The Efficacy of Interventions Utilized in Communicating Risk Information to Improve Behavioral Outcomes Among Individuals Who Are Genetically Predisposed of Type 2 Diabetes: A Systematic Review

OBJECTIVES: Some people with a genetic predisposition to type 2 diabetes (T2D) may be at an elevated risk. Only a few studies have evaluated the efficacy of risk communication or counseling to prevent T2D. The communication of risk information guided by behavioral theories or models can be advantageous in altering behavior patterns.

METHODS: This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing five databases (PubMed, PsycINFO, CINAHL Complete, Scopus, and Web of Science). Inclusion criteria included individuals with a strong family history (first-degree relatives or genetic testing) of T2D who received risk communication to improve behavioral outcomes and prevent T2D. Two authors independently searched, reviewed title, abstract, full text of selected articles, Theory Coding Scheme (TCS), Risk of Bias (ROB) Assessment, and Behavioral Change Techniques (BCTs).

RESULTS: Of 13 eligible articles, seven were guided by theories to study behavioral change. The most common theories applied were the Transtheoretical Model (n=2) and Theory of Planned Behavior (n=2). Seventeen BCTs were used across studies, with an average of 4.6 BCTs per study (range: 4–9). Information about health consequences (n=9) and goal settings (n=9) were the most used BCTs across interventions. Six studies had a high ROB, 2 had some concerns and 5 had a low risk. Lifestyle behavioral outcomes included weight (n=8), physical activity (n=9), and diet (n=6) improvement. Findings for weight and diet were mixed, while physical activity showed consistent non-improvement following intervention.

CONCLUSIONS: To date, the success of interventions has been limited. Looking forward, studies should carefully plan theory choice and application, number and types of BCTs and ROB assessments. The thorough application of BCTs with less bias may improve interventions leading to better outcomes.