Automated telephone communication systems for preventive healthcare and management of long‐term conditions

Pawel Posadzki; Nikolaos Mastellos; Rebecca Ryan; Laura H Gunn; Lambert M Felix; Yannis Pappas; Marie‐Pierre Gagnon; Steven A Julious; Liming Xiang; Brian Oldenburg; Josip Car

doi:10.1002/14651858.CD009921.pub2

Cochrane Database of Systematic Reviews

Sistemas de comunicación telefónica automatizados para la prevención de la salud y el tratamiento de enfermedades crónicas

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DOI:

https://doi.org/10.1002/14651858.CD009921.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

14 diciembre 2016see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Consumidores y comunicación

Copyright:

Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Pawel Posadzki

Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
Nikolaos Mastellos

Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
Rebecca Ryan

Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
Laura H Gunn

Public Health Program, Stetson University, DeLand, USA
Lambert M Felix

Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
Yannis Pappas

Institute for Health Research, University of Bedfordshire, Luton, UK
Marie‐Pierre Gagnon

Centre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé, Traumatologie – Urgence – Soins Intensifs, Québec, Canada
Steven A Julious

Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
Liming Xiang

Division of Mathematical Sciences, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore
Brian Oldenburg

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
Josip Car

Correspondencia a: Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

[email protected]

[email protected]

Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK

Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

Contributions of authors

Pawel Posadzki: revised the protocol, re‐ran the searches, screened, extracted and analysed and synthesised data, wrote and revised the drafts.
Nikolaos Mastellos: screened studies, extracted data, and revised the drafts.
Rebecca Ryan: managed the project, assessed methodological quality, revised the drafts.
Laura H Gunn: revised the drafts, and contributed to the statistical methods sections.
Lambert M Felix: revised the protocol, contributed to the design of the conceptual framework, and refined the data extraction form.
Yannis Pappas: revised the drafts.
Marie‐Pierre Gagnon: revised the drafts.
Steven A Julious: provided statistical expertise.
Brian Oldenburg: provided content expertise, revised the drafts.
Josip Car: conceived the idea for the review, managed the project, and revised the drafts.

All authors contributed to the writing or editing of the review.

Sources of support

Internal sources

No sources of support supplied

External sources

The NW London NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC), the Imperial NIHR Biomedical Research Centre, and the Imperial Centre for Patient Safety and Service Quality (CPSSQ), UK.

The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC), the Imperial NIHR Biomedical Research Centre, and the Imperial Centre for Patient Safety and Service Quality (CPSSQ). The views expressed in this publication are those of the authors and not necessarily those of the NIHR, BRC or CPSSQ.

Declarations of interest

Pawel Posadzki: none known.
Nikolaos Mastellos: none known.
Rebecca Ryan: This work was completed by RR as part of her role as editor with CCCG, funded by a Cochrane Infrastructure Grant provided by the National Health and Medical Research Council (NHMRC).
Laura H Gunn: none known.
Lambert M Felix: none known.
Yannis Pappas: none known.
Marie‐Pierre Gagnon: none known.
Steven A Julious:none known.
Liming Xiang: none known.
Brian Oldenburg: none known.
Josip Car: none known.

Acknowledgements

We would like to thank Igor Wei, John Kis‐Rigo, and Caroline Pang Soo Ling for their invaluable support with devising the search strategy for this review. We also acknowledge the referees and the editors for their valuable comments and suggestions. We are grateful to Dr Monika Semwal for initially validating the data extraction form and to Dr Ram Bajpai for his statistical and methodological inputs. We also thank Dr Simon Lewin for his generous role in validating the iCAT_SR tool, Professors Azeem Majeed from Diabetes Research Network and Rifat Atun for their contributions, Dr Nami Minorikawa for writing the initial protocol and designing the initial data extraction form, and Dr Lucinda Cash‐Gibson for revising the protocol and refining the data extraction form.

Version history

Published

Title

Stage

Authors

Version

2016 Dec 14

Automated telephone communication systems for preventive healthcare and management of long‐term conditions

Review

Pawel Posadzki, Nikolaos Mastellos, Rebecca Ryan, Laura H Gunn, Lambert M Felix, Yannis Pappas, Marie‐Pierre Gagnon, Steven A Julious, Liming Xiang, Brian Oldenburg, Josip Car

https://doi.org/10.1002/14651858.CD009921.pub2

2012 Jul 11

Automated telephone communication systems for preventive healthcare and management of long‐term conditions

Protocol

Lucinda Cash‐Gibson, Lambert M Felix, Nami Minorikawa, Yannis Pappas, Laura H Gunn, Azeem Majeed, Rifat Atun, Josip Car

https://doi.org/10.1002/14651858.CD009921

Differences between protocol and review

Objectives: we added a third secondary objective since publishing the protocol: to explore "the behaviour change techniques and theoretical models underpinning the ATCS interventions" to better understand any plausible mechanisms of action that underpin the interventions.
Methods: at protocol stage, the exclusions listed in Types of interventions included studies that "were exclusively for the purpose of electronic history‐taking or risk assessment with no health promotion or interactive elements". We have been modified this to "were exclusively for the purpose of electronic history‐taking or data collection or risk assessment with no health promotion or interactive elements"
We removed the following exclusion stated at protocol stage: "Studies that evaluate the groups that receive similar ATCS components but the interventions differ only by the advanced communicative functions (such as access to an advisor) or supplementary functions (such as email and short messaging service)", because it contradicted the extended inclusion criteria (please see point immediately below).
In Types of interventions, the protocol stated: "We will also include comparisons of one type of ATCS against another". We have altered this to: "We also included studies that compared ATCS interventions (e.g. unidirectional ATCS versus ATCS versus ATCS Plus) to compare the effects of different intervention designs on preventive healthcare or management of long‐term conditions."
In Types of outcome measures, the protocol stated: "To select only one of multiple outcomes, we used the following approach . . . Select the primary outcome which was identified by the publication authors (we took into consideration the possibility of selective outcome reporting bias; we attempted to compare the primary outcomes stated in the protocol with the ones listed in the review, to assist our judgement of this; when no primary outcome was identified, we selected the one specified in the sample size calculation; where there was no sample size calculation, we ranked the effect estimates and selected the median effect estimate." We have altered this to, "For each study we selected all relevant primary outcomes related to human physiology or health behaviour, as these are likely to be most meaningful to clinicians, consumers, the general public, administrators and policymakers." We followed a similar approach for selection of secondary outcomes, with the following text inserted: "For each study, we selected all relevant secondary outcomes as these were also meaningful for the various stakeholders."
The Information Specialist modified the search strategy for MEDLINE.
Unit of analysis issues: the protocol stated: "the comparator arm will be split equally between each treatment arm"; we changed this to: "we compared the relevant ATCS arm with the least active control arm", i.e. from studies with multiple intervention arms only one arm was included without splitting the comparison group.
Unit of analysis issues: we had planned to impute estimates of the ICC using external sources; however, we managed to calculate the ICC using the Fleiss‐Cuzick estimator for binary data in Hess 2013 study.
We incorporated an additional outcome. quality of life, under Secondary outcomes, Patient‐centred outcomes to add outcomes from medical care that are important to patients.
We also incorporated another secondary process outcome, cost‐effectiveness, to add a further layer of information relating to the description and evaluation of resource use associated with ATCS interventions, which might be used in a decision‐making process.
Dealing with missing data: we planned to contact the authors or impute the standard deviations from other similar studies; however, we managed to calculate the standard deviations from other statistics, such as 95% confidence intervals, standard errors, or P values.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Adult; Child; Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Primary preventive healthcare

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Figure 2

Influencing factors and preventive strategies in type 2 diabetes

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Figure 3

Conceptual framework of ATCS in preventive healthcare

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Figure 4

Conceptual framework of ATCS in the management of long‐term conditions

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Figure 5

Management of long‐term conditions

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Figure 6

Study flow diagram

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Figure 7

Subgroups for preventive health and/or management of long term conditions in this review

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Figure 8

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 9

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 ATCS vs control for improving health services uptake (immunisations), Outcome 1 Immunisation in children.

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Analysis 1.2

Comparison 1 ATCS vs control for improving health services uptake (immunisations), Outcome 2 Immunisation in adolescents.

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Analysis 1.3

Comparison 1 ATCS vs control for improving health services uptake (immunisations), Outcome 3 Immunisation in adults.

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Analysis 2.1

Comparison 2 ATCS vs control for improving health services uptake (screening rates), Outcome 1 Breast cancer screening.

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Analysis 2.2

Comparison 2 ATCS vs control for improving health services uptake (screening rates), Outcome 2 Colorectal cancer screening.

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Analysis 3.1

Comparison 3 ATCS vs control for reducing body weight, Outcome 1 BMI adults.

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Analysis 4.1

Comparison 4 ATCS vs usual care for managing diabetes mellitus, Outcome 1 Glycated haemoglobin.

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Analysis 4.2

Comparison 4 ATCS vs usual care for managing diabetes mellitus, Outcome 2 Self‐monitoring of diabetic foot.

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Analysis 5.1

Comparison 5 ATCS vs usual care for reducing healthcare utilisation in patients with heart failure, Outcome 1 Cardiac mortality.

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Analysis 5.2

Comparison 5 ATCS vs usual care for reducing healthcare utilisation in patients with heart failure, Outcome 2 All‐cause mortality.

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Analysis 6.1

Comparison 6 ATCS vs usual primary care and education or usual care for managing hypertension, Outcome 1 Systolic blood pressure.

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Analysis 6.2

Comparison 6 ATCS vs usual primary care and education or usual care for managing hypertension, Outcome 2 Diastolic blood pressure.

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Analysis 7.1

Comparison 7 ATCS for smoking cessation, Outcome 1 Smoking abstinence.

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Summary of findings for the main comparison. Preventive healthcare: effects of ATCS on health services uptake (immunisations)

ATCS versus control on immunisation rates
Patient or population: participants at risk of under‐immunisation (children, adolescents and adults) Settings: primary care Intervention: ATCS (ATCS+, IVR, unidirectional) Comparison: no intervention, usual care or health information (letter)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	ATCS
Behavioural outcome: immunisation rate ATCS Plus, IVR, unidirectional versus no calls, letters, usual care at median follow‐up of 4 months	Study population^a: children Comparator: no intervention		RR 1.25 (1.18 to 1.32)	10,454 (5 studies)	⊕⊕⊕⊝ Moderate^c	Franzini 2000 (N = 1138) reported that compared with controls (no calls), unidirectional ATCS (autodialer) may increase immunisation rates in children (86% versus 64%, low certainty).^d
	308 per 1000	385 per 1000 (363 to 406)
	Moderate^b
	373 per 1000	466 per 1000 (440 to 492)
Behavioural outcome: immunisation rate Unidirectional ATCS versus usual care at median follow‐up of 15 months	Study population^a: adolescents Comparator: usual care		RR 1.06 (1.02 to 1.11)	5725 (2 studies)	⊕⊕⊕⊝ Moderate^e	Szilagyi 2013 (N = 4115) also reported that unidirectional ATCS probably slightly improves the uptake of preventive care visits, compared with usual care (63% ATCS versus 59% usual care; moderate certainty evidence^f).
	543 per 1000	576 per 1000 (554 to 603)
	Moderate^b
	540 per 1000	572 per 1000 (551 to 599)
Behavioural outcome: immunisation rate Unidirectional ATCS versus no calls or health information at median follow‐up of 2.5 months	Study population^a: adults Comparator: no calls or health information		RR 2.18 (0.53 to 9.02)	1743 (2 studies)	⊕⊝⊝⊝ Very low^g,h	—
	10 per 1000	21 per 1000 (5 to 88)
	Moderate^b
	66 per 1000	144 per 1000 (35 to 595)
Adverse outcome: unintended adverse events attributable to the intervention ATCS+, IVR, unidirectional versus various controls	No studies reported adverse events.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS Plus: automated telephone communication systems with additional functions; ATCS: automated telephone communication systems; CI: confidence interval; IVR: interactive voice response; RR: risk ratio; unidirectional ATCS enable non‐interactive voice communication and use one‐way transmission of information or reminders.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aThe assumed risk represents the mean control group risk across studies (calculated by GRADEPro). ^bThe assumed risk represents the median control group risk across studies (calculated by GRADEPro). ^cDowngraded as all six studies were rated as at unclear risk of bias on most domains, including all unclear on allocation concealment; and one study at high risk for randomisation, one study at high risk of performance bias (−1). ^dDowngraded as results are from only one cluster RCT that failed to adequately adjust for clustering in analysis (−1); all risk of bias domains were rated as at unclear risk (−1). ^eDowngraded as one of two studies was rated as at unclear risk on allocation concealment and attrition bias domains (−1). ^fDowngraded as study was rated as at unclear risk on allocation concealment and attrition bias domains (−1). ^gDowngraded as both studies were rated as at unclear on attrition bias, and one study (Hess 2013) was rated as at unclear risk on allocation concealment and at high risk of bias on the 'other' domain (reflecting baseline imbalances between groups and a lack of information to judge whether selective recruitment of participants was adjusted for (−1). ^hDowngraded as there were wide confidence intervals around the effect estimate (imprecision) (−1); downgraded as substantial level of heterogeneity was detected (inconsistency) (−1).

