Targeted mass media interventions promoting healthy behaviours to reduce risk of non‐communicable diseases in adult, ethnic minorities

Annhild Mosdøl; Ingeborg B Lidal; Gyri H Straumann; Gunn E Vist

doi:10.1002/14651858.CD011683.pub2

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Figure 1

Logic model. Adapted based on Bertrand 2006 and Niederdeppe 2008b

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Figure 2

Study flow diagram.

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Figure 3

Approaches used in the included studies to target the intervention to the study population, by categories according to logic model.

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Figure 4

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 5

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

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Summary of findings for the main comparison. Targeted mass media intervention versus general population mass media intervention for promoting healthy behaviours

Comparison 1: targeted mass media intervention versus general population mass media intervention for promoting healthy behaviours
Patient or population: adult, ethnic minority: self‐described Americans of African heritage Setting: volunteers, smokers, USA Intervention: targeted mass media intervention Comparison: general population mass media intervention
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	N of participants (studies)	Quality of the evidence (GRADE)^a	Comments
	Assumed risk	Corresponding risk
	General population mass media intervention	Targeted mass media intervention
Indicators of behavioural change
Any outcome considered an indicator of change	No study provided data for this outcome.
Self‐reported behavioural change
Proportion smoking reduction, 3 months follow‐up	94%	95%	—	255 (1 RCT)	⊕⊝⊝⊝ Very low^b,c	No effect measures reported by authors. Not significantly different between groups
Quit‐attempts, 3 months follow‐up	—	—	Adjusted OR 1.97 (1.09 to 3.55) in favour of general population mass media intervention	255 (1 RCT)	⊕⊝⊝⊝ Very low^b,c	24‐hour and 7‐day point prevalence abstinence not significantly different between groups
Knowledge and attitudes to change
Contemplation ladder to quit smoking (1‐10), 3 months follow‐up	Mean score: 8.2 (SD 2.4)	Mean score: 7.3 (SD 2.6)	—	255 (1 RCT)	⊕⊝⊝⊝ Very low^b,c	Difference between group reported at P = 0.01
Adverse effects
Any outcome considered an adverse effect	No study provided data for this outcome.
*The risk in the intervention group (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) CI: confidence interval; OR: odds ratio; SD: standard deviation.
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aIn the GRADE assessments for the domain 'directness', we considered the studies directly relevant to the inclusion criteria. Thus, we have not downgraded on this domain. However, the population of interest will be dissimilar in different contexts, relating to characteristics of the ethnic minority group, the country and setting overall. The transferability of results must be considered for each context specifically. ^bDowngraded one level for unclear risk of bias. ^cDowngraded two levels for imprecision: Only one, relatively small study.

Summary of findings for the main comparison. Targeted mass media intervention versus general population mass media intervention for promoting healthy behaviours

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Summary of findings 2. Targeted mass media intervention for promoting healthy behaviours versus no intervention

