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Table 3 Indirect comparisons of multifaceted to single interventions ( N =23 reviews)

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

Author Study characteristics Review findingsa Conclusion
Comparison Findings
Arnold (2005) [31] N: 40 studies Single vs. control 14/32 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions have mixed effects when compared to controls
Interventions to Improve Antibiotic Prescribing Practices in Ambulatory Care Study designs: randomized controlled trials, controlled before-after, interrupted time series • 2/4 studies favoured audit and feedback vs. control
• 2/10 studies favoured educational meetings vs. control
Populations: physicians, nurses, other • 3/8 studies favoured educational outreach vs. control
Settings: primary care practices, outpatient clinics, communities, other • 2/2 studies favoured formulary vs. control
AMSTAR (quality) score: 7 • 2/3 studies favoured reminders vs. control
• 3/5 studies favour patient mediated vs. control
Overall: mixed effects (44%)
Multifaceted vs. control 4/7 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (57%)
Beach (2006)b[20] N: 27 studies Single vs. control 8/9 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Improving Health Care Quality for Racial/Ethnic Minorities: A Systematic Review of the Best Evidence Regarding Provider and Organization Interventions Study designs: randomized controlled trials, clinical trials • 6/7 studies favoured reminders vs. control
Populations: physicians, nurses, other • 1/2 studies favoured educational meetings vs. control
Settings: primary care practices, outpatient clinics, communities, other • 1/1 study favoured local consensus process vs. control
AMSTAR (quality) score: 5 Overall: generally effective (89%)
Multifaceted vs. control 5/7 studies reported a multifaceted intervention was effective over a control intervention  
Boonacker (2010) [34] N: 10 studies Single vs. control 17/19 comparison (across N = 6 studies) reported a single intervention was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
Interventions in Health Care Professionals to Improve Treatment in Children with Upper Respiratory Tract Infections Study designs: randomized controlled trials, controlled trials, controlled before-after • 11/13 comparisons favoured reminders vs. control (3 studies)
Populations: physicians, nurses, pharmacists, nurse practitioners • 4/4 comparisons favoured distribution of educational materials vs. control (2 studies)
Settings: primary care practices, hospitals, communities • 2/2 comparisons favoured a local consensus process vs. control (1 study)
AMSTAR (quality) score: 4 Overall: generally effective (89%)
Multifaceted vs. control 4/6 comparisons (across N = 4 studies) reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (67%)
Davey (2005) [28] N: 69 studies Single vs. control 24/34 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
• 5/6 studies favoured audit and feedback vs. control
• 9/11 studies favoured organizational—other vs. control
• 0/2 studies favoured educational outreach vs. control
• 5/6 studies favoured formulary vs. control
• 1/1 favoured professional—other vs. control
• 1/2 studies favoured revision of roles vs. control
• 3/5 studies favoured reminders vs. control
• 0/1 study favoured distribution of educational materials vs. control
Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients Study designs: controlled trials, controlled before-after, interrupted time series Overall: generally effective (71%)
Populations: physician, nurses, pharmacists, other
Settings: hospitals
AMSTAR (quality) score: 7
Multifaceted vs. control 18/26 studies reported a multifaceted intervention was effective over a control intervention
Overall: generally effective (69%)
Flodgren (2011) [35] N: 18 studies (in 19 papers) Single vs. control 29/40 comparisons (across N = 8 studies) reported a single intervention (local opinion leaders) was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
Local Opinion Leaders: Effects on Professional Practice and Health Care Outcomes Study designs: randomized controlled trials (cluster)
Populations: physicians, nurses, other Overall: generally effective (73%)
Settings: primary care practices, hospitals, communities, other
AMSTAR (quality) score: 9
Multifaceted vs. control 16/26 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention  
Overall: mixed effects (62%)
Forsetlund (2009) [18] N: 81 studies Single vs. control 12/16 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes Study designs: randomized controlled trials • 12/15 studies favoured educational meetings vs. control
Populations: nurses, pharmacists, physicians, psychiatrists, other • 0/1 study favoured changes in structure/facilities/equipment vs. control
Settings: communities, hospitals, outpatient clinics, pharmacists, primary care practices Overall: generally effective (75%)
AMSTAR (quality) score: 8 Multifaceted vs. control 10/14 studies reported a multifaceted intervention was effective over a control intervention
Overall: generally effective (71%)
French (2010)c[8] N: 28 studies Single vs. control 12/14 comparisons (across N = 11 studies) reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Interventions for Improving the Appropriate Use of Imaging in People with Musculoskeletal Conditions Study designs: randomized controlled trials, controlled trials, interrupted time series • 5/6 comparisons favoured distribution of educational materials vs. control (5 studies)
• 5/5 comparisons favoured reminders vs.
