Preventative behavioural interventions that reduce health inequities: a systematic review using the theoretical domains framework

BACKGROUND: Wider determinants of health, such as the conditions in which people are born, grow, live, work and age influence health and well-being, often contributing to health inequities. The purpose of this systematic review is to identify preventative behavioural interventions that reduce health inequities or inequalities and to analyse which theoretical domains have been used in the intervention design and implementation.

METHODS: Behavioural interventions that reduced health inequities and inequalities were identified with use of the Theoretical Domains Framework (TDF). Interventions that were aimed at individuals within the axes of inequality and used the TDF in the design and implementation met our inclusion criteria. Periodicals indexed in EMBASE, MEDLINE, PsycINFO and Cochrane Library databases were selected to undertake this review. Grey literature was sought from UK local government organisations, as the sector with significant influence over these determinants. A minimum of two independent reviewers used standardised methods to search, screen, critically appraise and synthesise included studies.

RESULTS: This systematic review identified a total of 41 articles which includes n = 33 primary studies and n = 8 local government reports of behavioural interventions that reduce inequalities for populations within the axes of inequality. Most of the evidence demonstrated that behavioural interventions significantly improved health outcomes and contributed towards positive behavioural changes in health and well-being. A large proportion of the evidence base consist of interventions focusing on diet and exercise uptake (n = 15) specifically aimed at ethnic minorities and those of immigrants and refugee status.

CONCLUSION: Most of the included studies incorporated elements from contemporary behavioural theory. Most health interventions identified in this review included a component to raise awareness and educate their target audience. However, whilst there was often an evidenced based rationale for use of a preventative behavioural intervention, specific frameworks were rarely used to align problems with solutions in a theoretically defined manner.

PROSPERO REGISTRATION: CRD42024553898.