Comparison 2: targeted mass media intervention for promoting healthy behaviours versus no intervention
Patient or population: adult, ethnic minority group: self‐described Americans of African heritage Setting: volunteers, community setting, USA Intervention: targeted mass media intervention Comparison: no intervention
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	N of participants (studies)	Quality of the evidence (GRADE)^a	Comments
	Assumed risk	Corresponding risk
	No intervention	Targeted mass media intervention
Indicators of behavioural change
BMI (kg/m²), 12 months from baseline	34.4 (SD 8.5)^b	Mean difference in change 0.1 (−0.4 to 0.6)	—	154 (1 RCT)	⊕⊕⊝⊝ Low^c	Corresponding risk at 3 months: mean difference in change −0.4 (−0.7 to −0.02)
Self‐reported behavioural change
Changes in dietary composition, 12 months from baseline	Food habits questionnaire, score on fat behaviours (no scoring scale provided by study authors): 1.0 (SD 0.4)	Mean difference in change −0.2 (−0.3 to ‐0.1)	—	154 (1 RCT)	⊕⊝⊝⊝ Very low^c,d	Corresponding risk at 3 months: mean difference in change −0.1 (−0.2 to −0.02)
Leisure time physical activity, 12 months from baseline	Physical activity score (no scoring scale provided by study authors): 60.0 (SD 47.0)^e	Mean difference in change 12.0 (1.0 to 23.0)	—	154 (1 RCT)	⊕⊝⊝⊝ Very low^c,d	Corresponding risk at 3 months: mean difference in change 10.0 (−1.7 to 21.8)
Knowledge and attitudes to change
Any measure of knowledge and attitude	No study provided data for this outcome.
Adverse effects
Any outcome considered an adverse effect	No study provided data for this outcome.
Use of health promotion services (secondary outcome)
Calls to smoking quit lines, during campaign	18 calls per estimated 10,000 African American smokers in the intervention group versus 0.2 calls in the control communities^f.			Estimated target population 641,800 (1 RCT)	⊕⊕⊕⊝ Moderate^g,h	—
Calls to smoking quit lines, during and after campaign	Change from pre‐campaign, calls per month (95% CI) from new pregnant smokers: 8 (1 to 14) first month of campaign, 8 (1 to 14) last month of campaign, 6 (−1 to 12) first month after campaign, 3 (−4 to 10) 4 months after campaign			Population in target city ˜300,000 (1 ITS)	⊕⊕⊝⊝ Low^i,j	—
Proportion of calls from target population during campaign	Proportion of calls from African Americans during trial: 82% in intervention and 26% in control communities			Estimated target population 641,800 (1 RCT)	⊕⊕⊝⊝ Low^g,k	—
Proportion of calls from target population during and after campaign	Proportion African Americans among pregnant callers: 41% before campaign, 86% during the campaign, 28% after campaign			Population in target city ˜300,000 (1 ITS)	⊕⊝⊝⊝ Very low^i,k	—
Costs of the project (secondary outcome)
Programme costs	USD 106,821 for radio advertisements and USD 6744 for television advertisements. No overall costs reported			Estimated target population 641,800 (1 RCT)	⊕⊕⊝⊝ Low^g,k	—
*The risk in the intervention group (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). CI: confidence interval; ITS: interrupted time series; RTC: randomised controlled trial; SD: standard deviation.
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aIn the GRADE assessments for the domain 'directness', we considered the studies directly relevant to the inclusion criteria. Thus, we have not downgraded on this domain. However, the population of interest will be dissimilar in different contexts, relating to characteristics of the ethnic minority group, the country and setting overall. The transferability of results must be considered for each context specifically. ^bMean BMI at baseline in comparison group. ^cDowngraded two levels for imprecision: only one relatively small study. ^dDowngraded one level for unclear risk of bias. ^eMean score at baseline in comparison group ^fMeasures of dispersion not reported. No adjustment for cluster‐randomised design. ^gDowngraded one level for unclear risk of bias in the largest study. ^hUnclear precision of estimate and no adjustment for cluster‐randomised design, but substantial effect. Results from ITS study concludes similarly. Therefore, we have not downgraded for imprecision. ⁱGrading of ITS study (observational study) starts at low quality evidence. ^jResults from RCT study concludes similarly. Therefore, we have not downgraded for imprecision. ^kDowngraded one level for imprecision.

Summary of findings 2. Targeted mass media intervention for promoting healthy behaviours versus no intervention

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Summary of findings 3. Targeted mass media intervention versus targeted mass media intervention plus personalised content

