Meta-Analysis of Complex Interventions

Tanner‐Smith, Emily E.; Grant, Sean

doi:10.1146/annurev-publhealth-040617-014112

Cited by 45 publications

(39 citation statements)

References 94 publications

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“…The social network interventions included in this review may have included other active intervention components, and the studies were not typically designed to test causal effects of social network mechanisms or to differentiate the effects of the four types of network intervention approaches. As Tanner-Smith and Grant have suggested, network science itself may offer added value in synthesising the evidence for these different types of network interventions [38]. Further studies are needed to rigorously evaluate different group-segmentation and leader-identification techniques and individuals network approaches such as identifying peripheral nodes, bridging nodes, and early adopters.…”

Section: Discussionmentioning

confidence: 99%

Social network interventions for health behaviours and outcomes: A systematic review and meta-analysis

et al. 2019

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Background There has been a growing interest in understanding the effects of social networks on health-related behaviour, with a particular backdrop being the emerging prominence of complexity or systems science in public health. Social network interventions specifically use or alter the characteristics of social networks to generate, accelerate, or maintain health behaviours. We conducted a systematic review and meta-analysis to investigate health behaviour outcomes of social network interventions. Methods and findings We searched eight databases and two trial registries from 1990 to May 28, 2019, for English-language reports of randomised controlled trials (RCTs) and before-and-after studies investigating social network interventions for health behaviours and outcomes. Trials that did not specifically use social networks or that did not include a comparator group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of health behaviours or outcomes at ≤6 months was assessed by random-effects meta-analysis. Secondary outcomes included those measures at >6–12 months and >12 months. This study is registered with the International Prospective Register of Systematic Reviews, PROSPERO: CRD42015023541. We identified 26,503 reports; after exclusion, 37 studies, conducted between 1996 and 2018 from 11 countries, were eligible for analysis, with a total of 53,891 participants (mean age 32.4 years [SD 12.7]; 45.5% females). A range of study designs were included: 27 used RCT/cluster RCT designs, and 10 used other study designs. Eligible studies addressed a variety of health outcomes, in particular sexual health and substance use. Social network interventions showed a significant intervention effect compared with comparator groups for sexual health outcomes. The pooled odds ratio (OR) was 1.46 (95% confidence interval [CI] 1.01–2.11; I 2 = 76%) for sexual health outcomes at ≤6 months and OR 1.51 (95% CI 1.27–1.81; I 2 = 40%) for sexual health outcomes at >6–12 months. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in haemoglobin A1c (HbA1c), and smoking cessation. Because of clinical and measurement heterogeneity, it was not appropriate to pool data on these other behaviours in a meta-analysis. For sexual health outcomes, prespecified subgroup analyses were significant for intervention approach ( p < 0.001), mean age of participants ( p = 0.002), and intervention length ( p = 0.05). Overall, 22 of the 37 studies demonstrated a high risk of bias, as measured by the Cochrane Risk of Bias tool. The main study limitations identified were the inclusion of studies of variable quality; difficulty in isolating the effects of specific...

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Section: Discussionmentioning

confidence: 99%

Social network interventions for health behaviours and outcomes: A systematic review and meta-analysis

et al. 2019

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“…Statistical heterogeneity was determined with I 2 . A random effects model was employed in our analyses due to the presence of clinical heterogeneity . Meta‐analysis was performed using Review Manager (RevMan) version 5.3 (Cochrane Library Software, Oxford, UK).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Wong

Smith²,

Chua³

et al. 2019

Diabet. Med.

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Aim Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes.Methods We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). ResultsIn total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between selfmanagement interventions and controls in post-intervention HbA 1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision.Conclusions Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes. Diabet. Med. 37, 229-241 (2020) Self-management is a cornerstone of diabetes care. Yet, many have difficulties accomplishing the complex regimen of self-care behaviours, including healthy eating, regular exercise, taking medications as prescribed, managing negative emotions and making regular clinic visits [8]. Additionally, up to 18% of young adults with type 1 diabetes and 30% with type 2 experience moderate to severe depressive symptoms [9], highlighting the need for self-management interventions to facilitate healthy behaviours and achieve optimal diabetes outcomes, while supporting psychological well-being. Self-management interventions form a diverse group, and differ in their method of delivery, mode of communication and intensity [10]. Self-management interventions also incorporate a variety of behavioural change techniques for self-care. The BCT Taxonomy v1

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“…As expected, significant levels of heterogeneity were present across studies in the complete sample analysis. Consequently, we also decided to perform a subgroup analysis as recommended by Tanner- Smith and Grant (2018). This involved dividing the identified interventions into subsections based on the definitions, approaches, and theoretical frameworks used by each individual intervention.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

Psychosocial Interventions for Family Carers of People With Dementia: A Systematic Review and Meta-Analysis

et al. 2020

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Objective:This study aimed to review and synthesize findings of the effectiveness of psychosocial interventions aimed at improving outcomes for family carers of people with dementia. Method: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the following databases: Cochrane, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Excerpta Medica Database (EMBASE), and Applied Social Sciences Index and Abstracts (ASSIA). RevMan 5 software was used to conduct meta-analysis and subgroup analysis using a random-effects model. Results: The search yielded 22 high-quality intervention articles that were suitable for further meta-analysis. Meta-analysis revealed that psychosocial interventions have a small to moderate significant effect on carer burden (standardized mean difference [SMD] = −0.34, confidence interval [CI] = [−0.59, −0.09]), depression (SMD = −0.36, CI = [−0.60, −0.13]), and general health (SMD = 0.34, CI = [0.18, 0.51]). Discussion: Psychosocial interventions had a positive impact on carer outcomes; however, these results should be interpreted with caution, given the significant level of heterogeneity in study designs. Future research could examine contextual and implementation mechanisms underlying psychosocial interventions to develop effective support systems for family carers of people with dementia.

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Meta-Analysis of Complex Interventions

Cited by 45 publications

References 94 publications

Social network interventions for health behaviours and outcomes: A systematic review and meta-analysis

Social network interventions for health behaviours and outcomes: A systematic review and meta-analysis

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Psychosocial Interventions for Family Carers of People With Dementia: A Systematic Review and Meta-Analysis

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