Skip to main content
Article thumbnail
Location of Repository

Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks

By Susan Michie, Karen Jochelson, Wolfgang A. Markham and Christopher Bridle


Background: Interventions to change health-related behaviours have potential to increase health inequalities. \ud Methods: This review investigated the effectiveness of interventions targeting low-income groups to reduce smoking or increase physical activity and/or healthy eating. Of 9766 papers identified by the search strategy, 13 met the inclusion criteria. Intervention content was coded into component technique and theoretical basis, and examined as a potential source of effect heterogeneity. \ud Results: Interventions were heterogeneous, comprising 4–19 techniques. Nine interventions had positive effects, seven resulted in no change and one had an adverse effect. Effective interventions had a tendency to have fewer techniques than ineffective interventions, with no evidence for any technique being generally effective or ineffective. Only six studies cited theory relative to intervention development, with little information about how theory was used and no obvious association with intervention content or effect. \ud Conclusion: This review shows that behaviour change interventions, particularly those with fewer techniques, can be effective in low-income groups, but highlights the lack of evidence to draw on in informing the design of interventions for disadvantaged groups

Topics: RA0421
Publisher: BMJ Group
Year: 2009
OAI identifier:

Suggested articles


  1. (disadvantage$ or depriv$ or poverty or low income).ti,ab.
  2. A ‘‘contract for change’’ increases produce consumption in low income women: a pilot study. doi
  3. (1998). A community-wide smoking cessation program: quit and win doi
  4. (2002). A comparison of program delivery methods for low income nutrition audiences. Topics Clin Nutr doi
  5. (2002). A controlled evaluation of staging dietary patterns to reduce the risk of diabetes in African-American women. Diabetes Care doi
  6. (1995). A heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada: theoretical model and early field experience. doi
  7. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychol doi
  8. A test of major assumptions about behaviour change: a comprehensive look at the effects of passive and active HIVprevention interventions since the beginning of the epidemic. doi
  9. (2000). Actual causes of death in the United States,
  10. (2000). Adherence in social context. Controlled Clin Trials doi
  11. An analysis of parental scaffolding among three AfricanAmerican mother–child dyads participating in the home instruction program for preschool youngsters (HIPPY).
  12. (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cult Diversity Ethnic Minority Psychol doi
  13. Behavior/19.
  14. Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. doi
  15. Cancer prevention among working class, multiethnic adults: results of the healthy directions-health centers study. doi
  16. (2000). Cardiovascular disease risk factor intervention in low-income women: the North Carolina WISEWOMAN project. Prev Med doi
  17. (1994). Changes in the health behaviours of older adults: the San Diego Medicare Preventive Health Project. Prev Med doi
  18. (1999). Characteristics associated with exposure toand participationin atelevised smoking cessation intervention program for women with high school or less education. Prev Med
  19. (1995). Conducting an exercise consultation: guidelines for health professionals.
  20. Cost-effectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: the Massachusetts WISEWOMAN Project. doi
  21. Designing and implementing ‘‘behaviour change’’ interventions to improve population health. doi
  22. (2004). Development of the Patient Activation Measure (PAM): conceptualising and measuring activation in patients and consumers. Health Service Res doi
  23. (2006). Effective recruitment and retention of minority research participants. Annu Rev Public Health doi
  24. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol doi
  25. Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, doi
  26. (2004). Effectiveness of a quit and win contest with a low-income population. Prev Med doi
  27. Effectiveness of strategies for informing, educating and involving patients. doi
  28. (2006). Effects of a primary care weight management intervention on physical activity in low-income African American women. Dissertation Abstracts International: Section B: The Sciences and Engineering
  29. (2004). Enhancing treatment fidelity in health behavior change studies: best practice and recommendations from the Behavior Change Consortium. Health Psychol doi
  30. Evaluation of a community-based home visiting program for low income families.
  31. (2007). Evidence for the effect on inequalities in health of interventions designed to change behaviour. EvidencefortheeffectonInequalitiesdesignedtochangebehavior.pdf.
  32. (2004). Exercise prescription for underprivileged minorities. Curr Sports Med Rep doi
  33. (2008). Fidelity of delivery of a physical activity intervention: predictors and consequences. Psychol Health doi
  34. (1998). Food Cent$—implementing and evaluating a nutrition education project focusing on value for money. doi
  35. (2007). for Health and Clinical Excellence. Behaviour change at population, community and individual levels. Public health programme guidance 6. London: National Institute of Health and Clinical Excellence, doi
