Long-term effects of healthcare professional behaviour change interventions: a systematic review of Cochrane reviews

Abstract

Background: Health professional behaviour needs to change long-term to implement evidence-based interventions and treatments, but failure to successfully implement and sustain change over the long term continues to be a major problem in health and social care. Various systematic reviews have synthesised the evidence for health professional behaviour change interventions. We aim to appraise and synthesise the systematic review evidence relating to sustained health and social care professional behaviour change. Methods: A systematic review of Cochrane reviews. We systematically searched the Cochrane Database for systematic reviews of RCTs, comparing health professional targeted behaviour change interventions to a usual care or no intervention control group. Systematic reviews were included if they reported change in health professional behaviour or behaviour-related outcomes for >12 months. Findings: We identified 6198 possible records and obtained full texts of 92 reviews; 18 reviews met the inclusion criteria. We identified 40 RCTs within the systematic reviews with reported outcomes >12months (median=2 per systematic review). Most reviews (n=12) did not consider or comment on long-term intervention effects. Of reviews commenting on the long-term effects of interventions, four drew inconclusive conclusions and two made neutral and general statements about sustainability. Discussion: Cochrane reviews of health professional behaviour change interventions typically do not examine or comment on long-term intervention effects. Consequently, there is a lack of knowledge about the long-term effects and sustainability of healthcare professional behaviour change interventions. More long-term trials are required and systematic reviews should focus on consistently highlighting long-term outcomes where present.