Systematic reviews of systematic reviews: communicating personalized disease risk to change behaviour as an exemplar

Abstract

Background: With increasing numbers of systematic reviews being published, which often overlap in scope, it is problematic to form a clear overview of an area. One solution is to apply systematic review methods to reduce the risk of bias in identifying, appraising and synthesising the findings of existing systematic reviews. This approach is applied with regard to systematic reviews that examine the effects of communicating disease risk information that is personalized to the individual on four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. Methods: This systematic review of systematic reviews involved searching four databases. A two-stage screening procedure with good reliability identified nine eligible systematic reviews, which each included between three and 15 primary studies. Results: Methods of personalizing risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimating and communicating risk, the reviews found no evidence that risk information had strong or consistent effects on health-related behaviours. The most promising effects came from interventions using visual or imaging techniques and with smoking cessation and dietary behaviour as outcomes, but effects were inconsistent. Few interventions explicitly used theory, few targeted self-efficacy or response efficacy, and a limited range of Behaviour Change Techniques were used. Discussion: Across reviews employing a broad range of methods of communicating personalised risk information, there is no good evidence that this is sufficient to produce sustained behaviour change on the four key health-related behaviours considered.