Comparison 3: targeted mass media intervention versus targeted mass media intervention plus personalised content
Patient or population: adult, ethnic minority groups: Latino immigrants, elderly Chinese immigrants, self‐described Americans of African heritage Setting: volunteers, community setting, USA Intervention: targeted mass media intervention Comparison: media intervention combined with personalised content
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	N of participants (studies)	Quality of the evidence (GRADE)^a	Comments
	Assumed risk	Corresponding risk
	Media intervention with personalised content (comparison)	Targeted mass media intervention
Indicators of behavioural change
BMI (kg/m²), 12 months from baseline	34.9 (SD 7.7)^b	Mean difference in change 0.4 (−0.1 to 0.8)	—	286 (1 RCT)	⊕⊕⊝⊝ Low^c	Two RCTs (643 participants) reported BMI at 3 months. None found significant differences in weight change between study groups
Self‐reported behavioural change
Intake meeting target from dietary guidelines, 3 months from baseline	Vegetables: adjusted OR 5.53^d (1.96 to 15.58) Fruit: adjusted OR 1.77^d (0.99 to 3.15)			718 (1 RCT)	⊕⊝⊝⊝ Very low^c,e	—
Changes in dietary composition, 12 months from baseline	Food habits questionnaire, score on fat behaviours (no scoring scale provided by study authors): 1.0 (SD 0.4)^f	Mean difference in change −0.1 (−0.2 to −0.02)	—	286 (1 RCT)	⊕⊝⊝⊝ Very low^c,e	Two RCTs (643 participants) reported changes in dietary composition at 3 months. None found significant differences/mean difference in change for energy or dietary fibre intake (study 1) or food habits questionnaire (fat behaviours) (study 2)
Weekly physical activity meeting target from guidelines, 3 months from baseline	Adjusted OR 1.27^d (0.89 to 1.80)			718 (1 RCT)	⊕⊝⊝⊝ Very low^c,e	—
Leisure time physical activity, 12 months from baseline	Physical activity score (no scoring scale provided by study authors): 68.0 (47.6)^f	Mean difference in change 12.9 (3.5 to 22.3)	—	286 (1 RCT)	⊕⊝⊝⊝ Very low^c,e	Corresponding risk at 3 months: mean difference in change −2.2 (−12.9 to 8.5)
Knowledge and attitudes to change
Knowledge of nutrition and physical activity guidelines	Daily vegetable intake: adjusted OR 12.6^d (6.50 to 24.5) Daily fruit intake: adjusted OR 16.2^d (5.61 to 46.5) Weekly physical activity: adjusted OR 2.70^d (0.31 to 23.2)				⊕⊝⊝⊝ Very low^c,e	—
Adverse effects
Any outcome considered an adverse effect	No study provided data for this outcome.
Costs of the project (secondary outcome)
Costs per person in each treatment arm	USD 9.00 for targeted newsletters, USD 45.00 individually tailored newsletters, and USD 135 for individually tailored newsletters followed by home visits			357 (1 RCT)	⊕⊝⊝⊝ Very low^c,e	—
*The risk in the intervention group (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). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial;RR: risk ratio.
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aIn the GRADE assessments for the domain 'directness', we considered the studies directly relevant to the inclusion criteria. Thus, we have not downgraded on this domain. However, the population of interest will be dissimilar in different contexts, relating to characteristics of the ethnic minority group, the country and setting overall. The transferability of results must be considered for each context specifically. ^bMean (SD) BMI at baseline in comparison group. ^cDowngraded two levels for imprecision: Relatively small studies and few measurement points. ^dOR > 1 in favour of targeted mass media combined with personalised content (control intervention). Effect estimates adjusted for cluster‐randomised design. ^eDowngraded one for unclear risk of bias. ^fMean (SD) score at baseline in comparison group.

Summary of findings 3. Targeted mass media intervention versus targeted mass media intervention plus personalised content

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Table 1. Re‐analyses of data from Kennedy 2013

Outcome	Estimated effect (95% CI)^a July 2009 (start of campaign)	Estimated effect October 2009 (last month of campaign)	Estimated effect November 2009 (first month after campaign)	Estimated effect March 2010 (4 months after campaign)
Total number of calls	42 (−115 to 198)	153 (−8 to 314)	146 (−13 to 304)	32 (−148 to 212)
Calls from pregnant women	14 (4 to 25)	15 (4 to 27)	8 (−3 to 19)	7 (−5 to 20)
Calls from unique pregnant women	8 (1 to 14)	8 (1 to 14)	6 (−1 to 12)	3 (−4 to 10)
Calls from unique previously unknown pregnant women ('first‐timers')	6 (1 to 11)	6 (1 to 10)	2 (−3 to 6)	3 (−3 to 8)
^aChange from pre‐campaign call rates.

Table 1. Re‐analyses of data from Kennedy 2013

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