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December 2018

Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management: A Systematic Review

Author Affiliations
  • 1Center for Policy, Outcomes and Prevention, Division of General Pediatrics, Stanford University School of Medicine, Stanford, California
  • 2RAMS Inc, San Francisco, California
  • 3Duke-NUS Medical School, Singapore, Singapore
  • 4University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 5Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
  • 6Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
JAMA Pediatr. 2018;172(12):1177-1186. doi:10.1001/jamapediatrics.2018.3039
Key Points

Question  Does evidence support theory-based health behavior interventions for management of chronic conditions in children and young adults?

Findings  This systematic review of 29 randomized clinical trial articles showed that most studies used Social Cognitive Theory as a framework for behavioral change interventions and observed an association between health-related behaviors and health outcomes.

Meaning  Identifying effective theory-based behavioral interventions can empower those who are involved in the care of children and young adults with chronic conditions.


Importance  Pediatric chronic conditions have become a major public health challenge, and behavioral change plays an important role in overcoming this problem. Many health behavior interventions are described as theory-based, but evidence that such programs properly use theoretical constructs is scant.

Objective  To identify effective theory-based behavioral interventions that motivate patients and families to adopt better self-management behaviors for chronic disease, to review theoretical constructs from each theory and identify the common elements for action, and to rate the level of evidence for each theory-based chronic disease intervention.

Evidence Review  Medline and PsycINFO electronic databases were searched for relevant randomized clinical trial articles published between January 1, 2000, and June 30, 2016, with English language and article type restrictions. These articles reported original data on children and young adults aged 21 years or younger, measured interventions for a pediatric chronic health problem, and assessed the association between interventions and health behavior, knowledge, and outcomes. The Jadad scale was used to evaluate the methods of each article. Articles that explicitly identified the theoretical basis for the intervention and scored 3 points or higher on the Jadad scale were included in the final analysis.

Findings  The database search yielded a total of 36 187 articles, from which duplicates and those that did not meet the inclusion criteria were eliminated, leaving 129 studies for the full review. Of the 129 studies, 29 (22.5%) had higher Jadad scale scores of 3 or 4 points and underwent the final detailed data abstraction and qualitative synthesis. Five chronic conditions were represented, including asthma (55% [16 of 29]), type 1 diabetes (21% [6 of 29]), obesity (14% [4 of 29]), attention-deficit/hyperactivity disorder (7% [2 of 29]), and autistic spectrum disorder (3% [1 of 29]). Most studies (55% [16 of 29]) used Social Cognitive Theory as the theoretical basis for intervention. The following intervention outcomes were reported: 23 (80%) saw a positive association with health-related behaviors (eg, adherence), 8 (28%) with knowledge, 7 (24%) with attitudes, and 26 (90%) with clinical outcomes. Ten studies (34%) showed results in both health behaviors and health outcomes. Twenty-two studies (76%) demonstrated short-term effects (within 6 months), whereas 12 (41%) reported longer-term changes.

Conclusions and Relevance  Identifying effective theory-based behavioral interventions can empower those who are involved in the care of children and young adults with chronic conditions.