Cited by 368Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

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Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews

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Squires, Janet E, Sullivan, Katrina, Eccles, Martin P, Worswick, Julia, Grimshaw, Jeremy M·2014·Implementation Science

DOI 10.1186/s13012-014-0152-6PMC PMC4194373

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Abstract

BACKGROUND: One of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals' behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing health-care professionals' behaviour in clinical settings. METHODS: The Rx for Change database, which consists of quality-appraised systematic reviews of interventions to change health-care professional behaviour, was used to identify systematic reviews for the overview. Dual, independent screening and data extraction was conducted. Included reviews used three different approaches (of varying methodological robustness) to evaluate the effectiveness of multifaceted interventions: (1) effect size/dose-response statistical analyses, (2) direct (non-statistical) comparisons of multifaceted to single interventions and (3) indirect comparisons of multifaceted to single interventions. RESULTS: Twenty-five reviews were included in the overview. Three reviews provided effect size/dose-response statistical analyses of the effectiveness of multifaceted interventions; no statistical evidence of a relationship between the number of intervention components and the effect size was found. Eight reviews reported direct (non-statistical) comparisons of multifaceted to single-component interventions; four of these reviews found multifaceted interventions to be generally effective compared to single interventions, while the remaining four reviews found that multifaceted interventions had either mixed effects or were generally ineffective compared to single interventions. Twenty-three reviews indirectly compared the effectiveness of multifaceted to single interventions; nine of which also reported either a statistical (dose-response) analysis (N = 2) or a non-statistical direct comparison (N = 7). The majority (N = 15) of reviews reporting indirect comparisons of multifaceted to single interventions showed similar effectiveness for multifaceted and single interventions when compared to controls. Of the remaining eight reviews, six found single interventions to be generally effective while multifaceted had mixed effectiveness. CONCLUSION: This overview of systematic reviews offers no compelling evidence that multifaceted interventions are more effective than single-component interventions.

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Figure 1 Article screening and selection. *Some reviews include more than one level of evidence. Therefore, the cumulative number of reviews is greater than the included number of reviews. N =7 of the reviews reporting indirect comparisons also reported direct comparisons, and N =2 of the reviews reporting indirect comparisons also reported dose-response/effect-based statistical analyses.CC BY · PubMed Central

Figure 2 AMSTAR scores of included reviews ( N =25).CC BY · PubMed Central

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1 retracted

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Authors: Squires, J. E., Sullivan, K., Eccles, M. P., Worswick, J., & Grimshaw, J. M.
Affiliations: University of Ottawa (CA)
Ottawa Hospital Research Institute (CA)
Newcastle University (GB)
Cochrane Canada (CA)
Corresponding author: Squires, Janet E
ORCID: Squires, Janet E
Sullivan, Katrina
Grimshaw, Jeremy M
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2014-10-06
Volume: 9
Issue: 1
Pages: 152-152
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/s13012-014-0152-6
PMC: PMC4194373
OpenAlex: W2140663693
Cited by: 368
References: 43
Citations by year: 2026: 21 · 2025: 24 · 2024: 50 · 2023: 30 · 2022: 33 · 2021: 39 · 2020: 36 · 2019: 26 · 2018: 19 · 2017: 31 · 2016: 20 · 2015: 37 · 2014: 2
FWCI: 5.11
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Implementation Science (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
uO Research (University of Ottawa) (submittedVersion, public-domain)
Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: multicomponent intervention, clinical practice change, evidence-to-practice translation, intervention effectiveness, dose-response relationship, indirect comparison
MeSH terms: Humans, Practice Patterns, Physicians', Research Design, Translational Research, Biomedical

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