  36. Framework for design and evaluation of complex interventions to improve health. doi
  37. (2000). Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Prev Med doi
  38. (2008). From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol Int Rev doi
  39. gain) or overweight).ti,ab.
  40. (2009). Health behavior change as it relates to the adoption of and adherence to a program of physical activity.
  41. (1980). Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, doi
  42. (2001). default.asp.
  43. (1995). Identifying active ingredients in complex behavioural interventions for obese adults with additional risk factors: a systematic review. Under review. APPENDICES A. Databases searched The following databases were searched from
  44. (2004). Identifying techniques that promote health behaviour change: evidence based or evidence inspired? Psychol Health doi
  45. (2002). Implementation, generalization and long-term results of the ‘‘choosing well’’ of diabetes self-management intervention. Patient Educ Counselling doi
  46. Improving control of high blood pressure among middle-aged Turkish women of low socio-economic status through public health training.
  47. in-home, pre-natal nutrition intervention for low-income women. J Am Diet Assoc 1999;99:1058–62. Unable to obtain full-text copies (n=9)
  48. (2004). Increasing access to smoking cessation treatment in a low-income, HIV-positive population: the feasibility of using cellular telephones. Nicotine Tob Res doi
  49. (2009). Downloaded from 4. (disadvantage$ or depriv$ or poverty or low income).ti,ab.
  50. limit 24 to (english language and
  51. limit 24 to (english language and yr=‘‘1995–2007’’) C. Previously unobtained full-text papers (n=21) Full copies now obtained—all independently screened and excluded (n=6)
  52. limit 24 to (english language and yr=‘‘1996–2007’’) Medline (Ovid)
  53. limit 24 to (english language and yr=‘‘1996–2007’’) PsycInfo (Ovid)
  54. (1998). Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans. doi
  55. (2004). nutrition and the prevention of excess weight gain and obesity. Public Health Nutr doi
  56. (2003). Office of National Statistics. Labour Force Survey, doi
  57. (2005). Office of National Statistics. Prevalence of cigarette smoking by sex and socioeconomic classification based on the current or last job of the household reference person.
  58. (2002). Organization. The world health report 2002. Reducing risks to health, promoting healthy life. Geneva: World Health Organization, doi
  59. Promoting physical activity in a socially and economically deprived community: a 12-month randomized control trial of fitness assessment and exercise consultation. doi
  60. Psychological factors influencing cardiovascular risk reduction behavior in low and middle income African-American women.
  61. (2004). RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years. Soc Sci Med doi
  62. (2001). Reducing risk for cardiovascular disease in uninsured women: combined results from two WISEWOMAN projects.
  63. (2007). Research Fund, American Institute of Cancer Research. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Washington DC: Institute of Cancer Research, doi
  64. Sister to sister: a pilot study to assist African American women in subsidized housing to quit smoking.
  65. (2004). Smoking and public health: a review of reviews of interventions to increase smoking cessation, reduce smoking initiation and prevent further uptake of smoking. London: Health Development Agency,
  66. (2006). Social class, education, and smoking cessation: long-term follow-up of patients treated at a smoking cessation unit. Nicotine Tob Res doi
  67. (1999). Social determinants of health. Oxford: doi
  68. (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs,
  69. (1998). Sociodemographic characteristics and individual health behaviors. doi
  70. (2004). Socioeconomic determinants of healthy lifestyles: does psychosocial stress matter? Dissertation Abstracts International: Section B: The Sciences and Engineering
  71. status and low).ti,ab.
  72. (2004). Status syndrome: how your social standing directly affects your health and life expectancy. doi
  73. (2006). The effectiveness of National Health Service intensive treatments for smoking cessation in England: a systematic review. London: National Institute for Clinical and Health Excellence,
  74. (2005). The effectiveness of public health interventions for increasing physical activity among adults: a review of reviews, 2nd edn. London: Health Development Agency,
  75. The English smoking treatment services: one-year outcomes. doi
  76. (1999). The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood. doi
  77. (2000). The short term impact of a health promotion program for low-income African American women. Res Social Work Pract
  78. Themes and issues in the self-regulation of behavior. doi
  79. Unhealthy societies: the afflictions of inequality. doi
  80. (2007). Using community-based participatory research to develop a culturally sensitive smoking cessation intervention with public housing neighbours. Ethnicity Disease
  81. (1997). Using the transtheoretical model of change as a framework for understanding smoking behavior in a sample of low-income, hospitalized, African-American smokers. Dissertation Abstracts International: Section B: The Sciences and Engineering

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.