Background: Behavioural interventions have been developed to empower patients with adrenal insufficiency and prevent adrenal crisis. Behavioural theory, such as the theoretical domains framework, can inform future intervention development. The current systematic review aims to describe what techniques have been employed in previous interventions and highlight neglected behavioural barriers that could be targeted in future interventions.
Methods: We performed a systematic review to identify studies in which a behavioural intervention was used to prevent adrenal crisis in patients with primary adrenal insufficiency. Data about the interventions were extracted by two reviewers and described narratively. Intervention components were described using the better reporting of interventions (TiDIER) checklist. Active components of the interventions were described using the behaviour change techniques (BCTs) taxonomy (v1). The techniques employed were then mapped onto the barriers and facilitators they were best suited to using the 14 theoretical domains described in the Theoretical Domains Framework and the capabilities-opportunities-motivation-behaviour (COM-B) model.
Results: We identified seven observational studies, no RCTs. Studies assessed their interventions effectiveness on adrenal crises (n = 4), and changes in patient knowledge (n = 4). Assessment of knowledge was inconsistent across studies and improvement in knowledge and self-management was reported in only three studies. Mean number of BCTs per intervention was 6 (3-8). The most frequently targeted domains were knowledge, social influence, and emotion. Seven of the theoretical domains were not targeted in any studies, including beliefs about capabilities, reinforcement, intentions, goals, social professional role and identity, memory, attention and decision processes and behavioural regulation.
Conclusions: Studies describing behavioural interventions to prevent adrenal crises are limited in number and rigor. Future interventions could target neglected barriers, eg, patients ability to regulate their behaviour and goals. Linkages between domains and BCTs offer some suggestions forward, which must be tailored to meet the needs of diverse groups of patients.
08 Nov 2021 - 10 Nov 2021