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Meta-Analysis
. 2021 Dec;15(4):508-539.
doi: 10.1080/17437199.2020.1721310. Epub 2020 Feb 17.

Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review

Bonnie Spring  1 , Katrina E Champion  1   2 , Rebecca Acabchuk  3 , Emily A Hennessy  3
Affiliations
Meta-Analysis

Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review

Bonnie Spring et al. Health Psychol Rev. 2021 Dec.

Abstract

Poor quality diet, physical inactivity, and obesity are prevalent, covariant risk factors for chronic disease, suggesting that behaviour change techniques (BCTs) that effectively change one risk factor might also improve the others. To examine that question, registered meta-review CRD42019128444 synthesised evidence from 30 meta-analyses published between 2007 and 2017 aggregating data from 409,185 participants to evaluate whether inclusion of 14 self-regulatory BCTs in health promotion interventions was associated with greater improvements in outcomes. Study populations and review quality varied, with minimal overlap among summarised studies. AMSTAR-2 ratings averaged 37.31% (SD = 16.21%; range 8.33-75%). All BCTs were examined in at least one meta-analysis; goal setting and self-monitoring were evaluated in 18 and 20 reviews, respectively. No BCT was consistently related to improved outcomes. Although results might indicate that BCTs fail to benefit diet and activity self-regulation, we suggest that a Type 3 error occurred, whereby the meta-analytic research design implemented to analyse effects of multi-component intervention trials designed for a different purpose was mismatched to the question of how BCTs affect health outcomes. An understanding of independent and interactive effects of individual BCTs on different health outcomes and populations is needed urgently to ground a cumulative science of behaviour change.

Keywords: Multiple behaviour change; diet; health promotion; obesity treatment; physical activity; self-regulation.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram of search and selection process for the promoting healthy behaviours review.
Figure 2.
Figure 2.
Quality Assessment Results according to AMSTAR-2 ratings, across all reviews. NRSI: non-randomised studies of interventions; PICO: specification of inclusion criteria including the population, intervention, comparison, outcome; RCT: randomised controlled trial; RoB: risk of bias; COI: conflict of interest.
Figure 3.
Figure 3.
Quality and supportiveness of meta-analyses supplied in favour (blue) or opposed (red) for individual self-regulation mechanisms across reviews focused on dietary quality. Bubbles for each meta-analysis are sized proportional to the numbers of studies each meta-analysis included. Darker shades indicate that multiple meta-analyses (i.e., within the same review or across reviews rated as the same overall quality) examined the same BCT.
Figure 4.
Figure 4.
Quality and supportiveness of meta-analyses supplied in favour (blue) or opposed (red) for individual self-regulation mechanisms across reviews focused on physical activity. Bubbles for each meta-analysis are sized proportional to the numbers of studies each meta-analysis included. Darker shades indicate that multiple meta-analyses (i.e., within the same review or across reviews rated as the same overall quality) examined the same BCT.
Figure 5.
Figure 5.
Quality and supportiveness of meta-analyses supplied in favour (blue) or opposed (red) for individual self-regulation mechanisms across reviews focused on weight loss. Bubbles for each meta-analysis are sized proportional to the numbers of studies each meta-analysis included. Darker shades indicate that multiple meta-analyses rated as the same overall quality examined the same BCT.
Figure 6.
Figure 6.
Quality and supportiveness of meta-analyses supplied in favour (blue) or opposed (red) for individual self-regulation mechanisms across reviews focused on hybrid/multiple health-related behaviour outcomes. Bubbles for each meta-analysis are sized proportional to the numbers of studies each meta-analysis included. Darker shades indicate that multiple meta-analyses (i.e., within the same review or across reviews rated as the same overall quality) examined the same BCT.
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