Does theory influence the effectiveness of health behavior interventions? Meta-analysis
Open accessAbstract
OBJECTIVE: To systematically investigate the extent and type of theory use in physical activity and dietary interventions, as well as associations between extent and type of theory use with intervention effectiveness. METHODS: An in-depth analysis of studies included in two systematic reviews of physical activity and healthy eating interventions (k = 190). Extent and type of theory use was assessed using the Theory Coding Scheme (TCS) and intervention effectiveness was calculated using Hedges's g. Metaregressions assessed the relationships between these measures. RESULTS: Fifty-six percent of interventions reported a theory base. Of these, 90% did not report links between all of their behavior change techniques (BCTs) with specific theoretical constructs and 91% did not report links between all the specified constructs with BCTs. The associations between a composite score or specific items on the TCS and intervention effectiveness were inconsistent. Interventions based on Social Cognitive Theory or the Transtheoretical Model were similarly effective and no more effective than interventions not reporting a theory base. CONCLUSIONS: The coding of theory in these studies suggested that theory was not often used extensively in the development of interventions. Moreover, the relationships between type of theory used and the extent of theory use with effectiveness were generally weak. The findings suggest that attempts to apply the two theories commonly used in this review more extensively are unlikely to increase intervention effectiveness.
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While psychosocial theories such as SCT, SLT, and TPB were most commonly used to inform the interventions, these interventions did not incorporate behaviour change taxonomy technique (BCTT).
“While psychosocial theories, such as SCT, SLT, and TPB were most commonly used to inform the interventions, these interventions did not incorporate behaviour change taxonomy technique (BCTT) [64, 65].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [65]
The Discussion (p. 17) identifies SCT and TTM as prominent theories in the interventions, but does not identify SLT and TPB as among the most commonly used. The Data Extraction section (p. 8) records behaviour change techniques used; neither it nor the other passages establishes that the interventions did not incorporate a BCT taxonomy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredLiterature suggests using BCTT with behaviour change theories and frameworks, such as goal setting theory, TTM, TRA, and COM-B framework, for more effective and sustainable behaviour change.
“Literature suggests using BCTT with behaviour change theories and frameworks, such as goal setting theory, TTM, TRA, and Capability, Opportunity, Motivation-Behaviour (COM-B) framework, for more effective and sustainable behaviour change [64–67].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [65]
The Theory and Interventions section (p. 5) says theory can guide the selection of behavior change techniques and that more extensive theory use could improve effectiveness. But the Discussion (p. 15) reports that most analyses found no association between theory use and effectiveness. The paper does not establish sustainable change or support the listed frameworks as a group, so it does not support the sentence’s broader recommendation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBCTTv1 has been used by systematic reviewers to identify BCTs within intervention papers, in order to facilitate intervention comparison and evaluate technique efficacy.
“BCTTv1 has also been used by systematic reviewers to identify BCTs within intervention papers, in order to facilitate intervention comparison and evaluate technique efficacy (e.g. [42–47]).”
Systematic literature reviews and meta-analyses have examined the association between BCTs and theory.
“Systematic literature reviews and meta-analyses have also examined the association between BCTs and theory [45], explored which BCTs are most effective in changing particular mechanisms of action, such as self-efficacy [76–79], and measured the overall effect of mechanisms of action, e.g. a change in intention on behaviour [80].”
A recent meta-analysis found that BCIs are often not designed on a clear theoretical foundation; only 22.5% of 235 implementation studies explicitly used theories of behaviour change, and the majority of those doing so gave no clear explanation for why the selected theories had been used.
“However, a recent meta-analysis found that BCIs are often not designed on a clear theoretical foundation; for example, only 22.5% of 235 implementation studies explicitly used theories of behaviour change 58,59 and the majority of those doing so gave no clear explanation for why the selected theories had been used.”
A meta-analysis of 190 interventions to increase physical activity and healthy eating found that 56% of studies claimed the interventions were based on a theory.
“For example, a meta-analysis of 190 interventions to increase physical activity and healthy eating interventions found that 56% of studies claimed the interventions were based on a theory.58”
Among the studies in that meta-analysis that claimed a theory basis, 90% did not report links between all BCTs and specific theoretical constructs.
“However, 90% of these did not report links between all of the BCTs and specific theoretical constructs.58”
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- Authors
- Prestwich, A., Sniehotta, F. F., Whittington, C., Dombrowski, S. U., Rogers, L., & Michie, S.
- Affiliations
- Newcastle University (GB)
- University College London (GB)
- University of Leeds (GB)
- Venue
- Health Psychology
- Published
- 2014-05
- Volume
- 33
- Issue
- 5
- Pages
- 465-474
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- OpenAlex
- W1987684330
- Cited by
- 562
- References
- 48
- Citations by year
- 2026: 14 · 2025: 35 · 2024: 36 · 2023: 50 · 2022: 53 · 2021: 55 · 2020: 98 · 2019: 43 · 2018: 40 · 2017: 38 · 2016: 41 · 2015: 32 · 2014: 23 · 2013: 2
- FWCI
- 48.88
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- UCL Discovery (University College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Medical Research Council
- Fuse, the Centre for Translational Research in Public Health
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Arts and Humanities › Literature and Literary Theory › Media Influence and Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- health behavior interventions, theory application, intervention effectiveness, behaviour change techniques, social cognitive theory, transtheoretical model, physical activity interventions, dietary intervention, healthy eating interventions, theory-based intervention development
- MeSH terms
- Diet, Health Promotion, Humans, Motor Activity, Psychological Theory, Program Evaluation, Health Behavior
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