control (4 studies)
Populations: physicians, other • 2/3 comparisons favoured audit and feedback vs. control (2 studies)
Overall: generally effective (86%)
Settings: primary care practices, hospitals Multifaceted vs. control 14/20 comparisons (across N = 16 studies) reported a multifaceted intervention was effective over a control intervention
AMSTAR (quality) score: 9 Overall: generally effective (70%)
Grimshaw (2004)c[7] N: 235 studies (in 283 papers) Single vs. control 53/62 comparisons (across N = 60 studies) reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
• 7/11 comparisons favoured distribution of educational materials vs. control (11 studies)
• 1/1 comparison favoured educational meetings vs. control (1 study)
• 7/7 comparisons favoured audit and feedback vs. control (6 studies)
• 30/33 comparisons favoured reminders vs. control (32 studies)
• 1/2 comparisons favoured professional—other vs. control (2 studies)
• 0/1 comparisons favoured revisions of roles vs. control (1 study)
• 1/1 comparisons favoured continuity of care vs. control (1 study)
Overall: generally effective (85%)
Effectiveness and Efficiency of Guideline Dissemination and Implementation Strategies Study designs: randomized controlled trials, controlled trials, controlled before-after, interrupted time series
Populations: physicians, nurses, pharmacists, other
Settings: primary care practices, hospitals, outpatient clinics, communities, nursing homes, other
AMSTAR (quality) score: 7
Multifaceted vs. control 74/92 comparisons (across N = 78 studies) reported a multifaceted intervention was effective over a control intervention
Overall: generally effective (80%)
Hakkennes (2008) [36] N: 14 studies (in 27 papers) Single vs. control 6/8 reported a single intervention was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
Guideline Implementation in Allied Health Professions: A Systematic Review of the Literature Study designs: randomized controlled trials, controlled trials, controlled before-after • 3/3 studies favoured educational meetings vs. control
Populations: pharmacists, other • 1/2 studies favoured distribution of educational materials vs. control
Settings: hospitals, pharmacies, primary care practices, outpatient clinics, communities • 1/1 study favoured educational outreach vs. control
AMSTAR (quality) score: 5 • 1/1 study favoured revision of roles vs. control
• 0/1 study favoured reminders vs. control
Overall: generally effective (75%)
Multifaceted vs. control 3/5 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (60%)
Hulscher (2001)b[21] N: 55 studies Single vs. control 13/18 comparisons (across N = 15 studies) reported a single intervention was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
Interventions to Implement Prevention in Primary Care Study designs: randomized controlled trials, controlled before-after • 6/6 comparisons favoured audit and feedback vs. control (5 studies)
Populations: physicians, nurses, other • 3/5 comparisons favoured educational meetings vs. control (4 studies)
Settings: primary care practices, outpatient clinics, medical centres • 1/3 comparisons favoured distribution of educational materials vs. control (3 studies)
AMSTAR (quality) score: 5 • 2/3 comparisons favoured educational outreach vs. control (2 studies)
• 1/1 comparison favoured local consensus proves vs. control (1 study)
Overall: generally effective (72%)
Multifaceted vs. control 4/6 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (67%)
Jamtvedt (2006)b[22] N: 118 studies Single vs. control 28/38 studies reported a single intervention (audit and feedback) was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Audit and Feedback: Effects on Professional Practice and Health Care Outcomes Study designs: randomized controlled trials
Population: any kind of health-care professional Overall: generally effective (74%)
Setting: Any kind of organization Multifaceted vs. control 61/74 studies reported a multifaceted intervention was effective over a control intervention
AMSTAR (quality) score: 8 Overall: generally effective (82%)
Laliberte (2011) [37] N: 13 studies (in 16 papers) Single vs. control 13/13 (100%) comparisons (across N = 6 studies) reported a single intervention was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
Effectiveness of Interventions to Improve the Detection and Treatment of Osteoporosis in Primary Care Settings: A Systematic Review and Meta-Analysis Study designs: RCT, CT, other (cluster RCT) • 12/12 comparisons favoured reminders vs. control (5 studies)
Population: physicians, pharmacists, other (orthopaedic surgeons) • 1/1 comparison (1 study) favoured continuity of care vs. control
Setting: primary care practices, pharmacies, communities Overall: generally effective (100%)
