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Table 4 Behavior change support—strategies with sufficient or some evidence to support their implementation

From: Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews

Sufficient evidenceSome evidence
Single strategies
 None identified• Video-assisted presentations for patient education may modify behaviors [18].
• Computerized prescribing support interventions can be effectively implemented and may change provider behaviour, but they may be ineffective for improving patient outcomes [9].
Combined strategies
 • “Patient-mediated Knowledge Translation” interventions (defined as strategies that inform, educate and engage patients in their own health care) using print and/or electronic materials before, during or after the consultation improve one or more measures of patient knowledge, decision-making, communication, and behavior [3].
 • Internet and mobile phone-based Information technology platforms for delivering behavior change interventions improve health outcomes (e.g., weight loss) and health behaviors across different disease categories [42].
 • Interventions using social networking sites (e.g., Facebook, Twitter), specific websites, and email as part of multi-component interventions improve behavior-related outcomes [36].
 • Tailored SMS messages combined with other interventions improve targeted behavior changes [30, 50, 54].
 • Patient-interactive computer-generated or computer operated interventions—in clinical encounters “in absentia”—as extensions of face-to-face patient care, combined with print materials or telephone positively affect health behavior change [41].
 • Text messaging as a tool for behavior change in disease prevention and management improves health behaviors (e.g. smoking cessation by smokers, and blood glucose monitoring and reporting via text message in diabetics) and clinical outcomes (e.g. greater weight loss in obese adults, and greater decrease in hemoglobin A1c levels in adolescents and adult diabetics) [27].
• When attributes of health information are framed negatively (e.g., chance of mortality with cancer) understanding may be better than when the same information is framed positively (e.g., chance of survival with cancer). However, perception may be better when it is positively framed [20].
• When goals of health information are framed as loss messages (e.g., “if you do not undergo screening test for cancer, your survival will be shortened”) there may be a more positive perception of effectiveness for screening messages and may be more persuasive for treatment messages than when framed as gain messages [20].
• Use of patient portals allowing patients to access their personal health information (and may also offer functions and services to enhance medical treatment) may lead to a quicker decrease in office visit rates and slower increase in the number of telephone contacts; increase in number of email messages sent; changes of the medication regimens; and better adherence to treatments [23].
• Online social network health behavior interventions may improve health behaviors [38].
• Reminders, lay health worker interventions, home visits plus vaccination, free vaccination, facilitators working with physicians and financial incentives to physicians may improve immunization rates [9].
• Simplified dosing regimens, reminders, cues and/or organizers, reminder packaging, material incentives, support and education, support and motivation, education and training, or information and counseling interventions may improve medicines adherence, but with mixed results [9].
• Other interventions involving pharmacists directly (such as expanded roles encompassing disease education and medicines management) may improve adherence, numbers of prescribed medicines and clinical outcomes, although results are mixed [9].
• SMS reminders and Multimedia Messaging Service may improve adherence to preventive care [50]. Web-based compared to non-Web-based interventions may improve knowledge or behavior change outcomes in many health conditions. Interventions were delivered using Web-based devices and could include: multimedia, classroom, internet support, help seeking strategies, interactive tools, home-based computer network, computer assisted clinic or Kiosk [51].
  1. SMS short message service