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Word of the Day

Peer-based interventions to promote behavior change produce mixed results

Clinical Question:
Are peer-based interventions effective in promoting healthy behavior?

Bottom Line:
Overall, peer-based activities to change behaviors produced mixed results. For specific behaviors, the data are limited and often in conflict. (LOE = 1a-)

Reference:
Webel AR, Okonsky J, Trompeta J, Holzemer WL. A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. Am J Public Health 2010;100(2):247-253.  [PMID:20019321]

Study Design:
Systematic review

Setting:
Various (meta-analysis)

Synopsis:
These authors searched several databases for randomized trials assessing the effectiveness of peer-based interventions in promoting any health-related behavior in adults. To address concerns about study rigor, 2 reviewers assessed quality with a standardized instrument. To meet their inclusion criteria, studies had to score at least 12 (of a possible 18) on a quality scale. The authors briefly mention that they looked for unpublished studies (no details given), but that none were included. They found 25 trials (56 to 2757 patients) that assessed the following outcomes: breastfeeding, physical activity, medication adherence, women?s cancer screenings, self-care activities, smoking cessation, and condom use. They identified 3 pervasive peer-based models: group education led by a peer group leader; pairing a peer with a patient; and a combination of these. In the studies, the intensity and duration of the interventions were quite variable (eg, 5 minutes to 150 minutes, 1 contact to 48 contacts). Here is what they found: Breastfeeding: 6 trials, 3 with statistically positive results, but the overall increase in breastfeeding was not significant (odds ratio [OR] = 2.9; 95% CI, 0.77 - 10.6) Physical activity: 5 studies with mixed results (intervention decreased activity for some and increased for others) Medication adherence: 3 studies, mixed results across studies, but no significant improvement overall Women?s cancer screenings: 3 studies, overall the increase in screening was not statistically significant (OR = 1.88; 0.82 - 4.30) Self-care activities: 2 studies, overall conflicting results on increased chronic disease self-care Smoking cessation: 2 studies, overall increased smoking cessation (OR = 1.64; 1.09 - 2.46) Condom use: 2 studies, both showed an increase in condom use (OR = 2.3; 1.145 - 3.54)

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