Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities
Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities
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DOI：
10.1080/17437199.2020.1718527
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发表时间：
2020-01-02
影响因子：
9.8
通讯作者：
Williams, Natasha J.
中科院分区：
文献类型：
--
作者：
Alcantara, Carmela;Diaz, Sarah Valentina;Williams, Natasha J.
健康的社会决定因素（SDOH）是指直接或间接影响健康结果并导致健康差异的广泛的社会，经济，政治和心理社会因素。在全世界范围内，解决SDOH问题的努力越来越多，而且协调一致。然而，SDOH在健康行为改变干预研究中的应用尚不清楚。我们回顾了以自我调节为目标的健康行为改变干预的综合文献，以（a）描述社会人口学特征，（B）确定哪些类型的社会决定因素被测试为健康行为改变干预的调节因素，（c）评估荟萃分析证据的方法学质量，（d）讨论科学差距和机会。66篇文章中有30篇（45.4%）通过SDOH检查了治疗效果的异质性。缺乏种族/民族、移民、性/性别少数和生命历程样本的多样性。总体而言，73.5%的SDOH调节剂分析测试了性别，种族/民族和干预设置的治疗效果的异质性;没有检查邻里因素。方法学质量与SDOH分析的数量呈负相关。大多数SDOH调节剂分析是非理论性的，表明统计学上无显著差异。我们提供了一个综合的SDOH和行为改变的科学框架，并讨论了健康行为改变的干预研究，以提高健康公平的科学机会。
Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.