Systematic review and meta-analysis of the effectiveness of volitional help sheet interventions for health behaviour change

Abstract

This systematic review aimed to synthesise studies evaluating the effectiveness of volitional help sheet (VHS) interventions in changing health behaviours, behavioural outcomes and behaviour-related cognitions. Controlled or uncontrolled VHS-based intervention studies targeting health behaviour change were included. Effect sizes were estimated using random effects meta-analyses as standardised mean differences (SMD), mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI). Twenty-seven studies met inclusion criteria; including 25 randomised trials. Interventions targeted health risk behaviours (e.g., alcohol consumption), health promoting behaviours (e.g., physical activity), and behaviour-related outcomes (i.e., weight). Overall, VHS interventions led to significant changes in health behaviours (SMD 0.22, 95% CI, 0.13, 0.30), and non-significant effects on cancer screening OR 0.93 (95% CI, 0.81, 1.07) and weight change (MD – 1.20 kg, 95% CI, – 2.79–0.38). The VHS led to significant changes in intentions (SMD 0.29, 95% CI, 0.08, 0.49; 6 comparisons, n = 770); self-efficacy (SMD 0.31, 95% CI, 0.15, 0.46) and self-regulatory effort (SMD 0.27, 95% CI, 0.03–0.51). Subgroup analysis found no difference for in-person vs remote delivery (P = 0.06) or behavioural categories (P = 0.23). The VHS is a scalable intervention for behaviour change with the potential to support small changes in some health-related behaviours.