Using Biofeedback to Promote Behaviour Change in Health Interventions: An Integrative Review

Introduction: Non-communicable diseases are now the leading cause of death globally, and the burden continues to increase. Health promotion initiatives aim to reduce overall burden by preventing future ill-health and improving population health. Behaviour change techniques are the individual components of health interventions, which are key to designing effective interventions. Two main groupings of behaviour change techniques include monitoring health behaviours or outcomes and communicating health consequences. Combining these techniques, we sought to determine if the inclusion of biological feedback to communicate risk, together with personalised advice, would lead to greater efficacy in health promoting interventions. Methods: We performed an integrative review of the last 25 years of literature surrounding the use of various types of biological feedback to communicate risk and generate personalised advice in health promotion interventions. From this body of evidence, it was found that interventions were largely unsuccessful at changing health behaviour. Therefore, we also aimed to identify features of effective interventions. Results: The key findings were that interventions using in-person communication were more effective than those which utilised written, digital or telephone communication. Furthermore, the most effective behaviour change techniques used were ‘increased awareness of consequences’ and ‘goal-directed’ techniques. We also determined that interventions often overlooked meaningful participant characteristics, such as age and gender or health literacy levels. Conclusions: Based on the findings, we propose key considerations for future health promotion interventions. Future research also needs to examine the feasibility and scalability of delivering in-person biofeedback and disentangle the combination of multiple behaviour change techniques within single interventions.