AMSTAR (quality) score: 9 Multifaceted vs. control 4/7 comparisons (across N = 3 studies) reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (57%)
Lemmens (2009) [38] N: 40 studies Single vs. control 2/7 studies reported a single intervention was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally ineffective when compared to controls
A Systematic Review of Integrated Use of Disease-Management Interventions in Asthma and COPD Study designs: randomized controlled trials, controlled before-after • 0/3 studies favoured revision roles—nursing vs. control
Populations: nurses, physicians and pharmacists • 2/3 studies favoured revision roles—pharmacy vs. control
• 0/1 study favoured continuity of care vs. control
Overall: generally ineffective (29%)
Settings: communities, hospitals, nursing homes, outpatient clinics, pharmacies, primary care practices
AMSTAR (quality) score: 8
Multifaceted vs. control 3/7 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (43%)
Lloyd-Evans (2011) [29] N: 11 studies Single vs. control 3/4 comparisons (across N = 2 studies) reported a single intervention (educational meetings) was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Initiatives to Shorten Duration of Untreated Psychosis: Systematic Review Study designs: randomized controlled trials, controlled trials, observational Overall: generally effective (75%)
Populations: physicians, youth workers, counsellors Multifaceted vs. control 7/10 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention
Settings: primary care practices, schools Overall: generally effective (70%)
AMSTAR (quality) score: 6
Lugtenberg (2009) [32] N: 20 studies (in 30 papers) Single vs. control 2/4 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions have mixed effects when compared to controls
Effects of Evidence-Based Clinical Practice Guidelines on Quality of Care: A Systematic Review Study designs: randomized controlled trials, controlled before-after, interrupted time series • 0/1 study favoured audit and feedback vs. control
• 1/1 study favoured distribution of educational materials vs. control
Populations: physicians, other
Settings: primary care practices, hospitals
AMSTAR (quality) score: 5
• 1/1 study favoured educational meetings vs. control
• 0/1 study favoured educational outreach vs. control
Overall: mixed effects (50%)
Multifaceted vs. control 10/18 comparisons(across N = 16 studies) reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (56%)
Marinopoulos (2007)b[23] N: 136 studies Single vs. control 14/22 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions have mixed effects when compared to controls
Effectiveness of Continuing Medical Education Study designs: randomized controlled trials, before-after, observational • 3/6 studies favoured distribution of educational materials vs. control
Populations: physicians, pharmacists, nurses, other 8/13 studies favoured educational meetings vs. control
Settings: primary care practices, hospitals, long-term care facilities 2/2 studies favoured educational outreach vs. control
AMSTAR (quality) score: 7 • 1/1 study favoured audit and feedback vs. control
Overall: mixed effects (64%)
Multifaceted vs. control 24/39 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (62%)
Naikoba (2001) [39] N: 21 studies Single vs. control 6/9 studies reported a single intervention was effective over a control intervention Multifaceted interventions are generally effective when compared to controls, while single interventions have mixed effects when compared to controls
The Effectiveness of Interventions Aimed at Increasing Handwashing in Healthcare Workers - A systematic Review Study designs: randomized controlled trials, controlled trials, observational • 2/4 studies favoured audit and feedback vs. control
Populations: physicians, nurses, other • 2/2 studies favoured reminders vs. control
• 1/2 studies favoured educational meetings vs. control
Settings: hospitals, nursing homes • 1/1 study favoured distribution of educational materials vs. control
AMSTAR (quality) score: 4 Overall: mixed effects (67%)
Multifaceted vs. control 6/7 studies reported a multifaceted intervention was effective over a control intervention
Overall: generally effective (86%)
O'Brien (2007)b[24] N: 69 studies Single vs. control 26/28 studies reported a single intervention (educational outreach) was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Educational Outreach Visits: Effects on Professional Practice and Health Care Outcomes Study designs: randomized controlled trials
Populations: any kind of health-care professional Overall: generally effective (93%)
