Using theory to develop and test interventions to promote changes in health behaviour: evidence, issues, and recommendations

Abstract

Using theory to develop health behaviour interventions provides a useful framework to accumulate evidence and has been associated with larger changes in health behaviour. The present review suggests, however, that the evidence that using theory in this way produces greater health behaviour change is mixed. Furthermore, evaluating such evidence is difficult because: (i) a significant proportion of interventions are not based on theory; (ii) those that are, tend not to apply the theory extensively; (iii) theory-based and comparison groups can be confounded; and (iv) interventions may be based on multiple theories. Such difficulties delay theory evolution and the development of interventions that are capable of achieving significant and sustained changes in health behaviours. Recommendations are made to address these issues.

A cluster randomised controlled trial of an intervention based on the Health Action Process Approach for increasing fruit and vegetable consumption in Iranian adolescents

“…Specifically, the present findings point to the importance of using theory to inform the design of interventions (Michie, Webb, & Sniehotta, 2010;Prestwich, Webb, & Conner, 2015) and involving family members (e.g. mothers) in such programmes.…”

Health behaviour: Current issues and challenges

“…There is some evidence that health behaviour interventions that are based on theory are more effective than those that are not (Prestwich, Webb, & Conner, 2015;Webb, Joseph, Yardley & Michie, 2010), although other reviews have concluded that they produce similar sized effects (Prestwich et al, 2014a). However, many so-called theory-based interventions are probably better classified as "theory-inspired" rather than "theory-based" (Hardeman et al, 2002;Michie & Abraham, 2004).…”

“…Relatedly, using theory to develop health behaviour interventions has been advocated by some (Prestwich et al, 2017) as it provides a useful framework for identifying the key modifiable determinants of health behaviour, designing interventions to target these determinants and accumulating evidence. Some reviews have reported that the use of theory is associated with larger changes in health behaviour (Prestwich et al, 2015), although other reviews have concluded that theory-based interventions and interventions that do not use theory produce similar effect sizes (Prestwich et al, 2014a). The lack of stronger effects for theory-based interventions may be due issues around poor reporting of theory, poor application of theory or just poor theories (Prestwich et al, 2015); future research should therefore be mindful of such issues.…”

“…Some reviews have reported that the use of theory is associated with larger changes in health behaviour (Prestwich et al, 2015), although other reviews have concluded that theory-based interventions and interventions that do not use theory produce similar effect sizes (Prestwich et al, 2014a). The lack of stronger effects for theory-based interventions may be due issues around poor reporting of theory, poor application of theory or just poor theories (Prestwich et al, 2015); future research should therefore be mindful of such issues. One common criticism of attempts to use theory to develop health behaviour interventions is that while they specify what should be changed (i.e., the theoretical constructs) to change behaviour, they typically do not specify how to change these constructs.…”

From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action

“…There is increased recognition of the need for systematic and extensive application of theory to the design of interventions [18,[55][56][57][58][59]; this is reflected, for example, in the UK Medical Research Council's framework for designing and evaluating complex interventions [21] and the Intervention Mapping framework [60] for planning health promotion programmes.…”