Summary of findings for the main comparison. Preventive healthcare: effects of ATCS on health services uptake (immunisations)

ATCS versus control on screening rates
Patient or population: participants at risk for breast, colorectal or cervical cancer; or osteoporosis Settings: primary, secondary and tertiary care Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR, unidirectional) Comparison: usual care, enhanced usual care or no intervention
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Usual care or enhanced usual care or no intervention	ATCS
Behavioural outcome: breast cancer screening Multimodal/complex intervention versus usual care at 12 months follow‐up	Study population^a		RR 2.17 (1.55 to 3.04)	462 (2 studies)	⊕⊕⊕⊕ High	—
	167 per 1000	363 per 1000 (259 to 508)
	Moderate^b
	167 per 1000	363 per 1000 (259 to 508)
Behavioural outcome: breast cancer screening IVR versus enhanced usual care at median follow‐up of 12 months	Study population^a		RR 1.05 (0.99 to 1.11)	2599 (2 studies)	⊕⊕⊕⊝ Moderate^c	Unidirectional ATCS versus letter 1 further study (Fortuna 2014) (N = 1008) found that unidirectional ATCS (plus letter) probably has little or no effect on breast cancer screening rates at 12 months, adjusted OR 1.3 (95% CI 0.7 to 2.4; moderate certainty^d).
	585 per 1000	614 per 1000 (579 to 649)
	Moderate^b
	432 per 1000	454 per 1000 (428 to 480)
Behavioural outcome: colorectal cancer screening Multimodal/complex intervention versus usual care at median follow‐up of 12 months	Study population^a		RR 2.19 (1.88 to 2.55)	1013 (3 studies)	⊕⊕⊕⊕ High	—
	249 per 1000	545 per 1000 (468 to 635)
	Moderate^b
	167 per 1000	366 per 1000 (314 to 426)
Behavioural outcome: colorectal cancer screening IVR versus usual care at 6‐month follow‐up	Study population^a		RR 1.36 (1.25 to 1.48)	16915 (2 studies)	⊕⊕⊕⊝ Moderate^e	IVR versus control 1 other study (Durant 2014) (N = 47,097) reported that IVR probably increases screening, with 1773 participants from the IVR group and 100 from the no‐call control group completing colorectal cancer screening within 3 months (moderate certainty^f). IVR versus usual care 1 study (Mosen 2010) (N = 6000) also reported that IVR probably increases completion of any colorectal cancer screening (moderate certainty^g).
	119 per 1000	161 per 1000 (148 to 176)
	Moderate^b
	119 per 1000	162 per 1000 (149 to 176)
Behavioural outcome: colorectal cancer screening IVR, unidirectional ATCS versus usual care or letter at longer (9‐12 months) follow‐up	Study population^a		RR 1.01 (0.97 to 1.05)	21,335 (2 studies)	⊕⊕⊕⊝ Moderate^h	IVR versus usual care 1 study (Simon 2010a) (N = 20,000) also reported that IVR probably increases slightly colorectal cancer screening via colonoscopy (moderate certaintyⁱ). Unidirectional ATCS versus letter 1 further study (Fortuna 2014) (N = 1008) at 12 months found that unidirectional ATCS (plus letter) has probably little or no effect on colorectal cancer screening rates at 12 months (15.3% versus 12.2%; adjusted OR 1.2; 95% CI 0.6 to 2.4; moderate certainty^d).
	302 per 1000	305 per 1000 (293 to 317)
	Moderate^b
	245 per 1000	247 per 1000 (238 to 257)
Behavioural outcome: cervical cancer screening ATCS Plus versus control (no calls) at 3 month follow‐up	See comment	See comment	Not estimable	75,532 (1 study)	⊕⊕⊕⊝ Moderate^j	Corkrey 2005 found that ATCS Plus intervention probably slightly improves cervical cancer screening rates at 3 months.
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional versus various controls	No studies reported adverse events.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS: automated telephone communication systems; ATCS Plus: automated telephone communication systems with additional functions; BMD: bone mineral density; CI: confidence interval; HR: hazard ratio; IVR: interactive voice response; OR: odds ratio; RR: risk ratio.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aThe assumed risk represents the mean control group risk across studies (calculated by GRADEPro). ^bThe assumed risk represents the median control group risk across studies (calculated by GRADEPro). ^cDowngraded as risk of bias was unclear for allocation concealment in both studies, and randomisation and blinding rated unclear in one study (−1). ^dDowngraded as confidence intervals were wide (imprecision) and included both a potential harm and a potential benefit (−1). ^eDowngraded as risk of bias was unclear for all items in one study, and in the other allocation concealment and blinding were rated as unclear (−1). ^fDowngraded as risk of bias was unclear for all items except 'other' bias, which was rated as high risk (−1). ^gDowngraded as risk of bias was rated unclear for allocation concealment and blinding (−1). ^hDowngraded as risk of bias was rated as unclear for allocation concealment in both studies and blinding was rated high risk in one study (−1). ⁱDowngraded as risk of bias was rated unclear for allocation concealment and high risk for blinding (−1). ^jDowngraded as all items were rated as at unclear risk of bias (−1).

ATCS versus control for body weight
Patient or population: overweight or obese individuals (both children and adults) Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR) Comparison: usual care, no intervention or control
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments^a
	Assumed risk	Corresponding risk
	Controls	ATCS
Clinical and behavioural outcome: BMI score in adults Multimodal/complex intervention, ATCS Plus or IVR versus usual care at median follow‐up of 18 months	The mean BMI in the control groups was 34.7 kg/m²	The mean BMI of adults in the intervention groups was 0.64 kg/m²lower (1.38 lower to 0.11 higher)	Not estimable	672 (3 studies)	⊕⊕⊝⊝ Low^b	ATCS Plus versus control Vance 2011 (N = 140) found that ATCS Plus may reduce slightly BMI (low certainty evidence^c).
Clinical and behavioural outcome: body weight in adults, 12 weeks	See comment	See comment	Not estimable	See comment	See comment	ATCS Plus versus control Vance 2011 (N = 140) found that ATCS Plus may reduce slightly body weight and waist circumference (low certainty evidence^c). IVR versus control Estabrooks 2008 (N = 77) reported that IVR may have little or no effect on body weight (percent lost or change in) (low certainty evidence^d).
Clinical and behavioural outcome: body weight in adults, at median follow‐up of 18 months	See comment	See comment	Not estimable	See comment	See comment	ATCS (multimodal/complex intervention, ATCS Plus, IVR) versus usual care Bennett 2012 (N = 365) found that ATCS Plus probably slightly reduces body weight at 18 months (moderate certainty evidence).^eBennett 2013 (N = 194) found that multimodal/complex intervention may reduce body weight at 18 months (low certainty evidence).^f IVR versus usual care Goulis 2004 (N = 122) found that IVR probably reduces slightly body weight but probably has little or no effect on obesity assessment scores at 6 months (moderate certainty evidence).^f
Clinical and behavioural outcome: blood pressure, blood glucose, cholesterol levels	See comment	See comment	Not estimable	See comment	See comment	ATCS (ATCS Plus, IVR) versus usual care/control Bennett 2012 (N = 365) found that ATCS Plus probably has little or no effect on systolic or diastolic blood pressure at 18 months (moderate certainty evidence^e). ATCS Plus versus control Vance 2011 found that ATCS Plus may slightly improve slightly systolic blood pressure and blood glucose levels at 12 weeks (low certainty evidence^c). IVR versus usual care Goulis 2004 (N = 122) found that IVR probably has little or no effect on systolic or diastolic blood pressure, plasma glucose levels, or high‐density lipoprotein cholesterol, but it probably slightly reduces total cholesterol and triglyceride levels at 6 months (moderate certainty evidence).^e
Clinical outcome: BMI z‐score in children at median follow‐up of 7.5 months	See comment	See comment	Not estimable	See comment	⊕⊕⊕⊝ Moderate^e	ATCS Plus versus control Estabrooks 2009 (N = 220) found that ATCS Plus has probably little or no effect on BMI z‐scores in children at 12 months. IVR versus control Wright 2013 (N = 100) found that IVR has probably little or no effect on BMI z‐scores in children at 3 months.
Behavioural outcome: physical activity, dietary habits in children at median follow‐up of 7.5 months	See comment	See comment	Not estimable	See comment	⊕⊕⊕⊝ Moderate⁴	ATCS Plus versus control Estabrooks 2009 (N = 220) found that ATCS Plus has probably little or no effect on self‐reported physical activity, sedentary behaviours or dietary habits at 12 months. IVR versus control (no calls) Wright 2013 (N = 100) found that IVR has probably little or no effect on total caloric intake, fruit intake, or sedentary behaviours at 3 months.
Adverse outcome: unintended adverse events attributable to the intervention IVR versus usual care	See comment	See comment	See comment	559 (2 studies)	See comment	Bennett 2012 (N = 365) reported 1 serious musculoskeletal injury in the intervention group and 3 events (1 cardiovascular and 2 cases of gallbladder disease) in the usual care group (moderate certainty evidence).^e,g Bennett 2013 (N = 194) reported 6 serious adverse events in the intervention arm, including gynaecological surgery in 2 participants and knee replacement, breast abscess, musculoskeletal injury, and cancer diagnosis in 1 participant each; all participants except the one with the cancer diagnosis required hospitalisation (low certainty evidence).^f,g
The corresponding risk* (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS: automated telephone communication systems; ATCS Plus: automated telephone communication systems with additional functions; BMI: body Mass Index; CI: confidence interval; IVR: interactive voice response; SMD: Standardised mean difference.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aAdditional findings presented are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as allocation concealment was rated as at unclear risk of bias in all three studies, and randomisation unclear in one study, with high risk of performance bias in two studies (−1); downgraded as substantial level of heterogeneity was detected (inconsistency) (−1). ^cDowngraded as all items were rated as at unclear risk of bias (−1); and results were obtained from a single small study at potential risk of bias (−1). ^dDowngraded as performance bias was rated as high risk (−1); and results were obtained from a single very small study at potential risk of bias (−1). ^eDowngraded as results were each obtained from a single small study (−1). ^fDowngraded as randomisation and allocation concealment was rated as at unclear risk and performance bias was rated as high risk (−1); and results were obtained from a single small study at potential risk of bias (−1). ^gThe authors of the study could not conclusively determine whether reported events resulted from study participation.

ATCS versus control as appointment reminders (reducing non‐attendance rates)
Patient or population: patients/healthcare consumers Settings: various settings Intervention: ATCS (ATCS Plus, IVR, unidirectional) Comparison: no intervention (calls) or nurse‐delivered calls
Outcomes	Effect of intervention^a	No of participants (studies)	Quality of the evidence (GRADE)
Health behaviour: attendance rates, 6 weeks ATCS Plus versus nurse‐delivered calls	ATCS Plus calls delivered 3 or 7 days prior to flexible sigmoidoscopy or/and colonoscopy examinations probably have little or no effect on appointment non‐attendance or preparation non‐adherence.	3610 (1 study)	⊕⊕⊕⊝ Moderate^b
Health behaviour: attendance rates, 4 months IVR versus no calls	IVR improves attendance rates: OR 1.52 (95% CI 1.34 to 1.71).	12,092 (1 study)	⊕⊕⊕⊕ High
Health behaviour: return tuberculin test rate, 3 days Unidirectional ATCS versus no calls	Unidirectional ATCS may improve test return rates.	701 (1 study)	⊕⊕⊝⊝ Low^c
Health behaviour: attendance rates, 1 month Unidirectional ATCS versus no calls	Undirectional ATCS may improve attendance rates RR 1.60 (95% CI 1.29 to 1.98).	517 (1 study)	⊕⊕⊝⊝ Low^c
Health behaviour: attendance rates, 6‐8 weeks Unidirectional ATCS versus no calls	2 studies reported conflicting results: Reekie 1998 (N = 1000) reported that unidirectional ATCS probably decrease non‐attendance rates at 6 weeks; while Maxwell 2001 (N = 2304) reported the interventions probably have little or no effect at 2 months.	3304 (2 studies)	⊕⊕⊕⊝ Moderate^d
Health behaviour: attendance rates, 6 months Unidirectional ATCS versus no calls	Unidirectional ATCS may improve attendance: OR 1.50 (P < 0.01).	2008 (1 study)	⊕⊕⊝⊝ Low^e
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR, unidirectional ATCS versus various controls	No studies reported adverse events.
ATCS: automated telephone communication systems; ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; IVR: interactive voice response; OR: odds ratio; RR: risk ratio.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aThe findings presented are based on a narrative summary and synthesis of results, many of which were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as most items (including randomisation and allocation concealment) were rated as being at unclear risk of bias (−1). ^cDowngraded as both studies considered were rated as being at high risk of bias on randomisation and at unclear risk on allocation concealment and other items (‐2) (Dini 1995; Tanke 1994). ^dDowngraded as all items were rated as being at unclear risk of bias (−1). ^eDowngraded as randomisation was rated as at high risk of bias; and study was rated as at unclear risk of bias on other items (‐2).

ATCS versus control for adherence to medication or laboratory tests
Patient or population: patients with various conditions or at risk of low adherence to medication or laboratory tests Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR, unidirectional ATCS) Comparison: usual care, no calls, controls (other ATCS)
Outcomes	Effect of interventions^a	No of participants (studies)	Quality of the evidence (GRADE)	Comments
Behavioural outcome: adherence to medication Multimodal/complex interventions^b versus usual care or control	The effects of multimodal/complex interventions are inconclusive.	888 (2 studies)	See comment	Ho 2014 (N = 241) reported that the multimodal/complex intervention probably improves adherence to cardioprotective medications at 12 months (moderate certainty^c). Stuart 2003 (N = 647) found uncertain effects of the intervention on adherence to antidepressant medications (very low certainty^c,d).
Behavioural outcome: adherence to medication ATCS Plus versus control or single IVR call	Results suggest that ATCS Plus probably slightly improve measures of adherence.	2340 (2 studies)	See comment	Cvietusa 2012 (N = 1393) reported that ATCS Plus, compared with control, probably improves time to first inhaled corticosteroid refill and probably slightly improves the proportion of days with medication on hand in children (moderate certainty^e). Stacy 2009 (N = 947) reported that ATCS Plus probably slightly improves statin adherence at 6 months, compared with a single IVR call (moderate certainty^f).
Behavioural outcome: adherence to laboratory tests ATCS Plus or IVR versus no intervention or usual care	Results suggest that ATCS Plus probably has little or no effect on adherence to testing, while IVR probably improves test completion.	15,218 (3 studies)	See comment	ATCS Plus versus no intervention Derose 2009 (N = 13,057) found that ATCS Plus probably has little or no effect on adherence to testing (completion of all 3 recommended laboratory tests for diabetes patients) at 12 weeks (moderate certainty^g). Simon 2010b (N = 1200) found that these interventions probably have little or no effect on retinopathy examination rates or tests for glycaemia, hyperlipidaemia or nephropathy in diabetic patients at 12 months (moderate certainty^h). IVR versus usual care Feldstein 2006 (N = 961) found that IVR probably improves patients' completion of all recommended laboratory tests at 25 days follow‐up (moderate certaintyⁱ).
Behavioural outcome: adherence to medication or composite outcome (medication adherence and rate of adverse events) ATCS Plus versus usual care	Results indicate that ATCS Plus probably improves medication adherence and may slightly improve a composite measure.	35,816 (4 studies)	See comment	2 studies (Derose 2013 (N = 5216) and Vollmer 2014 (N = 21,752)) reported that ATCS Plus probably improves adherence to statins to some extent. Vollmer 2011 (N = 8517) found that ATCS Plus probably slightly improves adherence to inhaled corticosteroids (moderate certainty^j). Sherrard 2009 (N = 331) found that ATCS Plus may slightly improve a composite measure of medication adherence and adverse events at 6 months follow‐up (low certainty^c,k).
Behavioural outcome: adherence to medication or laboratory tests IVR versus control	Results suggest that IVR probably improves slightly medication adherence.	4,238,362 (4 studies)	See comment	Adams 2014 (N = 475) found that IVR may slightly improve comprehensiveness of screening and counselling (low certainty^c,l). Bender 2010 (N = 50) reported that IVR may improve adherence to anti‐asthmatic medications at 2.5 months follow‐up (low certainty^c,e). Leirer 1991 (N = 16) reported that IVR may slightly reduce medication non‐adherence (low certainty^m). Mu 2013 (N = 4,237,821) found that IVR probably slightly improves medication refill rates at 1 month (moderate certaintyⁿ).
Behavioural outcome: adherence to medication IVR versus usual care	Results indicate that IVR probably slightly improves some measures of medication adherence.	56,140 (8 studies)	See comment	2 studies (Boland 2014 (N = 70); Friedman 1996 (N = 267)) reported that IVR probably slightly improves adherence to glaucoma and anti‐hypertensive medications at 3 and 6 months respectively (moderate certainty).^o 2 further studies (Glanz 2012 (N = 312); Migneault 2012 (N = 337)) reported that IVR has probably little or no effect on medication adherence at 8 and 12 months, respectively (moderate certainty).^p 2 studies (Green 2011 (N = 8306); Reynolds 2011 (N = 30,610)) assessed adherence via refill rates, reporting that IVR probably slightly improves medication refill rates at 2 weeks (moderate certainty).^q 2 further studies reported medication adherence assessed by medication possession ratio (MPR) at different time points. Patel 2007 (N = 15,051) found that IVR probably slightly improves MPR at 3 to 6 months, while Bender 2014 (N = 1187) reported that IVR probably improves MPR at 24 months (both studies of moderate certainty^r).
Behavioural outcome: adherence to medication Unidirectional ATCS versus control	Results suggest that unidirectional ATCS may have little effect, or improve medication adherence to a small degree.	107 (2 studies)	See comment	2 studies (Lim 2013 (N = 80); Ownby 2012 (N = 27)) reported that the intervention may have little effect or slightly improve medication adherence (low certainty^s).
Clinical outcome: blood pressure Multimodal/complex, ATCS Plus, IVR versus usual care	Results suggest that ATCS Plus probably slightly reduces blood pressure, while multimodal/complex or IVR interventions probably have little or no effect on blood pressure.	22,597 (3 studies)	See comment	Multimodal/complex intervention versus usual care Ho 2014 (N = 241) reported that multimodal intervention probably has little or no effect on achieving reduced blood pressure targets (moderate certainty^c). ATCS Plus versus usual care Vollmer 2014 (N = 21,752) reported that ATCS Plus probably slightly reduces systolic blood pressure (moderate certainty^t). IVR versus usual care Migneault 2012 (N = 337) reported that IVR probably has little or no effect on systolic or diastolic blood pressure (moderate certainty^c), while Friedman 1996 (N = 267) found that IVR may have little or no effect on systolic blood pressure but may slightly decrease diastolic blood pressure (low certainty^c,f).
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional versus various controls	No studies reported adverse events.
ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; HR: hazard ratio; IVR: interactive voice response; MPR: medication possession ratio; OR: odds ratio; RR: risk ratio; SD: standard deviation
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aMultimodal intervention included ATCS Plus, medication reconciliation and tailoring, patient education and collaborative care in Ho 2014; and education, nurse‐delivered call and IVR in Stuart 2003. ^bThe findings presented are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^cDowngraded as results were obtained from a single study at potential risk of bias (−1). ^dDowngraded as rated as at high risk for attrition, reporting and other bias and at unclear risk on randomisation and allocation concealment (‐2). ^eDowngraded as almost all items were rated as being at unclear risk of bias (−1). ^fDowngraded as rated as at unclear risk of bias on randomisation, allocation concealment and other items (−1). ^gDowngraded as rated at unclear risk of bias on allocation concealment and other items (−1). ^hDowngraded as rated as at unclear risk for all items (except attrition bias, rated as low risk) (−1). ⁱFeldstein 2006 did not appear to account for clustering, which may have resulted in an overestimation of the precision of the effect estimate (−1). ^jThree studies assessed together (Derose 2013; Vollmer 2011; Vollmer 2014): downgraded for risk of bias (allocation concealment rated as unclear in two studies and performance bias rated as high risk in one study) (−1). ^kDowngraded as rated at unclear risk of bias on randomisation and at high risk of detection bias (−1). ^lDowngraded as rated at unclear risk of bias on most items (except performance bias, rated as low risk) (−1). ^mDowngraded as all items were rated as being at unclear risk of bias (−1) and results were obtained from a single study with a very small sample size (N = 16) (−1). ⁿDowngraded as most items were rated as being at unclear risk of bias (except randomisation and allocation concealment); performance bias rated as high (−1). ^oTwo studies assessed together (Boland 2014; Friedman 1996): downgraded for risk of bias as allocation concealment was rated as unclear in both studies, randomisation and attrition bias rated unclear in one study each, and there was a high risk of other bias (baseline imbalances) in one study (−1). ^pTwo studies assessed together (Glanz 2012; Migneault 2012): downgraded for risk of bias as allocation concealment was rated as unclear in one study, and detection bias and other bias (baseline imbalances) were both rated as being at high risk in one study (−1). ^qTwo studies assessed together (Green 2011; Reynolds 2011): downgraded for risk of bias as all items were rated as unclear in both studies (−1). ^rDowngraded as all items were rated as being at unclear risk of bias (−1). ^sTwo studies assessed together (Lim 2013; Ownby 2012): downgraded for risk of bias as allocation concealment and attrition bias were rated as being at unclear risk in both studies, and detection bias was rated as being at high risk in one study (−1); downgraded on imprecision as combined sample size was small (N = 107) (−1). ^tDowngraded as allocation concealment was at unclear risk of bias, and there was a high risk of performance bias (−1).

