Health Behavior Interventions Among People With Lower Socio-Economic Status: A Scoping Review of Behavior Change Techniques and Effectiveness

Background. Behavior change interventions can unintendedly widen existing socio-economic disparities in health. Understanding why interventions are (in)effective among people with lower socio-economic status (SES) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in reducing physical inactivity, unhealthy eating, smoking and alcohol consumption according to SES. Methods. A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SES-operationalization, BCTs (type and number) and effectiveness. Results. Findings suggest that approaches for measuring, defining and substantiating lower SES vary. Current studies of behavior change interventions for people of different SES do not systematically identify specific BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SES-moderation effects are mostly not assessed. Conclusion. Using different SES-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SES population. To learn which BCTs effectively improve health behaviors among people with lower SES, future intervention developers should justify how SES is operationalized and must systematically describe and examine BCTs.