mitigate these risks.

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Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities

Cited by 45 publications

References 59 publications

Implementation science should give higher priority to health equity

Implementation science should give higher priority to health equity

Known knowns and known unknowns on behavior change interventions and mechanisms of action

Risk Factors for Malignancies in Pediatric Population: Results of A Population-Based Case-Control Study

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