ATCS versus control on alcohol consumption
Patient or population: participants addicted to alcohol Settings: various settings Intervention: ATCS (ATCS Plus, IVR) Comparison: no intervention, usual care, advice/education or packaged CBT
Outcomes	Effect of intervention^a	No of participants (studies)	Quality of the evidence (GRADE)
Behavioural outcomes: number of drinks per drinking day ATCS Plus, IVR versus usual care, (various) controls at median follow‐up of 2 months	ATCS Plus versus usual care Rose 2015 (N = 158) reported that ATCS Plus may have little or no effect on the number of drinks per drinking day at 2 months (low certainty^b,c). ATCS Plus versus control (advice/education) Hasin 2013 (N = 254) found that ATCS Plus may reduce the number of drinks per drinking day in the last 30 days at 2 months (low certainty^b,c), but it may have little effect at 12 months. IVR versus control (information) Rubin 2012 (N = 47) reported that IVR may slightly reduce the number of drinks per drinking day at 6 months (low certainty^c,e).	459 (3 studies)	⊕⊕⊝⊝ Low
Behavioural outcomes: drinking days, heavy drinking days, or total number of drinks consumed ATCS Plus, IVR versus (various) controls	ATCS Plus versus no intervention Mundt 2006 (N = 60) found that ATCS Plus may have little or no effect on drinking days, heavy drinking days, or total number of drinks consumed (low certainty^c,f). ATCS Plus versus control (packaged CBT) Litt 2009 (N = 110) found that ATCS Plus may have little or no effect on the number of heavy drinking days at 12 weeks posttreatment (low certainty^c,g). IVR versus control (information) Rubin 2012 (N = 47) reported that IVR may slightly reduce the number of heavy drinking days per month at 6 months (low certainty^c,e).	217 (3 studies)	⊕⊕⊝⊝ Low
Behavioural outcomes: proportion of days abstinent, other alcohol consumption indices, 12 weeks ATCS Plus versus control (packaged CBT)	ATCS Plus may slightly reduce the proportion of days abstinent but have little or no effect on coping or drinking problems or continuity of abstinence (Litt 2009).	110 (1 study)	⊕⊕⊝⊝ Low^c,g
Behavioural outcomes: weekly alcohol consumption, 6 months ATCS Plus versus usual care	ATCS Plus may have little or no effect on weekly alcohol consumption (Helzer 2008).	338 (1 study)	⊕⊕⊝⊝ Low^c,h
Behavioural outcomes: AUDIT score, 6 weeks IVR versus control (no intervention)	IVR probably improve slightly AUDIT scores (Andersson 2012).	1423 (1 study)	⊕⊕⊕⊝ Moderateⁱ
Behavioural outcomes: other alcohol consumption indices, 4 weeks IVR versus control (no intervention)	IVR may have little or no effect on drinking habits, alcohol craving, or PTSD symptoms (Simpson 2005).	98 (1 study)	⊕⊕⊝⊝ Low^c,h
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus various controls	No studies reported adverse events.
ATCS Plus: automated telephone communication systems with additional functions; AUDIT: Alcohol Use Disorders Identification Test; CBT: cognitive behavioural therapy; IVR: interactive voice response; PTSD: post‐traumatic stress disorder.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aThe findings presented in this table are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as all items except randomisation were rated as being at unclear risk of bias (−1). ^cResults were obtained from a single small study at potential risk of bias (−1). ^dDowngraded as allocation concealment was rated as being at unclear risk of bias, and there was a high risk of performance bias (−1). ^eDowngraded as all items except 'other' bias were rated as being at unclear risk of bias (−1). ^fDowngraded as rated as being at unclear risk of bias on randomisation, allocation concealment and others, and at high risk of attrition bias (−1). ^gDowngraded as rated as being at unclear risk of bias on allocation concealment and attrition bias, and at high risk of performance bias (−1). ^hDowngraded as rated as being at unclear risk of bias on randomisation, allocation concealment and other items (−1). ⁱDowngraded as all items were rated as being at unclear risk of bias (−1).

ATCS versus control on severity of cancer symptoms
Patient or population: cancer patients Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR) Comparison: usual care, control (other ATCS, nurse‐delivered calls)
Outcomes	Effects of intervention^a	No of participants (studies)	Quality of the evidence (GRADE)	Comments
Clinical outcomes: symptoms (severity or burden) ATCS Plus versus usual care (via ATCS) or control, 4‐12 weeks	Results suggest that ATCS Plus may have little or no effect on symptom severity, distress or burden.	701 (4 studies)	See comment	Cleeland 2011 (N = 79) found that ATCS Plus may slightly reduce symptom threshold events and cumulative distribution of symptom threshold events; and it may have little or no effect on mean symptom severity between discharge and 4 week follow‐up (low certainty^b,c). Mooney 2014 (N = 250) found that ATCS Plus probably has little or no effect on symptom severity scores at 6 week follow‐up (moderate certainty^c). Spoelstra 2013 (N = 119) found that ATCS Plus may have little or no effect on symptom severity at 10 week follow‐up (low certainty^c,d). Yount 2014 (N = 253) reported that ATCS Plus may have little or no effect on symptom burden at 12 weeks (low certainty^c,e).
Clinical outcomes: symptom severity, 10 weeks IVR versus nurse delivered calls	Results suggest that IVR may have little or no effect on symptom severity.	437 (1 study)	⊕⊕⊝⊝ Low^c,f	—
Clinical outcomes: pain Multimodal/complex intervention^g versus usual care	Results indicate that multimodal intervention probably reduces pain at 3 months and probably slightly reduces pain at 12 months.	405 (1 study)	⊕⊕⊕⊝ Moderate^c	—
Clinical outcomes: depression Multimodal/complex intervention^g versus usual care	Results indicate that multimodal intervention probably slightly reduces depression at 3 and 12 months.	405 (1 study)	⊕⊕⊕⊝ Moderate^c	—
Clinical outcomes:distress, 6 weeks ATCS Plus versus usual care (via IVR)	Results indicate that ATCS Plus probably has little or no effect on distress.	250 (1 study)	⊕⊕⊕⊝ Moderate^c	—
Behavioural outcome: medication adherence ATCS Plus versus usual care	Results indicate that ATCS Plus may have little or no effect on medication non‐adherence.	119 (1 study)	⊕⊕⊝⊝ Low^c,d	—
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR versus various controls	No studies reported adverse events.
ATCS: automated telephone communication systems; ATCS Plus: automated telephone communication systems with additional functions; IVR: interactive voice response.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aThe findings presented in this table are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as allocation concealment was rated as being at unclear risk of bias (−1). ^cDowngraded as results were obtained from a single study at potential risk of bias (−1). ^dDowngraded as randomisation and allocation concealment were rated as being at unclear risk of bias, and selective reporting rated as high risk (−1). ^eDowngraded as randomisation and allocation concealment were rated as being at unclear risk of bias, and performance bias was rated as being at high risk (−1). ^fDowngraded as allocation concealment was rated as being at unclear risk of bias, along with several other items (−1). ^gMultimodal/complex intervention included ATCS plus symptom monitoring by a nurse and medications.

ATCS versus usual care for managing diabetes mellitus
Patient or population: patients with diabetes mellitus Settings: various settings Intervention: ATCS (ATCS Plus, IVR) Comparison: usual care
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments^a
	Assumed risk	Corresponding risk
	Usual care	ATCS
Clinical outcome: glycated haemoglobin or blood glucose ATCS Plus, IVR versus usual care at median follow‐up of 6 months	The mean glycated haemoglobin in the control groups was 8.41%	The mean glycated haemoglobin in the intervention groups was 0.26% lower (0.50 to 0.01 lower)	Not estimable	1216 (7 studies)	⊕⊕⊝⊝ Low^b	ATCS Plus versus usual care 1 further study, Katalenich 2015 (N = 98), found that ATCS Plus may have little or no effect on median glycated haemoglobin levels compared with usual care at 6 months follow‐up (low certainty^c). IVR versus usual care 1 additional study, Homko 2012 (N = 80), found that IVR may have little or no effect on fasting blood glucose levels in pregnancy or infant birth weight at 26 months (low certainty^c).
Behavioural outcome: self‐monitoring of diabetic foot (various scales) ATCS Plus versus usual care at 12 months follow‐up	The mean self‐monitoring of diabetic foot in the control groups was 4.5 (range from 0 to 7, with higher scores indicating better foot care)	The mean self‐monitoring of diabetic foot in the intervention groups was 0.40 points higher^d (0.10 to 0.71 points higher)	Not estimable	498 (2 studies)	⊕⊕⊕⊝ Moderate^e	—
Behavioural outcome: self‐monitoring of blood glucose ATCS Plus, IVR versus usual care, 6‐12 months	See comment	See comment	Not estimable	See comment	See comment	ATCS Plus versus usual care Lorig 2008 (N = 417) found that ATCS Plus may have little no effect on self‐monitoring of blood glucose at 6 months (low certainty evidence^f). At 12 months, 2 studies (Piette 2001 (N = 272); Schillinger 2009 (N = 339)) reported that ATCS Plus probably slightly improves self‐monitoring of blood glucose (moderate certainty^e). IVR versus usual care Graziano 2009 (N = 112) found that IVR probably slightly increases the mean change in frequency of self‐monitoring of blood glucose (moderate certainty evidence^g).
Behavioural outcome: medication adherence or use ATCS Plus versus usual care, 6‐12 months	See comment	See comment	Not estimable	370 (2 studies)	See comment	Katalenich 2015 (N = 98) reported that ATCS Plus may have little or no effect on adherence rates at 6 months (low certainty^c), and Piette 2001 (N = 272) found that ATCS Plus has probably little or no effect on medication use at 12 months (moderate certainty^g.
Behavioural outcome: physical activity, diet, weight monitoring ATCS Plus versus usual care, 6‐12 months	See comment	See comment	Not estimable	1028 (3 studies)	See comment	Lorig 2008 (N = 417) found that ATCS Plus may have little or no effect on aerobic exercise at 6 months (low certainty^f). Schillinger 2009 (N = 339) found that ATCS Plus may slightly improve diet and exercise and moderate intensity physical activity levels, but it may have little or no effect on vigorous intensity physical activity levels at 12 months (low certainty^c). Piette 2001 (N = 272) reported that ATCS Plus probably has little or no effect on weight monitoring (moderate certainty^g).
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus usual care	No studies were found that reported adverse events.
The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; HRQoL: health‐related quality of life; IVR: interactive voice response; SMD: standardised mean difference.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aAdditional results are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as allocation concealment was rated as being at unclear risk in four studies and attrition bias was rated as being at high risk in two studies (−1), and there was a moderate level of heterogeneity in the results (−1). ^cDowngraded as allocation concealment was rated as being at unclear risk (−1), and results were based on a single small study at some potential risk of bias (−1). ^dAn SD of 1.7 (on a 7‐point Likert scale, where higher score means better behavioural outcome) was chosen from a representative study by Schillinger 2009, and this was used to convert the SMD to a familiar scale. 0.24 (SMD) x 1.7 (SD) = 0.40 points higher (on a 7 point scale). ^eTwo studies assessed together (Piette 2001; Schillinger 2009): downgraded as allocation concealment was rated as being at unclear risk in one study and performance bias was rated as being high risk in one study (−1). ^fDowngraded as all items were rated as being at unclear risk, except attrition bias which was rated as being at high risk of bias (−1), and results were based on a single study at some risk of bias (−1). ^gDowngraded as results were based on a single study (−1).