Settings: primary care practices, outpatient clinics, nursing homes, hospitals, pharmacies, communities Multifaceted vs. control 40/45 studies reported a multifaceted intervention was effective over a control intervention
AMSTAR (quality) score: 8 Overall: generally effective (89%)
Robertson (2010) [40] N: 21 studies Single vs. control 10/11 comparisons (across N = 10 studies) reported a single intervention (reminders) was effective over a control intervention Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls
The Impact of Pharmacy Computerised Clinical Decision Support on Prescribing, Clinical and Patient Outcomes: A Systematic Review of the Literature Study designs: randomized controlled trials, controlled trials, interrupted time series, controlled before-after, cohort
Populations: physicians, nurses, pharmacists, nurse practitioners Overall: generally effective (91%)
Multifaceted vs. control 3/9 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention
Settings: primary care practices, outpatient clinics, hospitals, pharmacies, communities
AMSTAR (quality) score: 4 Overall: mixed effects (33%)
Solomon (1998) [33] N: 49 studies Single vs. control 18/34 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions have mixed effects when compared to controls
Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework Study designs: randomized controlled trials, controlled trials • 8/15 studies favoured audit and feedback vs. control
Populations: physicians, nurses, medical and surgical residents • 5/7 studies favoured distribution of educational materials vs. control
Settings: hospitals, outpatient clinics, communities, other • 3/5 studies favoured reminders—general vs. control
AMSTAR (quality) score: 5 • 0/1 study favoured reminders—CPOE vs. control
• 0/4 studies favoured educational meetings vs. control
• 2/2 studies favoured local consensus process vs. control
Overall: mixed effects (53%)
Multifaceted vs. control 10/18 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (56%)
Steinman (2006) [30] N: 26 studies Single vs. control 10/10 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally effective when compared to controls
Improving Antibiotic Selection: A Systematic Review and Quantitative Analysis of Quality Improvement Strategies Study designs: randomized controlled trials, controlled before-after, interrupted time series • 7/7 studies favoured educational outreach vs. control
Populations: not specified • 1/1 study favoured educational meetings vs. control
Settings: primary care practices, outpatient clinics • 1/1 study favoured audit and feedback vs. control
AMSTAR (quality) score: 5 • 1/1 study favoured distribution of educational materials
Overall: generally effective (100%)
Multifaceted vs. control 21/23 studies reported a multifaceted intervention was effective over a control intervention
Overall: generally effective (91%)
Weinmann (2007)b[25] N: 18 studies (in 17 papers) Single vs. control 1/4 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions are generally ineffective when compared to controls
Effects of Implementation of Psychiatric Guidelines on Provider Performance and Patient Outcome: Systematic Review Study designs: randomized controlled trials, controlled trials, before-after • 1/3 favoured education vs. control
Populations: physicians, nurses, pharmacists, mental health clinicians, medical assistants • 0/1 favoured audit and feedback vs. control
Multifaceted vs. control Overall: generally ineffective (25%)
Settings: primary care practices, hospitals, communities 2/8 studies reported a multifaceted intervention was effective over a control intervention
Overall: generally ineffective (25%)
AMSTAR (quality) score: 5
Wensing (1994)b[6] N: 75 studies Single vs. control 18/30 studies reported a single intervention was effective over a control intervention Both multifaceted and single-component interventions have mixed effects when compared to controls
Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review Study designs: randomized controlled trials, controlled trials, before-after, cohort • 1/4 favoured distribution of educational materials vs. control
Populations: physicians • 2/3 favoured educational outreach vs. control
Settings: primary care practices • 7/10 favoured audit and feedback vs. control
AMSTAR (quality) score: 4 • 6/8 favoured reminders vs. control
• 2/5 favoured educational meetings vs. control
Overall: mixed effects (60%)
Multifaceted vs. control 7/16 studies reported a multifaceted intervention was effective over a control intervention
Overall: mixed effects (44%)
  1. aFindings are reported by the number of studies where available. In a small number of cases, reviews reported findings by the number of comparisons.
  2. bAlso in Table 2.
  3. cAlso in Table 1.