Key result
Interventions incorporating behaviour change techniques to reduce prehospital delay in time-critical conditions showed significant reductions in delay time in just over half (20 of 39) of the studies.
Why the study?
Reducing patient delay between symptom onset and treatment in time-critical conditions like ACS remains challenging, and it is unclear which behaviour change techniques (BCTs) embedded within interventions reduce delay.
Do interventions embedding behaviour change techniques reduce patient delay in adults with time-critical conditions like acute coronary syndrome?
Systematic Review (n=200,538)
Do interventions embedding behaviour change techniques reduce patient delay in adults with time-critical conditions like acute coronary syndrome?
Interventions to reduce prehospital delay in time-critical conditions show mixed results, but incorporating multiple behaviour change techniques may improve effectiveness.
Mixed results support selective implementation; leaves open identification of optimal techniques for consistent prehospital delay reduction.
Background: Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective: To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods: The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results: From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions: Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number: CRD42014013106.
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Farquharson et al. (2019) conducted a systematic review in Acute coronary syndrome and other time-critical conditions (n=200,538). Behaviour change techniques (BCTs) was evaluated on Patient delay. Interventions incorporating behaviour change techniques to reduce prehospital delay in time-critical conditions showed significant reductions in delay time in just over half (20 of 39) of the studies.
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