ATCS versus usual care for patients with heart failure
Patient or population: patients with heart failure Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR) Comparison: usual care or usual community care
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments^a
	Assumed risk	Corresponding risk
	Usual care or usual community care	ATCS
Clinical outcome: cardiac mortality ATCS Plus, IVR versus usual care or usual community care at median follow‐up of 11.5 months	Study population^b		RR 0.60 (0.21 to 1.67)	215 (2 studies)	⊕⊝⊝⊝ Very low^d,e	—
	95 per 1000	57 per 1000 (20 to 158)
	Moderate^c
	96 per 1000	58 per 1000 (20 to 160)
Clinical outcome: all‐cause mortality ATCS Plus versus usual care or usual community care at median follow‐up of 11 months	Study population^b		RR 1 (0.79 to 1.28)	2165 (3 studies)	⊕⊕⊕⊝ Moderate^f	—
	106 per 1000	106 per 1000 (84 to 136)
	Moderate^c
	106 per 1000	106 per 1000 (84 to 136)
Clinical outcome: heart failure hospitalisation ATCS Plus, IVR versus usual care or usual community care at median follow‐up of 11.5 months	See comment	See comment	Not estimable	2329 (4 studies)	See comment	ATCS Plus versus usual care or usual community care Chaudhry 2010 (N = 1653) found that the intervention had little or no effect on hospitalisation for heart failure (high certainty). Krum 2013 (N = 405) also reported that there was probably little or no effect of the intervention for this same outcome (moderate certainty^g), while Capomolla 2004 (N = 133) reported that ATCS Plus may decrease hospitalisation rates for heart failure (low certainty^h). IVR versus usual care Kurtz 2011 (N = 138) reported that IVR intervention has uncertain effects on hospitalisation for heart failure (very low certaintyⁱ).
Clinical outcome: all‐cause hospitalisation ATCS Plus versus usual care or usual community care	See comment	See comment	Not estimable	2191 participants (3 studies)	See comment	ATCS Plus versus usual care Capomolla 2004 (N = 133) found that ATCS Plus may reduce all‐cause hospitalisation (for chronic heart failure, cardiac cause and other cause; low certainty^h), and Krum 2013 (N = 405) similarly reported that the intervention probably slightly decreased all‐cause hospitalisation (moderate certainty^g).^fChaudhry 2010 (N = 1653) found that ATCS Plus has little or no effect on readmission for any reason (high certainty).
Clinical outcome: global health (well‐being) rating (7‐item questionnaire) ATCS Plus versus usual care 12 months	See comment	See comment	Not estimable	405 participants (1 study)	⊕⊕⊕⊝ Moderate^g	Krum 2013 (N = 405) reported that ATCS Plus probably increases slightly the proportion of patients with improved global health questionnaire ratings at 12 months.
Clinical outcome: emergency room and other health service use outcomes ATCS Plus versus usual care or usual community care	See comment	See comment	Not estimable	1786 participants (2 studies)	See comment	Emergency room use Capomolla 2004 (N = 133) found that ATCS Plus may reduce emergency room use at (median) 11 months (low certainty^h). Other service use Chaudhry 2010 (N = 1653) found that ATCS Plus had little or no effect on number of days in hospital or number of hospitalisations (readmissions)(high certainty).
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus usual care	See comment	See comment	See comment	1791 (2 studies)	See comment	ATCS Plus versus usual care Chaudhry 2010 (N = 1653) reported that no adverse events had occurred during the study (high certainty). IVR versus usual care Kurtz 2011 (N = 138) classified adverse events as cardiac mortality plus rehospitalisation for heart failure, reporting uncertain effects upon this composite outcome (very low certaintyⁱ).
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; CI: confidence interval; RR: risk ratio.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aAdditional results are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bThe assumed risk represents the mean control group risk across studies (calculated by GRADEPro). ^cThe assumed risk represents the median control group risk across studies (calculated by GRADEPro). ^dDowngraded as selection bias was rated as being at high risk in one study and allocation concealment was rated as being at unclear risk in both (−1). ^eDowngraded as the total number of events is less than 300 (−1), and wide CIs around the effect estimate included both a substantial potential benefit and a substantial potential harm (−1). ^fDowngraded as risk of bias was unclear on randomisation in one study and allocation concealment in two studies (Capomolla 2004; Krum 2013) (−1). ^gDowngraded as result is based on a single study (−1). ^hDowngraded as randomisation and allocation concealment judged as being at unclear risk of bias (−1); downgraded as results are based on a single study (−1). ⁱDowngraded as randomisation judged as being at high risk and unclear on allocation concealment and other items (‐2); downgraded as result is based on a single study (−1).

ATCS versus usual care for management of hypertension
Patient or population: patients with hypertension Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR, unidirectional) Comparison: usual care, with and without education
Outcomes	*Illustrative comparative risks (95% CI)**		No of Participants (comparisons)	Quality of the evidence (GRADE)	Comments^a
	Assumed risk	Corresponding risk
	Usual care	ATCS
Clinical outcome: systolic blood pressure (automated sphygmomanometer or electronic pressure monitor) ATCS Plus or IVR versus usual care at median follow‐up of 6 weeks	The mean systolic blood pressure in the control group was 141.1 mmHg	The mean systolic blood pressure in the intervention groups was 1.89 mmHg lower (2.12 to 1.66 lower)	65,256 (3 studies)	⊕⊕⊕⊝ Moderate^b	1 additional study (Dedier 2014) (N = 253) reported that compared with usual care plus education, IVR may have little or no effect on systolic blood pressure at 3 months (low certainty^c).
Clinical outcome: diastolic blood pressure (automated sphygmomanometer and electronic cuff) ATCS Plus, unidirectional versus usual care at median follow‐up of 14 weeks	The mean diastolic blood pressure in the control group was 81.2 mmHg	The mean diastolic blood pressure in the intervention groups was 0.02 mmHg higher (2.62 lower to 2.66 higher)	65,056 (2 studies)	⊕⊕⊝⊝ Low^d,e	—
Clinical outcome: blood pressure control, 26 weeks Multimodal/complex intervention^f versus usual care	See comment	See comment	166 (1 study)	⊕⊕⊕⊝ Moderate^g	Bove 2013 (N = 241) found that a multimodal/complex intervention probably has little or no effect on blood pressure control.
Clinical outcome: Health status^h, depressionⁱ, 6 weeks ATCS Plus versus enhanced usual care (plus information)	See comment	See comment	200 (1 study)	⊕⊕⊝⊝ Low^j	Piette 2012 (N = 200) found that ATCS Plus may slightly improve health status and may decrease depressive symptoms.
Behavioural outcome: medication use Multimodal/complex^k, ATCS Plus versus usual care or enhanced usual care (plus information)	See comment	See comment	483 (2 studies)	⊕⊕⊝⊝ Low	Multimodal/complex versus usual care Magid 2011 (N = 283) found that multimodal/complex intervention may have little or no effect on medication adherence assessed by Medication Possession Ratio or proportion adherent (low certainty^l). ATCS Plus versus enhanced usual care Piette 2012 (N = 200) found that ATCS Plus may reduce the number of medication‐related problems^m (low certainty^j).
Behavioural outcome: physical activity levels, 12 weeks IVR versus enhanced usual care	See comment	See comment	253 (1 study)	⊕⊕⊝⊝ Low^c	IVR versus enhanced usual care Dedier 2014 (N = 253) reported that IVR may slightly increase physical activity levels.
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional ATCS versus various controls	No studies reported adverse events.
ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; IVR: interactive voice response; MD: mean difference; SD: standard deviation.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aAdditional results are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bDowngraded as risk of bias for randomisation was rated unclear in one study, allocation concealment was rated as at unclear risk in two studies, and in one study each, performance bias and other bias (baseline imbalances in blood pressure) were rated as being at high risk (−1). ^cDowngraded as all domains were judged to be at unclear risk of bias (−1), and results were based on a single small study at some potential risk of bias (−1). ^dDowngraded due to unclear risk of bias for allocation concealment in one study, and high risk for other bias (baseline imbalances in blood pressure) in one study (−1). ^eDowngraded as a substantial amount of heterogeneity was detected and effects were in opposite directions (−1). ^fMultimodal/complex intervention included ATCS Plus plus sphygmanometer, a weighting scale, pedometer and instructions on their use. ^gDowngraded as results were based on a single small study at some potential risk of bias (−1). ^hHealth status was self‐reported perceived general health status, assessed on a 5‐point scale (where 1 = poor, 2 = fair, 3 = good, 4 = very good, and 5 = excellent). ⁱDepression assessed using the 10‐item Center for Epidemiological Studies‐Depression Scale. ^jDowngraded as risk of bias was rated as unclear for allocation concealment and most other domains, with a high risk of performance bias (−1); and results were based on a single small study at some potential risk of bias (−1). ^kMultimodal/complex intervention included ATCS Plus plus patient education, home blood pressure monitoring, and clinical pharmacist management of hypertension with physician oversight. ^lDowngraded due to high risk of bias for other bias (baseline imbalances in blood pressure) (−1); results were based on a single small study at some potential risk of bias (−1). ^mMedication‐related problems assessed using a 7‐item scale (yes/no responses) on barriers to medication taking, including cost, side effects, complexity of regimen, worries over taking medicines and/or over long‐term effects of medication.

ATCS versus control for smoking cessation
Patient or population: patients with tobacco dependence Settings: various settings Intervention: ATCS (multimodal/complex intervention, ATCS Plus, IVR) Comparison: usual care, control (no calls, 'placebo' (inactive) ATCS, self‐help intervention, stage‐matched manuals)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments^a
	Assumed risk	Corresponding risk
	Control	ATCS
Behavioural outcome: smoking abstinence Multimodal/complex intervention, ATCS Plus, IVR versus (various) controls or usual care at median follow‐up of 12 months	Study population^b		RR 1.2 (0.98 to 1.46)	2915 (7 studies)	⊕⊕⊝⊝ Low^d,e	ATCS Plus versus usual care 1 further study, Reid 2011 (N = 440), reported that ATCS Plus may improve smoking abstinence rates at 26 weeks, and this may be maintained at 52 weeks (low certainty evidence^f).
	201 per 1000	241 per 1000 (197 to 293)
	Moderate^c
	241 per 1000	289 per 1000 (236 to 352)
Behavioural outcome: medication use Multimodal/complex, ATCS Plus versus control (inactive IVR or self‐help booklet)	See comment	See comment	See comment	1127 (2 studies)	⊕⊕⊕⊝ Moderate^g	Multimodal/complex intervention versus control (self‐help booklet) Brendryen 2008 (N = 396) found that a multimodal/complex intervention probably has little or no effect on adherence to NRT (moderate certainty evidence). ATCS Plus versus control (inactive IVR) Regan 2011 (N = 731) found that ATCS Plus probably has little or no effect on medication use (moderate certainty evidence).
Behavioural outcome: support programme enrolment ATCS Plus versus control (inactive IVR)	See comment	See comment	See comment	521 (1 study)	⊕⊕⊝⊝ Low^h	Carlini 2012 found that ATCS Plus may improve re‐enrolment into a quit line support programme.
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR versus various controls	No studies were found that reported adverse events.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ATCS Plus: automated telephone communication systems with additional functions; CI: confidence interval; IVR: interactive voice response; NRT: nicotine replacement therapy; OR: odds ratio; RR: risk ratio;
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
^aAdditional results are based on a narrative summary and synthesis of results that were not amenable to statistical analysis; please see Effects of interventions for detailed findings. ^bThe assumed risk represents the mean control group risk across studies (calculated by GRADEPro). ^cThe assumed risk represents the median control group risk across studies (calculated by GRADEPro). ^d Downgraded due to unclear risk of bias for allocation concealment in four studies and high risk of attrition bias in one study (−1). ^eDowngraded for inconsistency, as two studies by Ershoff 1999 and McNaughton 2013 showed contradictory results favouring the control group and heterogeneity was moderate overall (−1). ^fDowngraded as all items were judged to be at an unclear risk of bias (−1), and results were based on a single study at some risk of bias (−1). ^gDowngraded as results (for each outcome) were based on a single study (−1). ^hDowngraded as most items were judged to be at unclear risk of bias (−1), and results were based on a single study at some risk of bias (−1).

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Dichotomous outcomes
Primary outcome	Study ID	Timing of outcome assessment (months)	Intervention group		Comparator group		Between group difference			Notes
Primary outcome	Study ID	Timing of outcome assessment (months)	Observed (n)	Total (N)	Observed (n)	Total (N)	P value	Effect estimate (OR/RR/HR)	95% CI	Notes
IMMUNISATIONS
Immunisation uptake	Dini 2000	24	107	189	87	186	—	1.21	0.99 to 1.47	—
	Franzini 2000	*	270	314	273	429	—	—	—	—
	Hess 2013	3	146	5599	46	6383	< 0.001	3.69	2.64 to 5.15	Cluster RCT unadjusted for clustering. Approximate sample size calculations gave the following adjusted values: intervention 20/791; control 6/902; see Appendix 14 for calculations
	Lieu 1998	4	89	167	70	162	0.11	—	29.0 to 43.8	CIs for % values and for IVR alone; P value from Chi²
	Linkins 1994	1	1684	4636	955	3366	< 0.01	1.28	1.20 to 1.37	—
	LeBaron 2004	13	305	763	259	763	< 0.05	—	—	—
	Nassar 2014	2	3	26	3	24	—	—	—	—
	Stehr‐Green 1993	1	46	112	41	110	—	1.07	0.78 to 1.46	—
	Szilagyi 2006	18	928	1496	873	1510	0.02	—	—	—
	Szilagyi 2013	12	748	1423	651	1296	< 0.05	1.3	1.0 to 1.7	—
SCREENING
Screening rate	Baker 2014	6	191	225	90	225	< 0.001	—	—	—
	Cohen‐Cline 2014	6	801	8005	234	3005	0.0012	1.32	1.14 to 1.52
	Corkrey 2005	3	—	45,303	—	30,229	—	—	1.28 to 1.42^a 0.11 to 0.17^b	^aWomen aged 50‐69 years ^bWomen aged 20‐49 years
	DeFrank 2009	10 to 14	960	1355	574	847	0.014	1.32	1.06 to 1.64	—
	Fiscella 2011	12	55^a 47^b	134^a 163^b	23^a 16^b	137^a 160^b	—	3.44^a 3.70^b	1.91 to 6.19^a 1.93 to 7.09^b	^aBreast cancer screening; ^bColorectal cancer screening
	Fortuna 2014	12	36^a 24^b	158^a 157^b	28^a 19^b	157^a 156^b	> 0.05	1.4^a 1.3^b	0.8 to 2.4^a 0.7 to 2.5^b	^aBreast cancer screening; ^bColorectal cancer screening (both crude estimates)
	Hendren 2014	12	30^a 43^b	101^a 114^b	15^a 21^b	90^a 126^b	0.034^a 0.0002^b	1.96^a 3.22^b	0.87 to 4.39^a 1.65 to 6.30^b	^aBreast cancer screening; ^bColorectal cancer screening
	Heyworth 2014	12	385	1565	290	1558	< 0.001	—		—
	Mosen 2010	6	662	2943	474	2962	< 0.001	1.31	1.10 to 1.56	—
	Phillips 2015	9	19^a 33^b	90^a 198^b	17^a 27^b	88^a 199^b	—	—	—	^aBreast cancer screening; ^bColorectal cancer screening
	Simon 2010a	12	3192	10,432	3194	10,506	0.76	1.01	0.94 to 1.07	In the adjusted model
	Solomon 2007	10	144	997	97	976	0.006	1.52	1.13 to 2.05	In the adjusted model
APPOINTMENT REMINDERS
Reducing non‐attendance rates	Dini 1995	1	144	277	78	240	< 0.05	1.60	1.29 to 1.98	—
	Griffin 2011	1.5	333^a 169^b	794^a 411^b	324^a 164^b	790^a 409^b	> 0.05	—	−6 to 5^a −8 to 7^b	^aColonoscopy ^bFlexible sigmoidoscopy
	Maxwell 2001	2	347	700	322	670	> 0.05	—	—	—
	Parikh 2010	4	2662	3219	2576	3350	< 0.001	1.52	1.34 to 1.71	—
	Reekie 1998	1.5	473	500	453	500	< 0.001	3.41	1.87 to 6.20	—
	Tanke 1994	6	257	407	235	456	< 0.01	1.50	—	—
	Tanke 1997	3 days	652	701	617	701	< 0.05	1.71	—	—
ADHERENCE
Adherence to medications/laboratory tests	Bender 2010	2.5	16	25	12	25	0.003	—	—	—
	Derose 2009	3	453	2199	298	1550	0.31	1.09	0.92 to 1.28	At 8 weeks differences were not significant (P = 0.23)
	Feldstein 2006	25 days	177	267	53	237	< 0.001	4.1	3.0 to 5.6	—
	Friedman 1996	6	24	133	16	134	0.03	—	—	—

