背景:行为改变干预措施是COVID-19应对措施的核心,对于加强大流行准备和抵御能力至关重要。为了有效,干预措施必须针对特定的行为决定因素,但是决定因素是复杂和多方面的,在健壮方面存在差距,理论驱动的证据表明,哪些行为决定因素在改变口罩使用和手部卫生行为方面最有效。
目的:绘制有关COVID-19大流行期间进行的手部卫生和口罩使用行为改变干预措施类型的现有证据,并评估其有效性,可行性和可接受性。
方法:我们进行了系统评价,在4个同行评审数据库中搜索与COVID-19、目标行为(手部卫生和口罩使用)和干预措施相关的术语.符合条件的研究是那些专注于成人或儿童的自然主义,非实验性设置;报告了旨在改变手部卫生和/或口罩使用以减少COVID-19传播的干预措施;提供了明确的结果措施,包括通过自我报告,代理指标或观察。如果研究是纯粹定性的,则被排除在外,意见书或仅基于次要数据;重点关注卫生工作者;衡量预期行为而非制定行为;在实验室或基于卫生保健的环境中进行;涉及婴儿;在2020年3月11日(COVID-19被宣布为大流行)之前发表,并以英语以外的其他语言发表。没有设定地理限制。产生描述性摘要,并评估证据和报告的质量。根据行为目标将研究分为三个子组,并绘制了行为改变技术(BCT)。总结了效果估计,并探讨了BCT与效果之间的关系。在报告的地方总结了可行性和可接受性。由于纳入研究的异质性,无法进行荟萃分析。
结果:16次引用符合标准,子研究(两个引用,包括多个研究)共19个符合条件的研究。大多数是随机对照试验,仅针对手部卫生,并在高收入国家进行。没有人在危机环境中进行。由于大流行的限制,许多干预措施是在网上提供的。研究质量很低,大多数人表现出中等偏倚风险(李克特量表:低,中等,高)。虽然可接受性和可行性很好,两者都很少被评估。“自然后果”是最常用的BCT组。14项研究在至少一个干预臂和/或目标行为中引起了积极或潜在的积极影响。有效的干预措施通常针对多个个体BCT,包括“关于如何执行行为的指令”,\'有关健康后果的信息\',和组\'奖励和威胁\',通过持续一段时间的反复接触。
结论:存在很大的知识差距,特别是在资源匮乏和危机环境中,和现有的证据是低质量的。我们必须解决这些差距,以实现循证实践,并加强大流行的防范和抵御能力。未来的研究应该包括另一个系统的回顾,包括灰色文献和不同的语言,以及更强大的评估,使用实施研究来探索多个BCT在低资源和危机环境中的影响。评价应包括可接受性评估,实用性,可负担性和公平性。
BACKGROUND: behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions must target specific behavioural determinants, but determinants are complex and multifaceted and there is a gap in robust, theory driven evidence on which behavioural determinants are most effective at changing mask usage and hand hygiene behaviour.
OBJECTIVE: to map available evidence on the types of hand hygiene and mask usage behaviour change interventions conducted during the COVID-19 pandemic and assess their effectiveness, feasibility and acceptability.
METHODS: we conducted a systematic
review, searching four peer-reviewed databases for terms related to COVID-19, targeted behaviours (hand hygiene and mask usage) and interventions. Eligible studies were those which focused on adults or children in naturalistic, non-experimental settings; reported on an intervention designed to change hand hygiene and or mask usage to reduce COVID-19 transmission; provided clear outcome measures, including through self-report, proxy indicators or observation. Studies were excluded if they were purely qualitative, opinion pieces or based on secondary data alone; focused on health workers; measured intended rather than enacted behaviour; were conducted in laboratory or health care-based settings; involved infants; were published before the 11th of March 2020 (when COVID-19 was declared a pandemic) and published in a language other than English. There were no geographical limits set. Descriptive summaries were produced and the quality of evidence and reporting was evaluated. Studies were divided into three sub-groups according to the behaviour targeted and behaviour change techniques (BCTs) were mapped. Effect estimates were summarised and the relationship between BCTs and effect was explored. Feasibility and acceptability was summarised where reported. Due to the heterogeneity of studies included, meta-analysis could not be conducted.
RESULTS: sixteen citations met the criteria, with sub-studies (two citations including multiple studies) totalling nineteen eligible studies. The majority were randomised controlled trials which targeted hand hygiene only and were conducted in high income nations, with none conducted in crisis settings. Due to the constraints of the pandemic, many interventions were delivered online. The quality of studies was low, with the majority demonstrating a medium risk of bias (Likert scale: low, medium, high). Whilst acceptability and feasibility was good, both were rarely evaluated. \'Natural consequences\' was the most commonly used BCT group. Fourteen of the studies elicited positive or potentially positive effects in at least one intervention arm and/or targeted behaviour. Effective interventions typically targeted multiple individual BCTs, including \'Instruction on how to perform a behaviour\', \'Information about health consequences\', and group \'Reward and threat\', through repeated engagement over a sustained period of time.
CONCLUSIONS: there is a substantial knowledge gap, particularly in low resource and crisis settings, and available evidence is of low quality. We must address these gaps to enable evidence-based practice and strengthen pandemic preparedness and resilience. Future research should include another systematic
review which includes grey literature and different languages, as well as more robust evaluations which use implementation research to explore the impact of multiple BCTs in low resource and crisis settings. Evaluations should include assessments of acceptability, practicability, affordability and equity.