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Behavior theory for dietary interventions for cancer prevention: a systematic review of utilization and effectiveness in creating behavior change

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Abstract

Purpose

Theory-based approaches are now recommended to design and enact dietary interventions, but their use in cancer trials is unknown. This systematic review examined application of behavior theory to dietary interventions aimed at preventing cancer to improve the design and interpretation of trials.

Methods

Electronic databases were searched (inception-July 2011). Data were synthesized and a theory coding scheme (TCS) used to describe and assess how behavior theory informed interventions. Studies not reporting a dietary behavior intervention informed by a specified behavior change model(s) were excluded.

Results

Of 237 potentially eligible studies, only 40 (16.9 %) were relevant, mostly RCTs (34, 85.0 %). Twenty-one interventions targeted diet alone (52.5 %) or integrated diet into a lifestyle intervention (19, 47.5 %). Most (24, 60.0 %) invoked several behavior change models, but only 10 (25.0 %) interventions were reported as explicitly theory-informed and none comprehensively targeted or measured theoretical constructs or tested theoretical assumptions. The 10 theory-informed interventions were more effective at improving diet.

Conclusions

Dietary interventions for cancer prevention improved diet more effectively if they were informed by behavior theory. While behavior theory was often applied to these dietary interventions, they were rarely implemented or described thoroughly. Accurate intervention reporting is essential to assess theoretical quality and facilitate implementation effective behavior change techniques. Guidelines regarding the application and reporting of behavior theory for complex interventions, for example, proposed by the National Institutes of Health and Medical Research Council, should be revised accordingly. Failure to adequately ground dietary interventions in behavior theory may hinder establishing their effectiveness and relationships between diet and cancer.

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Acknowledgments

This work was supported by the National Institute for Health Research. This work is produced by Kerry Avery under the terms of a Post Doctoral Award research training fellowship issued by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health.

The ProtecT trial is funded by the UK National Institute for Health Research, Health Technology Assessment Programme (HTA 96/20/99) and the CAP trial by Cancer Research UK/UK Department of Health (C11043/A4286, C18281/A8145 and C18281/A11326). Funding for additional research has been received from the World Cancer Research Fund, the University of Bristol Cancer Research Fund and the National Cancer Research Institute (formed by the Department of Health, Medical Research Council and Cancer Research UK).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK

    Kerry N. L. Avery, Jenny L. Donovan, Jeremy Horwood & J. Athene Lane

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  1. Kerry N. L. Avery
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  2. Jenny L. Donovan
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  3. Jeremy Horwood
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Correspondence to Kerry N. L. Avery.

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Avery, K.N.L., Donovan, J.L., Horwood, J. et al. Behavior theory for dietary interventions for cancer prevention: a systematic review of utilization and effectiveness in creating behavior change. Cancer Causes Control 24, 409–420 (2013). https://doi.org/10.1007/s10552-012-9995-9

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