Study ID	Study type^a	Study subtype^b	Country	Sample size	Mean age (years unless stated otherwise)	Male (%)	Female (%)	Ethnicity^c	Duration of condition	Comorbidities, medication	Incentives for participation	Incentives
Tucker 2012	P	Alcohol misuse	USA	187	45	63	37	White ‐ 54% Other ‐ 46%	—	—	Yes	Visa gift cards or checks (USD 50 per in‐person interview, USD 15 per phone interview). IG participants received USD 0.50 minimum for each daily call and USD 1.00 after seven consecutive calls
Franzini 2000	P	I	USA	1138	—	—	—	—	—	—	—	—
Hess 2013	P	I	USA	11,982	72	—	—	—	—	—	—	—
Dini 2000	P	I	USA	1227	2‐3 months	—	—	—	—	—	—	—
LeBaron 2004	P	I	USA	3050	9 months^d	49	51	Black ‐ 76% Hispanic ‐ 14% White ‐ 7% Other – 3%	—	—	—	—
Lieu 1998	P	I	USA	752	20 months	—	—	—	—	—	—	—
Linkins 1994	P	I	USA	8002	—	51	49	Black ‐ 50% White ‐ 45% Other – 5%	—	—	—	—
Nassar 2014	P	I	USA	50	24	0	100	Black ‐ 86% White ‐ 14%	—	—	Yes	USD 35 per month to help pay for cell phone service or a free, unlimited minutes cell phone until 6 weeks postpartum
Stehr‐Green 1993	P	I	USA	229	9 months	52	48	Black ‐ 90% Other – 7% Hispanic ‐ 3%	—	—	—	—
Szilagyi 2006	P	I	USA	3006	—	51	49	Other – 41% Black ‐ 35% White ‐ 17% Hispanic ‐ 7%	—	—	—	—
Szilagyi 2013	P	I	USA	4115	14	50	50	—	—	—	—	—
David 2012	P	Physical activity	USA	71	57	0	100	White ‐ 93% Other ‐ 7%	—	—	—	—
Dubbert 2002	P	Physical activity	USA	181	69	99	1	—	—	Mean (SD) number of comorbidities IG: 3.8 (1.5) CG: 3.9 (1.4)	Yes	USD 15 for completing each visit to help defray expenses
Jarvis 1997	P	Physical activity	USA	85	67	24	76	Other ‐ 70% Black ‐ 30%	—	Mean co‐morbidities: 3	—	—
King 2007	P	Physical activity	USA	218	61	31	69	White ‐ 90% Other ‐ 10%	—	—	—	—
Morey 2009	P	Physical activity	USA	398	78	100	0	White ‐ 77% Black ‐ 23%	—	Mean (SD) number of diseases IG: 5.2 (2.5) CG: 5.5 (2.7)	—	—
Morey 2012	P	Physical activity	USA	302	67	97	3	White ‐ 70%	—	Mean (SD) number of comorbidities IG: 4.2 (2.4) CG: 3.9 (2.4)	—	—
Pinto 2002	P	Physical activity	USA	298	46	28	72	White ‐ 45% Black ‐ 45% Other ‐ 10%	—	—	—	—
Sparrow 2011	P	Physical activity	USA	103	71	69	31	—	—	Depression (unclear %)	—	—
Baker 2014	P	Screening	USA	450	60	28	72	Hispanic 87% Other‐ 13%	—	≥ 1 long‐term conditions ‐ 68%	No	—
Cohen‐Cline 2014	P	Screening	USA	11,010	61	54	46	White ‐ 86% Other ‐ 14%	—	—	—	—
Corkrey 2005	P	Screening	Australia	75,532	—	0	100	—	—	—	—	—
DeFrank 2009	P	Screening	USA	3547	—	0	100	White ‐ 88% Black ‐ 11% Asian or Other ‐ 1%	—	—	—	—
Durant 2014	P	Screening	USA	47,097	58	47	53	—	—	—	—	—
Fiscella 2011	P	Screening	USA	469	—	56 (for colorectal cancer)	44 (for colorectal cancer)	White ‐ 61% Black ‐ 28% Latinos ‐ 5% Asian ‐ 5%	—	—	—	—
Fortuna 2014	P	Screening	USA	1008	—	45	55	White ‐ 48% Black ‐ 37% Other ‐ 15%	—	—	No	—
Hendren 2014	P	Screening	USA	366	—	—	—	White ‐ 50% Black ‐ 41% Other (including Hispanic) ‐ 9%	—	—	—	—
Heyworth 2014	P	Screening	USA	4685	57	0	100	—	—	Anticonvulsants ‐ 6% Corticosteroids ‐ 4% COPD (unclear %) Oophorectomy ‐ 3%	—	—
Mosen 2010	P	Screening	USA	6000	60	50	50	White ‐ 93% Other ‐ 7%	—	Obesity ‐ 40%	—	—
Phillips 2015	P	Screening	USA	685	58	38	62	Non‐Hispanic white ‐ 78% Black ‐ 13% Other ‐ 9%	—	—	—	—
Simon 2010a	P	Screening	USA	20,936	57	47	53	White ‐ 86% Other ‐ 9% Black ‐ 5%	—	—	—	—
Solomon 2007	P	Screening	USA	1973	69	8	92	—	—	Use of oral glucocorticoids ‐ 22% Fractures ‐ 12%	—	—
Mahoney 2003	P	Stress management	USA	100 (caregiver)	63 (caregiver)	22 (caregiver)	78 (caregiver)	Black ‐ 64% Hispanic ‐ 21% White ‐ 15% Other ‐ 1%	—	—	—	—
Aharonovich 2012	P	Substance use	USA	33	46	76	24	White ‐ 64% White ‐ 15% Hispanic ‐ 21%	—	HIV medication ‐ 64% Hepatitis A, B, or C ‐ 49%	Yes	USD 20 gift certificates for each assessment
Bennett 2012	P	Weight management	USA	365	55	31	69	Black ‐ 71% Hispanic ‐ 13% White ‐ 4% Other ‐ 2%	—	Cholesterol medication ‐ 36% Diabetes medication ‐ 30% Mean BMI ‐ 37 kg/m²	Yes	USD 50 reimbursement at the first 3 follow‐up visits and USD 75 at 24 months
Bennett 2013	P	Weight management	USA	194	35	0	100	Black ‐ 100%	—	Hypertension ‐ 36% Metabolic syndrome ‐ 31% Depression ‐ 22% Diabetes mellitus ‐ 7%	Yes	Reimbursements of USD 50 each at baseline and at all follow‐up study visits
Estabrooks 2008	P	Weight management	USA	77	59	29	71	White ‐ 68% Hispanic ‐ 18% Other ‐ 7% Black ‐ 4% Asian ‐ 3%	—	—	—	—
Estabrooks 2009	P	Weight management	USA	220	11	54	46	White‐ 63% Hispanic ‐ 26% Other ‐ 11%	—	—	—	—
Goulis 2004	P	Weight management	Greece	122	44	12	88	—	—	Hypertension ‐ 13% Diabetes mellitus ‐ 2%	—	—

Assessment levels and criteria for each dimension	Study	Assessment of the intervention (a‐d)/description of the intervention/justification	Control (or usual care)
Core dimension 1: active components included in the intervention compared with the control
a. More than 1 component and delivered as a bundle b. More than 1 component c. 1 component	Baker 2014	(a.) A mailed reminder letter, a free faecal immunochemical test, an automated telephone and text message reminding them that they were due for screening and that a faecal immunochemical test was being mailed to them, an automated telephone and text reminder 2 weeks later for those who did not return the faecal immunochemical test, and personal telephone outreach by a colorectal cancer screening navigator after 3 months	(b.) Usual care included computerised reminders, standing orders for medical assistants to give patients home faecal immunochemical test, and clinician feedback on colorectal cancer screening rates
	Bennett 2013	(a.) Behaviour change goals, self‐monitoring via IVR phone calls, tailored skills training materials, monthly interpersonal counselling calls, and a 12‐month gym membership.	(b.) Control group received + newsletters that covered general wellness topics but did not discuss weight, nutrition, or physical activity
	Bove 2013	(a.) Internet‐ and telephone‐based telemedicine system + automatically generated emails or telephone calls as reminders + sphygmomanometer, a weighting scale (if needed), a pedometer and instructions on their use	(c.) Control group received usual care
	Brendryen 2008	(a.) Email, webpages, IVR and short message service (SMS) + craving helpline	(c.) Control group received self‐help (booklet)
	Dubbert 2002	(a.) 10 personal phone calls from the nurse interspersed randomly with 10 automated phone calls + clinic‐based activity counselling	(b.) Clinic‐based activity counselling + no calls
	Fiscella 2011	(b.) Clinician prompt, patient prompts, patient outreach consisting of 2 personalised letters which also include testing kits for colorectal cancer and up to 4 ATCS calls over 26 weeks	(c.) The clinician was responsible for discussing cancer screening with the patients and for initiating any referral or for handing out faecal occult blood testing cards over 12 months
	Hendren 2014	(b.) Letters, ATCS calls, a point‐of‐care prompt and mailing of a home colorectal cancer testing kit; and medical record reviews at week 12	(c.) Usual care received blinded chart review
	Ho 2014	(b.) Medication reconciliation and tailoring, patient education (provided through automated voice messages and pharmacist telephone calls when requested by the patient), collaborative care between pharmacists and providers (primary care providers or cardiologists), and voice messaging reminders (educational and medication refill reminder calls).	(c.) Usual care received standard hospital discharge instructions e.g., numbers to call, follow‐up appointments, diet and exercise advice, a discharge medication list, and educational information about cardiac medications
	Kroenke 2010	(a.) Symptom monitoring by a nurse + automated monitoring either via IVR or by Internet + medications (analgesics, antidepressants)	(c.) Usual care from oncologist
	Kroenke 2014	(a.) Symptom monitoring, either via IVR or by Internet + nurse care + stepped care with analgesics	(c.) Usual care from primary care physician
	Magid 2011	(b.) Patient education, home blood pressure monitoring, home blood pressure measurement reporting to an ATCS, and clinical pharmacist management of hypertension with physician oversight + usual care	(c.) The control group received usual care
	Morey 2009	(b.) Baseline in‐person and biweekly then monthly telephone counselling by a lifestyle counsellor, one‐time clinical endorsement of physical activity and monthly automated telephone messaging by primary care provider, and quarterly tailored mailings of progress in physical activity.	(c.) Patients in the control group received usual care
	Morey 2012	(b.) 1 in‐person baseline counselling session, regular telephone counselling, physician endorsement in clinic with monthly ATCS calls encouragement, and tailored mailed materials, plus a consult to a Veterans Affairs (VA) weight management program.	(b.) Patients in the control group received usual care + MOVE
	Shet 2014	(b.) An IVR call once a week + a weekly non‐interactive neutral pictorial message sent out as a reminder 4 days after the IVR call + usual care	(b.) Usual care included up to 3 counselling sessions + antiretroviral treatment
	Solomon 2007	(b.) Education and reminders delivered to primary care physicians + mailings and ATCS	(c.) The control group received no education
	Stuart 2003	(b.) Treatment team education and patient self‐care education, nurse telephone call and IVR program	(c.) Treatment team education and patient self‐care education
	Velicer 2006	(a.) Automated counselling plus nicotine replacement therapy, manuals, and expert system (TEL + EXP + NRT + MAN)	(c.) The control group received stage (of change) matched manuals
Core dimension 2: behaviours or actions of intervention recipients or participants to which the intervention is directed
a. Single target b. Dual target c. Multitarget d. Varies^a	Baker 2014	(a.) Single target: colorectal cancer screening	(a.) Single target: colorectal cancer screening
	Bennett 2013	(a.) Single target: weight management	(a.) Single target: weight management
	Bove 2013	(c.) Single target: diet, exercise, smoking and blood pressure control	(a.) Single target: blood pressure control
	Brendryen 2008	(a.) Single target: smoking abstinence	(a.) Single target: smoking abstinence
	Dubbert 2002	(c.) Multiple target: physical activity; BMI; mobility; quality of life	(c.) Multiple target: physical activity; BMI; mobility; quality of life
	Fiscella 2011	(b.) Dual target: breast cancer and colorectal cancer screening	(b.) Dual target: breast cancer and colorectal cancer screening
	Hendren 2014	(b.) Dual target: breast cancer and colorectal cancer screening	(b.) Dual target: breast cancer and colorectal cancer screening
	Ho 2014	(c.) Medication adherence, blood pressure, blood lipid levels	(c.) Medication adherence, blood pressure, blood lipid levels
	Kroenke 2010	(b.) Dual target: pain and depression management	(b.) Dual target: pain and depression management
	Kroenke 2014	(a.) Single target: musculoskeletal pain management	(a.) Single target: musculoskeletal pain management
	Magid 2011	(b.) Dual target: blood pressure monitoring and blood pressure measuring	(b.) Dual target: blood pressure monitoring and blood pressure measuring
	Morey 2009	(c.) Multitarget: improving gait speed, self‐reported physical activity, function and disability	(c.) Multitarget: improving gait speed, self‐reported physical activity, function and disability
	Morey 2012	(c.) Multitarget: improving blood sugar indices, anthropometric measures, and self‐reported physical activity, health‐related quality of life, and physical function	(c.) Multitarget: improving blood sugar indices, anthropometric measures, and self‐reported physical activity, health‐related quality of life, and physical function
	Shet 2014	(a.) Single target: antiretroviral treatment medication adherence	(a.) Single target: antiretroviral treatment medication adherence
	Solomon 2007	(a.) Single target: osteoporosis screening	(d.) Varies
	Stuart 2003	(a.) Single target: antidepressant medication adherence	(a.) Single target: antidepressant medication adherence
	Velicer 2006	(a.) Single target: smoking abstinence	(a.) Single target: smoking abstinence
Core dimension 3: organisational levels and categories targeted by the intervention
a. Multilevel b. Multicategory c. Single category	Baker 2014	(c.) Intervention directed only at single category of individuals within the individual level: patients past due for colorectal cancer screening	(c.) Intervention directed only at single category of individuals within the individual level: patients past due colorectal cancer screening
	Bennett 2013	(c.) Intervention directed only at single category of individuals within the individual level: obese females of Black ethnic origin	(c.) Obese females of black ethnic origin

