An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

摘要

Background: There is a need to identify and analyse the range of models developed touddate for delivering health-related lifestyle advice (HRLA), or training, for effectiveness andudcost-effectiveness in improving the health and well-being of individuals and communities inudthe UK, with particular reference to the reduction of inequalities.ududObjectives: To identify the component intervention techniques of lifestyle advisors (LAs) inudthe UK and similar contexts, and the outcomes of HRLA interventions.ududData sources: Stakeholder views, secondary analysis of the National Survey of HealthudTrainer Activity, telephone survey of health trainer leads/coordinators. A search of a rangeudof electronic databases was undertaken [including the Applied Social Sciences Index andudAbstracts (ASSIA), EMBASE, NHS Economic Evaluation Database (NHS EED), MEDLINE,udPsyc INFO, etc.], as well searching relevant journals and reference lists, conducted fromudinception to September 2008.ududReview methods: Identified studies were scanned by two reviewers and those meeting theudfollowing criteria were included: studies carrying out an evaluation of HRLA; those takingudplace in developed countries similar to the UK context; those looking at adult groups;udinterventions with the explicit aim of health improvement; interventions that involved paidudor voluntary work with an individual or group of peers acting in an advisory role; adviceuddelivered by post, online or electronically; training, support or counselling delivered toudpatients, communities or members of the public. After quality assessment, studies wereudselected for inclusion in the review. Data were abstracted from each study according toudan agreed procedure and narrative, and realist and economic approaches were used toudsynthesise the data. Cost-effectiveness analysis of interventions was undertaken.ududResults: In total, 269 studies were identified but 243 were excluded. The 26 includedudstudies addressing chronic care, mental health, breastfeeding, smoking, diet and physicaludactivity, screening and human immunodeficiency virus (HIV) infection prevention. Overall,udthere was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL), and thus uncertainty about the interventions’udcost-effectiveness. However, the economic analysis showed that LA interventions wereudcost-effective in chronic care and smoking cessation, inconclusive for breastfeeding andudmental health and not cost-effective for screening uptake and diet/physical activity. LAudinterventions for HIV prevention were cost-effective, but not in a UK context.ududLimitations: The wide variety of LA models, delivery settings and target populationsudprevented the reviewers from establishing firm causal relationships between interventionudmode and study outcomes.ududConclusions: Evidence was variable, giving only limited support to LAs having a positiveudimpact on health knowledge, behaviours and outcomes. Levels of acceptability appearedudto be high. LAs acted as translational agents, sometimes removing barriers to prescribedudbehaviour or helping to create facilitative social environments. Reporting of processes ofudaccessing or capitalising on indigenous knowledge was limited. Ambiguity was apparentudwith respect to the role and impact of lay and peer characteristics of the interventions.udA future programme of research on HRLA could benefit from further emphasis onudidentification of needs, the broadening of population focus and intervention aims, theudmeasurement of outcomes and the reviewing of evidence.udFunding: This study was funded by the Health Technology Assessment programme of theudNational Institute for Health Research.