Applications of equity frameworks in theory-based health behavior interventions: a scoping review.

Abstract

Background: Health behavior theories are scientific frameworks used to inform health behavior interventions to address health-related issues, given their use in understanding and modifying behavior change.

Purpose: We aimed to assess how theory-informed health behavior interventions utilize health equity frameworks and methods.

Methods: Using the PRISMA guidelines, we conducted a scoping review of ten often taught health behavior theories found in health behavior textbooks. We identified 656 intervention papers, and after the title and abstract screening and full-text review, we extracted data from 26 studies. We conducted a thematic analysis to examine 1) the prevalence and quality of behavior interventions informed by health equity frameworks and 2) the application of health equity frameworks in the design and implementation of health behavior interventions.

Results: Theory-informed health behavior interventions incorporating equity frameworks predominately focused on two strategies. First, by incorporating multilevel frameworks via the socioecological model to influence behavior at multiple levels of risk. The second was utilizing community-based participatory methods to integrate the community's cultural, social, and lived experiences into the interventions. Creating practices and policies rooted in lived experiences, such as recording meetings, having childcare, and processes for inclusion of feedback served to embed equity into the intervention design and implementation. Studies that were more dedicated to community involvement showed greater community acceptance and improved intervention outcomes.

Conclusions: Our scoping review identified that incorporating equity into health behavior interventions is essential yet not widely practiced and poorly understood regarding how to "bake in equity." Enhanced training on incorporating equity into theory-informed behavioral interventions could improve health behavior and health education training, research, and practice.