Study ID	ATCS^a	Content^b	Theory^c	BCTs^d	Received instructions?	Caller^e	Telephone keypad^f	Toll free	Study duration	Call duration^g	Frequency^h	Intensity ⁱ	Speaker features	Security arrangement^j
Adams 2014	IVR	AF	—	1	—	P	Other	—	25 months	29.3 min	—	—	Synthetic speech	—
Aharonovich 2012	ATCS Plus	AF,SF	MI	9, 25, 40	Yes	E	Yes	Yes	2 months	1‐3 min	Daily	—	—	—
Andersson 2012	IVR	AF	—	25	—	—	—	—	1.5 months	—	—	< 500 words	—	—
Baker 2014	Unidirectional¹	AF	TCD	1, 42	No	H	—	—	6 months	—	2	92 words	—	—
Bender 2010	IVR	AF	HBM	20, 21, 42	—	H	Yes	Yes	2.5 months	< 5 min	2	—	—	—
Bender 2014	IVR	AF	—	20,21	—	—	—	—	24 months	—	—	—	—	—
Bennett 2012	ATCS Plus	AF, CF	SCT, TRA, TTM	3, 9, 12, 13, 17, 20, 21, 25, 33, 39, 40, 42	—	—	—	—	24 months	—	—	—	—	—
Bennett 2013	ATCS Plus¹	AF, CF	SCT, TRA, TTM, MI	3, 9, 12, 13, 17, 20, 21, 25, 33, 39, 40, 42	—	H	—	—	12 months	2–4 min	Weekly	—	—	—
Boland 2014	IVR	AF	—	29,42	—	H	Yes	—	3 months	—	Daily	51 words	—	Reminder information was sent securely to Memotext¹
Bove 2013	ATCS Plus¹	AF, CF, SF	—	9,10,42	Yes	P	Yes¹	Yes	6 months	—	Biweekly	—	—	Password and log‐in
Brendryen 2008	ATCS Plus¹	AF, SF	CBT, SCT, MI, SRT, SCL, RP	3,12, 20,27, 34, 39	Yes	P	Yes	—	24 months	—	Twice daily then biweekly¹ for 6 weeks	—	Personal pronouns and active voice	—
Capomolla 2004	ATCS Plus	AF, CF	—	20, 42	Yes	P	Yes	Yes	12 months	—	Daily	—	—	PIN²
Carlini 2012	ATCS Plus	AF, CF	—	3	—	H	Yes	Yes	4 months	—	—	—	—	—
Chaudhry 2010	ATCS Plus	AF, CF	—	20, 42	Yes	P	Yes	Yes	6 months	—	Daily	—	—	—
Cleeland 2011	ATCS Plus	AF, SF	—	21	Yes	H	Yes	—	1 month	4 weeks	Biweekly	—	—	—
Cohen‐Cline 2014	IVR	AF	—	1,42	—	H	—	—	12 months	5 min¹	1	—	—	—
Corkrey 2005	ATCS Plus	AF, CF	—	3, 27, 39	Yes	H	Yes	—	6 months	—	—	—	—	—
Cvietusa 2012	ATCS Plus	AF, CF	—	29,42	—	H	Other	—	12 months	—	≤ 3	—	—	—
David 2012	ATCS Plus	AF, CF	TTM, SCT, PST	3,10	Yes	E	—	—	3 months	15‐30 s²	Twice daily	—	—	—
Dedier 2014	IVR	AF	TTM, SCT	1,9	—	H	—	—	3 months	10 min	Weekly	—	Pre‐recorded human speech	—
DeFrank 2009	IVR	AF	HBM¹	27, 42	—	H	Yes	—	24 months	69 s	Average ‐ 3	224 words	Female voice	Verification³
DeMolles 2004	IVR	AF	—	3, 18, 20, 40, 42	Yes	P	Yes	—	2 months	—	3‐day call², weekly	—	—	Password protected⁴
Derose 2009	ATCS Plus	AF, SF	—	40, 42	—	H	Yes	Yes	6 months	40 s	1	100 words	—	PIN⁵
Derose 2013	ATCS Plus	AF, SF	—	40, 42	—	H	—	Yes	3 months	40 s	1	—	—	—
Dini 1995	Unidirectional	AF	—	40	No	H	—	—	1 months	—	1	—	—	—
Dini 2000	Unidirectional	AF	—	42	No	H	—	—	36 months	—	1³	—	—	—
Dubbert 2002	Unidirectional¹	AF	TTM	9,10,40	—	H	—	—	10 months	—	—	Approx 30 words	Nurse	—
Durant 2014	IVR	AF	—	42	—	H	—	—	2 weeks	—	1‐2 attempts	—	—	—
Ershoff 1999	IVR	AF	TTM	20, 39	Yes	P	Yes	Yes	34 weeks	5 min	—	—	Professional	Password protected⁴, PIN²
Estabrooks 2008	IVR	AF	—	3, 9	Yes	—	—	—	3 months	1‐10 min³	Weekly	—	—	—
Estabrooks 2009	ATCS Plus	AF, CF	GM	2, 3, 9, 15, 20	—	E	—	—	12 months	—	10	—	—	—
Farzanfar 2011	IVR	AF	—	3, 6, 20, 30, 39, 42	Yes	E	Yes	Yes	6 months	30‐90 min²	Monthly	—	Female voice actor	Password protected⁴
Feldstein 2006	IVR	AF	—	39, 42	—	—	—	—	25 days	—	—	—	—	PIN⁶
Fiscella 2011	ATCS Plus¹	AF, CF	—	20,42	—	H	—	—	26 weeks	—	Up to 4	—	—	—
Fortuna 2014	Unidirectional	AF	—	29,30	—	H	—	—	12 months	—	2	—	—	—
Franzini 2000	Unidirectional	AF	—	40,42	No	H	—	—	—	—	—	—	—	—
Friedman 1996	IVR	AF	SCT	21, 32, 35, 39	—	E	Yes	Yes	6 months	4 min	Weekly	—	—	Password protected⁴
Glanz 2012	IVR	AF	—	3,16	—	E	Other	—	9 months	—	12	—	—	—
Goulis 2004	IVR	AF	—	1, 10, 20, 21,	Yes	—	—	—	6 months	15 min	Weekly	—	—	—
Graziano 2009	IVR	AF	HBM	3, 7, 20, 21, 42	—	H	—	—	12 months	> 1 min	Daily	—	Trained actor	PIN⁷
Green 2011	IVR	AF	—	16	—	H	Yes	—	—	—	—	—	—	—
Greist 2002	ATCS Plus	AF, SF	BT	34	—	E	Yes	—	3 months	8.6 min¹	12	—	—	—
Griffin 2011	ATCS Plus	AF, CF	HBM, SMP	3, 7, 27, 30, 40	—	H	—	—	6W	—	1	—	—	—
Halpin 2009	ATCS Plus	AF, CF, SF	—	21, 40, 42	Yes	H	—	—	4 months	—	Daily, 4⁴	—	—	—
Harrison 2013	Unidirectional	AF	—	20,42	—	H	—	—	1 month	—	—	80 words	—	—
Hasin 2013	ATCS Plus	AF, CF, SF	MI	9,12	Yes	P	—	Yes	12 months	60 days	Daily	1‐3 min	—	—
Helzer 2008	ATCS Plus	AF,CF	—	20,34	Yes	P	Yes	Yes	6 months	2 min	Daily	—	—	—
Hendren 2014	ATCS Plus¹	AF, CF	—	20,42	—	H	—	—	25 weeks	25 s	Up to 4	—	—	—
Hess 2013	Unidirectional	AF	—	16	—	H	—	—	3 months	1 min	Monthly	2 30‐s scripts	—	—
Heyworth 2014	ATCS Plus	AF, CF	—	16	—	H	—	—	3 months	4‐5 min	1	—	—	—
Ho 2014	ATCS Plus¹	AF, CF	—	20,42	—	H	—	—	12 months	—	Monthly⁵	—	—	—
Homko 2012	IVR	AF	—	21	Yes	P	Yes	Yes	26 months	—	Weekly	45 s of speaking	—	PIN²
Houlihan 2013	IVR	AF	TTM, SCT	4,20,21	Yes	H	—	—	6 months	4.12 min	Weekly	12.4 calls¹	Digitised speech	—
Hyman 1996	IVR	AF	—	20, 39, 42	—	E	Yes	—	6 months	—	Daily	—	—	—
Hyman 1998	ATCS Plus	AF, CF	SCT	20, 39, 42	—	E	Yes	—	6 months	2‐3 min	Biweekly	—	—	—
Jarvis 1997	IVR	AF	TTM	7, 9, 20, 39	Yes	P	Yes	—	3 months	—	Weekly	—	—	Password protected⁴
Katalenich 2015	ATCS Plus	AF,CF, SF	—	16,21,30	—	E	—	—	6 months	—	Daily	—	—	—
Khanna 2014	ATCS Plus	AF, SF	—	20	Yes	H	Yes	—	3 months	—	2.2/week	26 calls¹	Female voice	—
Kim 2014	ATCS Plus	AF, CF	—	20,29,30	—	H	—	—	12 months	≤ 10 min	Weekly	—	—	—
King 2007	IVR	AF	SCT, TTM	3, 9, 20, 39	Yes	H	Yes	—	12 months	10‐15 min	Weekly⁶	—	—	—
Kroenke 2010	ATCS Plus¹	AF, CF	TCM	39	—	E	—	—	12 months	—	Biweekly, weekly, bimonthly, monthly⁷	—	—	—
Kroenke 2014	ATCS Plus¹	AF, CF	—	21,39	—	H	—	—	12 months	—	Weekly⁸	—	—	—
Krum 2013	ATCS Plus	AF, CF, SF	—	20,21,42	—	E	Yes	—	12 months	—	Monthly	18 questions	—	—
Kurtz 2011	IVR	AF	—	39	No	P	Yes	—	24 months	48 s¹	Weekly	—	—	—
LeBaron 2004	ATCS Plus	AF, SF	—	40, 42	—	H	—	—	24 months	—	—	—	—	—
Leirer 1991	IVR	AF	—	20,42	Yes	H	Yes	—	2 weeks	—	—	3 segments	Personalised voice messages	—
Lieu 1998	IVR	AF	—	42	—	H	—	—	4 months	96.8 s	—	—	—	—
Lim 2013	Unidirectional	AF	—	42	—	H	—	—	5 months	—	Monthly	—	—	—
Linkins 1994	Unidirectional	AF	—	42	—	H	—	—	5 months	—	2/d⁹	—	—	—
Litt 2009	ATCS Plus	AF,SF	CBT	3,20,34,38	—	H	Yes	—	12 weeks	2.5 min	8/d¹⁰	—	—	—
Lorig 2008	ATCS Plus	AF, CF	—	21	—	—	—	—	15 months	90 s	Monthly	—	—	—
Magid 2011	ATCS Plus¹	AF, CF	—	20, 21, 25, 42	Yes	P	Yes	—	6 months	5‐10 min	Weekly	—	—	—
Mahoney 2003	ATCS Plus	AF, SF	PT, PM	3, 13, 25, 39, 42	Yes	P	Yes	Yes	18 months	18 min	—	22 h/d²	Professional radio announcer	Password protected⁴
Maxwell 2001	Unidirectional	AF	—	40	No	H	—	—	2 months	—	—	—	—	—
McNaughton 2013	IVR	AF	—	20, 21, 25, 34, 42	—	H	Other	—	24 months	3‐5 min	Biweekly	—	—	—
Migneault 2012	IVR	AF	SCT, TTM, MI	25, 39	Yes	—	Yes	Yes	8 months	—	Weekly	—	African – American voice professionals	—
Mooney 2014	ATCS Plus	AF, SF, CF	—	21	—	P	Yes	Yes	1.5 months	5.18 min¹	Daily	—	—	Personalised password
Moore 2013	ATCS Plus	AF, SF	CBT	17,34,38	Yes	H	Yes	—	1 month	9.3 min¹	Daily	—	—	—
Morey 2009	Unidirectional¹	AF	SCT, TTM	9, 10, 20, 25, 39	—	H	—	—	12 months	—	Monthly	Approx 60 words	Primary care provider	—
Morey 2012	Unidirectional¹	AF	SCT, TTM	9, 10, 20, 25, 39	—	H	—	—	12 months	—	Monthly	Approx 60 words	Primary care provider	—
Mosen 2010	IVR	AF	—	27, 42	—	H	Yes	Yes	6 months	1 min	3	—	—	—
Mu 2013	IVR	AF	—	25, 39	—	H	—	—	1 month	—	—	—	—	Correspondence with the author: "Upon answering a call, patients are required to authenticate with their date of birth."
Mundt 2006	ATCS Plus	AF, CF, SF	CBT	4,20,34,38	Yes	E	—	Yes	6 months	9.2 min	Daily	—	—	Valid ID number and a personally selected 4‐digit pass code
Nassar 2014	Unidirectional	AF	—	29	Yes	H	—	—	2 months	—	At least every 3 days	Every hour for 2 consecutive hours	Community health worker	—
Naylor 2008	IVR	AF	CBT	3, 16, 20, 22, 25, 39, 42	Yes	P	—	Yes	4 months	3‐16 min	Daily	—	Experienced therapist	—
Ownby 2012	Unidirectional	AF	—	42	—	H	—	—	24 months	—	Daily	—	First author	—
Parikh 2010	IVR	AF	—	40	—	H	—	—	4 months	—	—	—	—	—
Patel 2007	IVR	AF	—	39, 42	—	—	—	—	6 months	—	3	—	—	—
Peng 2013	ATCS Plus	AF, SF	CBT, TTM, MI	9, 0, 12, 20, 21	—	H	Yes	—	2 months	18.9 min^^	Biweekly weeks 1‐3, weekly weeks 4‐6, no call week 7, weekly week 8‐9	8.61²,³	—	—
Phillips 2015	IVR	AF	—	29, 30	—	H	—	—	3.5 months	—	up to 5 times	—	—	—
Piette 2000	ATCS Plus	AF, CF	SCT	3, 18, 21, 25, 39	No	E	Yes	Yes	24 months	1‐8 min²	Biweekly¹¹	—	Human voice	PIN²
Piette 2001	ATCS Plus	AF, CF	SCT	3, 18, 21, 25, 39	—	H	Yes	—	12 months	1‐8 min²	Biweekly¹¹	—	—	—
Piette 2012	ATCS Plus	AF, CF	—	13, 20, 21, 39	Yes	—	Yes	Yes	1.5 months	≤ 9 min	Weekly	—	Native speaker	—
Pinto 2002	ATCS Plus	AF, SF	DMT, SCT, TTM	3, 19, 20, 32	Yes	P	Yes	—	6 months	10 min	Weekly (first 3 months), and at least biweekly thereafter	—	Digitised human speech	—
Reekie 1998	Unidirectional	AF	—	39, 40	No	H	—	—	—	—	—	—	Receptionist	—
