A systematic literature review of computer-based behavioural change interventions to inform the design of an online vbac intervention for the optibirth european randomised trial (Project health – f3 – 2012-305208)

Aim: The aim of this research was to systematically review computer-based, behaviour change (BC) interventions during pregnancy and their design components in order to determine their best application within the context of theOptiBIRTH intervention.

Design: A systematic literature review was undertaken using the Cochrane collaboration guidelines for systematic reviews of health promotion and public health interventions. Literature searches were conducted in: OvidMEDLINE, PubMed, Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied to assess the methodological quality and a taxonomy of BC techniques was used to appraisethe interventions.

PICO: Participants included healthy pregnant women who were ≥18 years old. The types of intervention used were computer-based interventions designed to facilitate a BC approach in a sample of pregnant women. The comparison was routine antenatal care. The primary outcome included improved health behaviour(s), as an indicator of the intention behind the intervention design.

Results: A total of 343 papers were identified through database-searching and hand-searching methods; 80 duplicates were removed. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full-text articles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a total of three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011; Tsoh et al, 2010).The computer-based interventions were designed to bring about BC in relation to alcohol consumption, smoking or diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011; Tsoh et al, 2010). Techniques used included motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomes varied but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes were seen in the interventions by Jackson et al (2011) and Tsoh et al (2010), but not Tzilos et al (2011). The GRADE analysis identified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.

Conclusion: This systematic review reports on the best available evidence and theory to design an online component of a complex intervention for use in an RCT to enhance women’s shared decision-making experience about vaginal births after caesarean (VBAC). The review reports the differences between the observed BC approach and that of a decision-making approach: BC techniques are applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a more healthy option. As a result, techniques designed to create dissonance are considered appropriate.Shared decision-making, however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel for her as a person. Therefore, the authors argue that it is crucial for healthcare professionals designing complex healthcare interventions (either BC techniques or shared decision-making) to ensure that a person’s self-determination is respected through having access to relevant and understandable information and healthcare professionals who understand a woman’s motivation. However, it is not possible to draw firm conclusions from three studies and there is a requirement for further research.