Self-regulation mechanisms in health behavior change: a systematic meta-review of meta-analyses, 2006-2017

Abstract

Self-regulation is one primary mechanism in interventions for health behavior change and has been examined in numerous recent meta-analyses. This pre-registered meta-review (PROSPERO CRD42017074018) examined Mmeta-analyses of any intervention and health behavior/outcome were eligible if they quantitatively assessed self-regulation and appeared between January 2006 and August 2017. In total, 66 meta-analyses were ultimately eligible; 27% reported a protocol, 11% used GRADE; 58% focused on RCTs. Reviews satisfied only a moderate number of items on the AMSTAR 2 (M = 45.45%, SD = 29.57%). Only 6% of meta-analyses directly examined whether changes in self-regulation predicted the behavior change (i.e., self-efficacy and physical activity, l = 2; frequency of self-monitoring and goal attainment, l = 1; cognitive bias modification and addiction, l = 1). Meta-analyses more routinely assessed self-regulation by comparing the efficacy of intervention components (97%), such as those from behavior change taxonomies. Meta-analyses that focused on intervention components identified several as successful, including personalized feedback, goal setting, and self-monitoring; however, none were consistently successful in that each worked only for some health behaviors and with particular populations. Some components had inconclusive evidence, given that they were only examined in low- quality reviews. Future reviewers should utilize advanced methods to assess mechanisms, and study authors should report hypothesized mechanisms to facilitate synthesis.

Keywords: Behavior change techniques; health; intervention; meta-review; self-regulation.

Figure 1.

Logic model of review aims and proposed behaviour change pathways. Note. NCD: non-communicable disease; CVD: cardiovascular disease; COPD: chronic obstructive pulmonary disease; BMI: body-mass index

Figure 2.

Flow of reports and meta-analyses into the meta-review. Note. The asterisk indicates that some additional titles/abstracts were deemed ineligible and excluded at certain points in the screening process.

Figure 3.

Quality Assessment Results according to AMSTAR 2 ratings, across all included meta-analyses. Note. NSRI: non-randomized studies of interventions; PICO: specification of inclusion criteria including the population, intervention, comparison, outcome; RCT: randomized controlled trial; RoB: risk of bias.

Figure 4.

Quality and supportiveness of meta-analyses supplied in favour (a) or opposed (b) for individual self-regulation mechanisms across all reviews. Bubbles for each meta-analysis are sized proportional to the numbers of studies each included. The vertical, green line shows the cut-point for higher versus lower quality meta-analyses.