Regan 2011	ATCS Plus	AF, CF	—	20, 42	—	H	—	—	3 months	—	—	—	—	—
Reid 2007	ATCS Plus	AF, CF	—	3, 9, 13, 39, 40, 42	—	H	—	—	12 months	1‐20 min⁵	3	—	—	—
Reid 2011	ATCS Plus	AF, CF	—	20, 42	—	—	—	—	12 months	—	8	—	—	—
Reynolds 2011	IVR	AF	—	42	—	P	—	—	—	—	—	—	—	—
Rigotti 2014	ATCS Plus	AF, CF, SF	—	13, 34	—	H	—	Yes	6 months	—	5 times¹²	—	—	—
Rose 2015	ATCS Plus	AF, CF, SF	CBT	4, 20, 34, 38	Yes	P	—	—	4 months	—	Daily	—	—	—
Rubin 2012	IVR	AF	MI	9, 12	—	H	Other	—	6 months	—	≤ 26 calls over 13 weeks	—	—	—
Schillinger 2009	ATCS Plus	AF, CF	CCM, SCT	1, 3, 9, 10, 13, 20, 21, 35, 39	—	E	Yes	Yes	12 months	6‐12 min	Weekly	—	—	—
Sherrard 2009	ATCS Plus	AF, CF	—	27, 39, 42	—	H	—	—	6 months	—	11	—	—	Password protected⁴
Shet 2014	IVR¹	AF	TPB	16,20	—	H	—	—	24 months	—	Weekly	—	—	—
Siegel 1992	IVR	AF	—	17, 20, 42	—	H	Other	—	6 weeks	—	3 calls 6 weeks apart	12 questions; 397 words	Digitally stored voice	—
Sikorskii 2007	IVR	AF	—	17, 20, 30, 39, 40	—	H	Yes	—	2 months	—	Weekly¹³	—	Female voice	—
Simon 2010a	IVR	AF	GMDBC, Others²	3, 27, 39	Yes	E	—	—	3 months	2‐6 min	—	—	—	Verification
Simon 2010b	ATCS Plus	AF, CF	—	30, 42	No	H	No	—	12 months	—	3¹⁴	—	Human voice	—
Simpson 2005	IVR	AF	—	20	Yes	P_H	Yes	Yes	1 months	—	Daily	—	—	—
Solomon 2007	ATCS Plus¹	AF, CF	—	16	—	H	—	Yes	—	—	—	—	Female voice	—
Sparrow 2010	IVR	AF	SCT, MI	3, 12, 17, 20, 25, 39, 40, 42	—	E	Yes	—	12 months	—	Weekly then monthly¹⁵	—	—	Password protected⁴
Sparrow 2011	IVR	AF	SCT	3, 12, 17, 20, 25, 39, 40, 42	Yes	E	Yes	—	12 months	—	Weekly then monthly¹⁵	—	—	Password protected⁴
Spoelstra 2013	ATCS Plus	AF, CF	CBT	2, 20	Yes	H	Yes	—	2 months	—	Weekly	—	—	—
Stacy 2009	ATCS Plus	AF, SF	HBM, CCM, SCT, TTM, MI, SRT, RL	2, 3, 20, 32, 39	—	H	—	Yes	6 months	—	3	—	—	—
Stehr‐Green 1993	Unidirectional	AF	—	42	—	H	—	—	1 month	—	1³	—	Human voice	—
Stuart 2003	IVR¹	AF	—	9, 10, 42	Yes	P	Yes	—	3 months	—	Daily/2 weeks; weekly/10 weeks	25 calls	Female voice	—
Szilagyi 2006	Unidirectional	AF	—	42	—	H	—	—	18 months	—	Weekly	—	—	—
Szilagyi 2013	Unidirectional	AF	—	42	—	H	—	—	12 months	—	—	—	—	—
Tanke 1994	Unidirectional	AF	HBM	7*, 39, 40, 42	No	H	—	—	—	—	1¹⁶	—	Female using native languages	—
Tanke 1997	Unidirectional	AF	HBM	39, 40, 42	No	H	—	—	—	—	1¹⁶	—	Female using native languages	—
Tucker 2012	IVR	AF	BET	9, 20, 25, 34	Yes	—	—	—	6 months	≤ 5 min	Daily	—	—	PIN⁶
Vance 2011	ATCS Plus	AF,SF	—	10	—	—	—	—	3 months	—	3/week	—	—	—
Velicer 2006	IVR¹	AF	TTM	4, 13, 20, 34, 38	—	E	Yes	—	6 months	15‐20 min	Weekly¹⁷	—	—	—
Vollmer 2006	ATCS Plus	AF, CF	—	39	—	H	Other	—	10 months	< 10 min	3¹⁸	—	—	—
Vollmer 2011	ATCS Plus	AF, CF	—	20, 42	—	H	Other	Yes	18 months	2‐3 min	—	—	—	—
Vollmer 2014	ATCS Plus	AF, CF, SF	—	20, 42	Yes	H	Other	Yes	12 months	2‐3 min	Monthly	—	—	—
Williams 2012	IVR	AF	—	3, 21, 39	Yes	P	Yes	Yes	6 months	5‐20 min	Weekly	—	—	PIN⁶
Wright 2013	IVR	AF	SCT	2, 9, 10	No	P	Other	—	3 months	—	Biweekly	—	Synthetic speech	—
Xu 2010	IVR	AF	—	21, 40	—	H	Yes	—	6 months	—	Biweekly	—	—	—
Yount 2014	ATCS Plus	AF, SF	—	21, 40	—	P	Yes	—	3 months	—	Weekly	—	—	PIN
Zautra 2012	Unidirectional	AF	SCT	4,13	—	—	—	—	—	—	—	—	—	—
^aATCS ¹For more detailed evaluation of multimodal/complex interventions, please refer to Table 4. ^bContent delivery: AF: automated functions; CF: communicative functions; SF: supplementary functions. ^cTheory: BET: behavioural economic theory; BT: behavioural therapy; CBT: cognitive behavioural therapy; CCT: self‐management support strategies using chronic care model; DMT: Golan's model based on social–ecologic theory decision making theory; GMDBC: general model of the determinants of behavioural change; HBM: health belief model process theory; MI: motivational interviewing; PM: Pearlin's model of AD caregiver's stress; RL: reflective listening; RP: relapse prevention; SCT: social cognitive theory; SMP: social marketing principles; SRT: self‐regulation theory; TCD: theory of cognitive dissonance; TCM: 3‐component model; TPB: theory of planned behaviour; TRA: theory of reasoned action; TTM: transtheoretical model. ¹For enhanced letter reminders group. ²Synthesis of behavioural theories. ^dBehaviour change techniques: 1 ‐ action planning; 2 ‐ agree behavioural contract; 3 ‐ barrier identification/problem solving; 4 ‐ emotional control training; 5 ‐ environmental restructuring; 6 ‐ facilitate social comparison; 7 ‐ fear arousal; 8 ‐ general communication skills training; 9 ‐ goal setting (behaviour); 10 ‐ goal setting (outcome); 11 ‐ model/demonstrate the behaviour; 12 ‐ motivational interviewing; 13 ‐ plan social support/social change; 14 ‐ prompt anticipated regret; 15 ‐ prompt identification as a role model/position advocate; 16 ‐ prompt practice; 17 ‐ prompt review of behavioural goals; 18 ‐ prompt review of outcome goals; 19 ‐ prompt self talk; 20 ‐ prompt self‐monitoring of behaviour; 21 ‐ prompt self‐monitoring of behavioural outcome; 22 ‐ prompt use of imagery; 23 ‐ prompting focus on past success; 24 ‐ prompting generalisation of a target behaviour; 25 ‐ provide feedback on performance; 26 ‐ provide information about other's approval; 27 ‐ provide information on consequences of behaviour in general; 28 ‐ provide information on consequences of behaviour to the individual; 29 ‐ provide information on where and when to perform the behaviour; 30 ‐ provide instruction on how to the perform the behaviour; 31 ‐ provide normative information about others' behaviour; 32 ‐ provide rewards contingent on effort or progress towards behaviour; 33 ‐ provide rewards contingent on successful behaviour; 34 ‐ relapse prevention/coping planning; 35 ‐ set graded tasks; 36 ‐ shaping; 37 ‐ stimulate anticipation of future rewards; 38 ‐ stress management; 39 ‐ tailoring; 40 ‐ teach to use prompts/cues; 41 ‐ time management; 42 ‐ use of follow up prompts. ¹Only those in the IG received importance statement. ^eCaller: E ‐ either participant or healthcare provider/researcher; H ‐ healthcare provider/researcher; P ‐ participant; P_H ‐ If P fails to call then H calls. ^fTelephone keypad for response: the calls were made using speech recognition (or speech‐enabled) technology; ¹‐ both data entry via Web screen or voice or telephone keypad. ^gDuration of calls ¹Mean value. ²Assessments: 5‐8 min, health tips: 30‐60 s, healthcare education module: 3‐5 min. ³7 calls provided about 5–10 min of counselling, while the remaining 5 calls provided a tip of the week that lasted < 1 min. ⁴Screening session. ⁵20 min ‐ telecounselling, 30‐60 s ‐ health tips, 3‐5 min (optional) ‐ interactive self‐care education module. ^hFrequency ¹Twice daily, follow‐up phase ‐ daily for another 4 weeks, twice a week for another 2 weeks, and then once a week. ²1st call 3 days after starting CPAP. ³Up to 9 attempts. ⁴Alert calls. ⁵The medication reminder calls occurred monthly; the medication refill calls were synchronised to when a medication refill was due. During months 2‐6 of the intervention, participants received both medication reminder (monthly) and medication refill calls (timed to refill due dates) for the 4 medications of interest. During months 7‐12 of the intervention, participants only received medication refill calls; ⁶2 weekly calls, 3 biweekly, and 10 monthly calls. ⁷Weeks 1‐3, biweekly; weeks 4‐11, weekly; months 3‐6, bimonthly; months 7‐12, monthly. ⁸For the first month, every other week for months 2 and 3, and monthly for months 4 through 12. ⁹Twice daily for 7 days until successful telephone contact was established. ¹⁰For assessment only (a total of 12 sessions were administered). ¹¹Up to 6 call attempts. ¹²At 2, 14, 30, 60, and 90 days postdischarge. ¹³ Except week 5. ¹⁴Up to six attempts, leaving up to two messages requesting a call back. ¹⁵1st month ‐ weekly followed by monthly calls. ¹⁶Up to 5 follow‐up calls at half hour intervals if busy phone lines or non‐response. ¹⁷Weekly for the first month, biweekly the second month, and monthly for months 3–6 and applied to smokers who received nicotine replacement therapy. ¹⁸5 months apart. ⁱIntensity ¹Mean value. ²Except for 2 h during the night for network file backup. ³Estimate for IG only. ^jSecurity arrangement ¹Memotext ‐ the place where the reminders were actually generated. ²Personal identification number. ³Automated messages instructed the listener to 'press 1' if the call had reached the intended recipient, and they were not left on answering machines. ⁴Confidential password was used to access the system. ⁵Personal identification number (PIN) ‐ medical record number. ⁶PIN ‐ health record number and year of birth; ⁷PIN ‐ study number and telephone number.

