Review ArticleComparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials

- Multiple health behavior change interventions are growing in popularity.
- It is unknown if sequential or simultaneous delivery is more efficacious.
- This systematic review identified six relevant trials with substantial heterogeneity.
- Both approaches should be considered equally efficacious.
- More trials directly comparing sequential and simultaneous delivery are required.

BackgroundGrowing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors.PurposeThis review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components; b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and; c) differences in trial retention between simultaneously and sequentially delivered interventions.MethodsMHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken.ResultsSix trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches.ConclusionsThere is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876.