Study ID	Type^a	Subtype	Participant age (years)	Sex	Ethnicity^b	Primary outcome measures	Effect^c
Tucker 2012	P	Alcohol misuse	41‐70	> 50% M	W	Drinking practices Spending on alcohol	2 2 (median effect = 2)
Franzini 2000	P	Immunisation	—	—	—	Immunisation status Cost‐effectiveness	1 1 (median effect = 1)
Hess 2013	P	Immunisation	≥ 71	—	—	Herpes zoster immunisations	1
Dini 2000	P	Immunisation	0‐21	—	—	Immunisation status	2
LeBaron 2004	P	Immunisation	0‐21	M = F (± 3%)	W,B,H	Completion by the age of 24 months of the 4‐3‐1‐3 immunisations series	2
Lieu 1998	P	Immunisation	0‐21	—	—	Immunisation status	2
Linkins 1994	P	Immunisation	—	M = F (± 3%)	W,B	Immunisation status	1
Nassar 2014	P	Immunisation	22‐40	> 50% F	W,B	Immunisation rate	2
Stehr‐Green 1993	P	Immunisation	0‐21	M = F (± 3%)	B,H	Immunisation status	2
Szilagyi 2006	P	Immunisation	0‐21	M = F (± 3%)	W,B,H	Immunisation status	2
Szilagyi 2013	P	Immunisation	0‐21	M = F (± 3%)	—	Immunisation status Preventive visit rate	1 1
David 2012	P	Physical activity	41‐70	> 50% F	W	1‐mile walk after the intervention	5
Dubbert 2002	P	Physical activity	41‐70	> 50% M	—	Self‐reported (diary) walking adherence	1
Jarvis 1997	P	Physical activity	41‐70	> 50% F	B	Minutes walked per week	1
King 2007	P	Physical activity	41‐70	> 50% F	W	Minutes of moderate to vigorous physical activity	1
Morey 2009	P	Physical activity	≥ 71	> 50% M	W,B	Gait speed (usual and rapid) Self‐reported physical activity Function and disability	2, 1 1 2 (median effect = 2)
Morey 2012	P	Physical activity	41‐70	> 50% M	W	Homeostasis model assessment of insulin resistance	2
Pinto 2002	P	Physical activity	41‐70	> 50% F	W,B	Energy expenditure in moderate‐intensity‐physical activity % meeting recommendations for moderate‐intensity‐physical activity Motivational readiness for physical activity	2 2 2 (median effect = 2)
Sparrow 2011	P	Physical activity	≥ 71	> 50% M	—	Muscle strength Balance Walk distance Mood	1 1 2 1 (median effect = 1)
Baker 2014	P	Screening	41‐70	> 50% F	H	Colorectal cancer screening adherence (faecal occult blood testing)	1
Cohen‐Cline 2014	P	Screening	41‐70	> 50% M	W	Receipt of any recommended colorectal cancer screening	1
Corkrey 2005	P	Screening	—	> 50% F	—	Screening rate	2
DeFrank 2009	P	Screening	—	> 50% F	W,B,A	Mammography adherence	1
Durant 2014	P	Screening	41‐70	M = F (± 3%)	—	Receipt of colorectal cancer screening after 3 months	—
Fiscella 2011	P	Screening	—	> 50% F	W,B,H,A	Chart documentation of breast cancer screening, colorectal cancer screening, or both	1
Fortuna 2014	P	Screening	—	> 50% F	W,B	Breast cancer and colorectal cancer screening	2
Hendren 2014	P	Screening	—	> 50% F	W,B,H	Documentation of breast cancer screening, colorectal cancer screening, or both	1
Heyworth 2014	P	Screening	41‐70	> 50% F	—	Bone mineral density screening after 12 months	1
Mosen 2010	P	Screening	41‐70	M = F (± 3%)	W	Completion of faecal occult blood testing at 6 months	1
Phillips 2015	P	Screening	41‐70	> 50% F	W,B	Completed mammogram or colorectal cancer screening within 36 weeks of randomisation	2
Simon 2010a	P	Screening	41‐70	M = F (± 3%)	W	Colorectal cancer screening	2
Solomon 2007	P	Screening	41‐70	> 50% F	—	Bone mineral density testing and/or filling a prescription for a bone active medication	1
Mahoney 2003	P	Stress management among caregivers	41‐70	> 50% F	W,B	Caregiver's appraisal of the bothersome nature of caregiving Anxiety Depression	2 2 2 (median effect = 2)
Aharonovich 2012	P	Substance use	41‐70	> 50% M	W,H	Days using primary drug	2
Bennett 2012	P	Weight management	41‐70	> 50% F	B,H	Change in body weight and BMI	1
Bennett 2013	P	Weight management	22‐40	> 50% F	B	Change in body weight and BMI	1
Estabrooks 2008	P	Weight management	41‐70	> 50% F	W,B,H,A	Physical activity Dietary habits Weight loss	2 2 2 (median effect = 2)
Estabrooks 2009	P	Weight management	0‐21	> 50% M	W,H	BMI z‐score Physical activity and sedentary behaviour Dietary habits Eating disorder symptoms	2 2 2 2 (median effect = 2)
Goulis 2004	P	Weight management	41‐70	> 50% F	—	Body weight BMI Systolic blood pressure Diastolic blood pressure Plasma glucose Serum triglycerides Serum serum high‐density lipoprotein‐cholesterol Total serum cholesterol SF‐36 EQ‐5D Obesity Assessment Survey	1 2 2 2 2 1 1 2 2 2 2 (median effect = 2)
Vance 2011	P	Weight management	—	—	—	Weight change	2
Wright 2013	P	Weight management	0‐21	> 50% M	W,B	BMI Calorie intake Fat intake Fruit intake Vegetable intake Television‐viewing time	2 2 2 2 2 2 (median effect = 2)
Dini 1995	E	Appointment reminder	—	—	—	Appointment adherence	1
Griffin 2011	E	Appointment reminder	41‐70	> 50% M	W	Appointment non‐attendance Preparation non‐adherence	2 2 (median effect = 2)
Maxwell 2001	E	Appointment reminder	22‐40	> 50% F	W,B,H	Attendance rate	2
Parikh 2010	E	Appointment reminder	—	M = F (± 3%)	—	Appointment adherence	1
Reekie 1998	E	Appointment reminder	—	—	—	Appointment adherence	2
Tanke 1994	E	Appointment reminder	0‐21	> 50% M	H	Appointment adherence	1
Tanke 1997	E	Appointment reminder	0‐21	> 50% F	W,H	Appointment adherence (3‐day interval)	1
Moore 2013	M	Illicit drugs addiction	41‐70	> 50% M	W,B	Patient interest Perceived efficacy Ease of use Treatment satisfaction Retention rate Drug consumption Methadone counselling Coping	5 5 5 4 4 2 2 2 (median effect = 4)
Andersson 2012	M	Alcohol consumption	—	—	—	AUDIT score	1
Hasin 2013	M	Alcohol consumption	41‐70	> 50% M	B,H	Number of drinks per drinking day	1
Helzer 2008	M	Alcohol consumption	41‐70	> 50% M	W	Weekly alcohol consumption	3
Litt 2009	M	Alcohol consumption	41‐70	> 50% M	W,B,H	Proportion of days abstinent Proportion of heavy drinking days Continuous abstinence Drinking problems Coping problems	1 2 2 2 2 (median effect = 2)
Mundt 2006	M	Alcohol consumption	41‐70	> 50% M	W,B	Self‐reported drinking patterns Blood alcohol content Work and social adjustment scale Obsessive–compulsive drinking scale SF‐36 health survey Drinker inventory of consequences	2 2 2 2 2 2 (median effect = 2)
Rose 2015	M	Alcohol consumption	41‐70	M = F (± 3%)	—	Alcohol consumption	2
Rubin 2012	M	Alcohol consumption	41‐70	> 50% M	W,B	Number of heavy drinking days per month % days abstinent per month Drinks per drinking day	2 2 2 (median effect = 2)
Simpson 2005	M	Alcohol consumption	41‐70	> 50% M	W,B	Drinking habits Alcohol craving Post‐traumatic stress disorder symptoms	2 2 2 (median effect = 2)
Vollmer 2006	M	Asthma	41‐70	> 50% F	W	Healthcare utilisation Medication use QoL	2 2 2 (median effect = 2)
Xu 2010	M	Asthma	0‐21	M = F (± 3%)	—	Healthcare utilisation	4
Cleeland 2011	M	Cancer	41‐70	> 50% M	W	Number of symptom threshold events Cumulative distribution of symptom threshold events Differences in mean symptom severity between discharge and follow‐up	1 2 2 (median effect = 2)
Kroenke 2010	M	Cancer	41‐70	> 50% F	W,B	Depression severity Pain severity	1 1 (median effect = 1)
Mooney 2014	M	Cancer	41‐70	> 50% F	W	Symptom presence, severity, and distress data	2
Siegel 1992	M	Cancer	41‐70	M = F (± 3%)	W,B,H	Prevalence of unmet needs	2
Sikorskii 2007	M	Cancer	41‐70	> 50% F	—	Symptom severity	2
Spoelstra 2013	M	Cancer	41‐70	> 50% F	W,B,A	Adherence to medications Symptom severity	2 1 (median effect = 2)
Yount 2014	M	Cancer	41‐70	M = F (± 3%)	W,B,H	Symptom burden	2
Naylor 2008	M	Chronic Pain	41‐70	> 50% F	W	Pain Function/disability Coping	1 1 1 (median effect = 1)
Kroenke 2014	M	Chronic Pain	41‐70	> 50% M	W	Pain intensity	1
Halpin 2009	M	Chronic obstructive pulmonary disease	41‐70	> 50% M	—	Frequency of exacerbations Proportion of patients experiencing 1 or more exacerbations	2 2 (median effect = 2)
Adams 2014	M	Adherence	0‐21	> 50% M	B	Comprehensiveness of screening and counselling	1
Bender 2010	M	Adherence	41‐70	> 50% F	W,B,H,A	Medication adherence	1
Bender 2014	M	Adherence	0‐21	—	—	Medication adherence	1
Boland 2014	M	Adherence	41‐70	M = F (± 3%)	W,B,H,A	Medication adherence	1
Cvietusa 2012	M	Adherence	0‐21	—	—	Medication adherence	1
Derose 2009	M	Adherence	41‐70	> 50% M	W,B,H,A	Adherence (completion of all 3 recommended laboratory tests)	2
Derose 2013	M	Adherence	41‐70	M = F (± 3%)	W,B,H,A	Medication adherence	1
Feldstein 2006	M	Adherence	41‐70	M = F (± 3%)	—	Completion of all recommended laboratory tests	1
Friedman 1996	M	Adherence	≥ 71	> 50% F	B	Medication adherence Systolic blood pressure Diastolic blood pressure	1 2 1 (median effect = 1)
Glanz 2012	M	Adherence	41‐70	> 50% M	W,B	Medication adherence Refill adherence Appointment adherence	2 2 2 (median effect = 2)
Green 2011	M	Adherence	—	—	—	Medication refill rate	1
Ho 2014	M	Adherence	41‐70	> 50% M	W	Medication adherence	1
Leirer 1991	M	Adherence	≥ 71	> 50% F	—	Medication non‐adherence Cognitive assessment	1 2 (median effect = 2)
Lim 2013	M	Adherence	41‐70	M = F (± 3%)	W,B,H,A	Adherence rate Therapeutic coverage	2 2 (median effect = 2)
Migneault 2012	M	Adherence	41‐70	> 50% F	B	Medication adherence Diet Moderate or greater intensity physical activity	2 1 4 (median effect = 2)
Mu 2013	M	Adherence	—	—	—	Medication adherence	1
Ownby 2012	M	Adherence	≥ 71	—	—	Medication adherence	1
Patel 2007	M	Adherence	41‐70	M = F (± 3%)	—	HRQLAdherence to statins	1
Reynolds 2011	M	Adherence	—	—	—	Medication adherence (refill rate)	1
Sherrard 2009	M	Adherence	41‐70	—	—	Adherence and adverse events	1
Simon 2010b	M	Adherence	41‐70	> 50% M	B	Retinopathy examination	4
Stacy 2009	M	Adherence	41‐70	> 50% F	—	6‐month point prevalence	1
Stuart 2003	M	Adherence	—	—	—	Adherence to medications	2
Vollmer 2011	M	Adherence	41‐70	> 50% F	W,B,A	Medication adherence	1
Vollmer 2014	M	Adherence	41‐70	M = F (± 3%)	W,B,A	Medication adherence	1
Graziano 2009	M	Diabetes mellitus	41‐70	> 50% M	W	Glycated haemoglobin	2
Homko 2012	M	Diabetes mellitus	41‐70	> 50% F	W,B,H	Maternal blood glucose level Infant birth weight	2 2 (median effect = 2)
Katalenich 2015	M	Diabetes mellitus	41‐70	> 50% F	W,B,H,A	Glycated haemoglobin Medication adherence Quality of life Cost‐effectiveness	2 2 2 1 (median effect = 2)
Khanna 2014	M	Diabetes mellitus	41‐70	> 50% M	H	Glycated haemoglobin	4
Kim 2014	M	Diabetes mellitus	—	—	—	Glycated haemoglobin	1
Lorig 2008	M	Diabetes mellitus	41‐70	> 50% F	H	Glycated haemoglobin Health distress Global health Hypoglycaemia Hyperglycaemia Activity limitation Fatigue Physical activity levels Communication with physician Glucose monitoring Self‐efficacy Healthcare utilisation	4 4 4 2 4 4 4 2 4 1 4 2 (median effect = 4)
Piette 2000	M	Diabetes mellitus	41‐70	> 50% F	W,H	Depression Anxiety Self‐efficacy Days in bed because of illness Days cut down on activities because of illness Diabetes‐specific health‐related quality of life Satisfaction with care (English speakers only) General health‐related quality of life (English speakers only)	1 2 1 1 2 6 1 1 (median effect = 1)
Piette 2001	M	Diabetes mellitus	41‐70	> 50% M	W,B,H	Glucose monitoring Foot inspection Weight monitoring Medication adherence Glycated haemoglobin Serum glucose levels Diabetic symptoms (all) Hyperglycaemic symptoms Hypoglycaemic symptoms Vascular symptoms Other symptoms Satisfaction with care (summary score)	1 1 2 4 2 2 1 2 2 2 1 1 (median effect = 2)
Schillinger 2009	M	Diabetes mellitus	41‐70	> 50% F	W,B,H,A	Change in self management behaviour (self‐monitoring of blood glucose and self‐monitoring of diabetic foot)	1
Williams 2012	M	Diabetes mellitus	41‐70	> 50% M	—	Glycated haemoglobin Health‐related quality of life (mental) Health‐related quality of life (physical)	1 1 2 (median effect = 1)
Capomolla 2004	M	Heart failure	41‐70	> 50% M	—	All‐cause mortality Re‐hospitalisation Emergency room use (composite outcome)	1
Chaudhry 2010	M	Heart failure	41‐70	> 50% M	W,B	Readmission for any reason or death from any cause	4
Krum 2013	M	Heart failure	≥ 71	> 50% M	—	Packer clinical composite score: death, hospital admission for heart failure, withdrawal from study due to worsening heart failure, 7‐point global health assessment questionnaire	2
Kurtz 2011	M	Heart failure	41‐70	> 50% M	—	Cardiovascular deaths and hospitalisations (outcomes in isolation included cardiovascular deaths, hospitalisations for heart failure, and time to primary endpoint)	1
Shet 2014	M	HIV	—	> 50% M	A	Time to virological failure (viral load > 400 copies/mL on 2 consecutive measurements)	2
Hyman 1996	M	Hypercholestorolemia	41‐70	> 50% F	W	Total cholesterol reduction	2
Hyman 1998	M	Hypercholesterolemia	41‐70	> 50% F	B	Total cholesterol reduction	2
Bove 2013	M	Hypertension	41‐70	> 50% F	W,B,H	Blood pressure control at 6 months	2
Dedier 2014	M	Hypertension	41‐70	> 50% F	H	Change in minutes of moderate or greater physical activity Change in systolic blood pressure	1 2 (median effect = 2)
Harrison 2013	M	Hypertension	—	—	—	Blood pressure	1
Magid 2011	M	Hypertension	41‐70	> 50% M	W,H	Proportion to achieve guideline‐recommended blood pressure goals Systolic blood pressure Diastolic blood pressure	2 1 2 (median effect = 2)
Piette 2012	M	Hypertension	41‐70	> 50% F	—	Systolic blood pressure	2
Farzanfar 2011	M	Mental health	22‐40	> 50% F	W,B	Quality of life (physical scale score and mental scale score) Depression Stress levels Total well‐being	2, 2 2 2 2 (median effect = 2)
Greist 2002	M	Mental health	22‐40	> 50% M	W	Yale‐Brown obsessive compulsive scale (YBOCS) score	1
Zautra 2012	M	Mental health	—	—	—	Emotional health Physical health Stress	1 1 1 (median effect = 1)
DeMolles 2004	M	Obstructive sleep apnoea syndrome	41‐70	—	—	Continuous positive airway pressure use	2
Sparrow 2010	M	Obstructive sleep apnoea syndrome	41‐70	> 50% M	—	Continuous positive airway pressure use	1
Brendryen 2008	M	Smoking	22‐40	M = F (± 3%)	—	Repeated point abstinence	1
Carlini 2012	M	Smoking	22‐40	> 50% F	W,B,H,A	Re‐enrollment into quit line support	1
Ershoff 1999	M	Smoking	22‐40	> 50% F	W,B	Smoking abstinence	2
McNaughton 2013	M	Smoking	41‐70	> 50% M	—	Self‐reported abstinence Biochemically confirmed smoking abstinence	2 4 (median effect = 3)
Peng 2013	M	Smoking	0‐21	> 50% M	A	Stage of change Self‐efficacy Decisional balance	5 5 5 (median effect = 5)
Regan 2011	M	Smoking	41‐70	> 50% M	—	Smoking abstinence	4
Reid 2007	M	Smoking	41‐70	> 50% M	—	Smoking abstinence	2
Reid 2011	M	Smoking	—	—	—	Smoking abstinence	2
Rigotti 2014	M	Smoking	41‐70	M = F (± 3%)	W,B,H,A	Biochemically confirmed tobacco abstinence at 6 months	1
Velicer 2006	M	Smoking	41‐70	> 50% M	W,B,A	24‐h point prevalence 7‐d point prevalence 6‐month prolonged abstinence	2 2 2 (median effect = 2)
Houlihan 2013	M	Spinal cord dysfunction	41‐70	> 50% M	W,B,H	Prevalence of pressure ulcers Depression severity Healthcare utilisation	2 1 2 (median effect = 2)
^aStudy type: E: either prevention or management; M: management of long‐term condition; P: prevention. ^bEthnicity: A: American Indian/Alaskan native; B: black/African American; H: Hispanic; W: white. ^cEffect: 1: Significant positive; 2: non‐sig positive; 3: significant negative; 4: non‐significant negative; 5: no difference (significant); 6: no difference (non‐significant)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immunisation in children Show forest plot	5	10454	Risk Ratio (M‐H, Random, 95% CI)	1.25 [1.18, 1.32]

2 Immunisation in adolescents Show forest plot	2	5725	Risk Ratio (M‐H, Random, 95% CI)	1.06 [1.02, 1.11]

3 Immunisation in adults Show forest plot	2	1743	Risk Ratio (M‐H, Random, 95% CI)	2.18 [0.53, 9.02]

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