A Systematic Search and Critical Review of the Complex Interplay between Social Cognitive Theory and Community-Based Participatory Research in Health Promotion-Focused Interventions
Creators: name: Washburn, Tessa
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Public Health Education and Promotion
subject: Public Health
subject: Medicine and Health Sciences
subject: Social and Behavioral Sciences

description: INTRODUCTION Despite increasing research and recognition, health disparities persist (Commission on Social Determinants of Health [CSDH], 2008; Levine, 2021; Thornton et al., 2016). These disparities, primarily experienced by disadvantaged groups, are preventable differences in health outcomes (Braveman et al., 2010; CSDH, 2008). The United Nations adopted the sustainable development goals (SDGs) to improve equity, reduce disease, and promote prosperity (World Health Organization [WHO], n.d.-b). The majority of the SDGs aim to improve health directly or indirectly by addressing the social determinants of health (SDoH) — the conditions in which people live, work, and play (e.g., substandard education, unstable employment, low income, and unsafe housing; WHO, n.d.-a). Similarly, one of the overarching goals of Healthy People 2030 is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” (Office of Disease Prevention and Health Promotion, n.d.). Racial and ethnic minorities experience considerable health disparities as evidenced by increased rates of morbidity and mortality from various health conditions, including cancer (Siegel et al., 2020), diabetes (Fang, 2018; Menke et al., 2015), and HIV/AIDS (Sullivan et al., 2021). The relationship between the SDoH and health equity has been further magnified with the ongoing coronavirus disease (COVID-19) pandemic (Ataguba &amp; Ataguba, 2020; Paremoer et al., 2021; Shah et al., 2020). While health disparities existed before COVID-19, the pandemic’s exacerbation of the SDoH will intensify long-term negative health outcomes that could have been prevented (Abrams &amp; Szefler, 2020; Mein, 2020). Health promotion interventions have the potential to improve health outcomes and reduce health disparities (Centers for Disease Control and Prevention [CDC], 2016). A review of reviews conducted by Jepson et al. (2010) found that although health promotion interventions can be used to target a variety of health conditions and populations, such interventions vary in their effectiveness. One explanation for this could be a lack of community engagement (Clinical and Translational Science Awards [CTSA] Consortium Community Engagement Key Function Committee Task Force, 2011). Grumbach et al. (2021) stated that multidisciplinary collaboration and community involvement are necessary to sustainably address health disparities. Community-engaged research (CEnR) aims to address specific health issues by involving the affected community members, empowering them to generate solutions, and supporting them in taking responsibility for sustainable health outcomes (CTSA Consortium Community Engagement Key Function Committee Task Force, 2011). The most recognized CEnR approach is community-based participatory research (CBPR) (CTSA Consortium Community Engagement Key Function Committee Task Force, 2011). Public health professionals may apply CBPR to improve health outcomes and health equity in conjunction with a health promotion intervention (Salimi et al., 2012). The overarching goal of CBPR is to address social and health disparities by developing collaborative, equitable partnerships between community members and academic researchers (Israel et al., 2008; Viswanathan et al., 2004; Ward et al., 2018). CBPR is guided by 11 principles (Israel et al., 2008; Minkler et al., 2012). A few noteworthy principles are utilizing community strengths, disseminating research results, and prioritizing sustainable solutions (Israel et al., 2008). Benefits of using CBPR include improved understanding of the problem, co-learning between the researchers and community, and development of quality interventions that are culturally appropriate (Gibbs et al., 2008; Viswanathan et al., 2004). This type of community-based engagement positions CBPR to be an effective approach for translational intervention research that promotes sustainable health equity (Wallerstein &amp; Duran, 2010). Despite the benefits of using CBPR, areas for improvement remain (Tobias et al., 2013; Wallerstein et al., 2017). For example, many researchers struggle with identifying whom to involve, engaging ample representation from the community (Rhodes et al., 2017), and dedicating sufficient time to develop trusting relationships that engender partnership synergy (Lucero et al., 2020; Rodriguez Espinosa &amp; Verney, 2021). Health promotion interventions guided by CBPR may also vary in effectiveness due to whether health behavior theory is used and the amount of theory applied (National Cancer Institute, 2005). DiClemente et al. (2019) have suggested Bandura’s Social Cognitive Theory (SCT) is one of the most important health promotion frameworks because of its emphasis on the bidirectional interplay between the environment, person, and behavior (i.e., triadic reciprocal causation). SCT highlights both an individual’s belief in their ability to engage in a certain behavior (i.e., self-efficacy) and their ability to carry out actions to engage in that behavior (i.e., agency) (Bandura, 1997, 2000; Newman &amp; Newman, 2016). In addition, SCT extends beyond individual level constructs of agency and self-efficacy to group level constructs of collective efficacy, collective agency, and collective action (Bandura, 2000; McAlister et al., 2008). Bandura (1997) has described collective efficacy as interpersonal interactions where a group recognizes their health problems are shared and believes in their collective ability to overcome the identified problems. This parallels CBPR’s approach to empower communities to make healthy changes. Researchers frequently apply SCT in health promotion interventions (Davis et al., 2015; Golden &amp; Earp, 2012; National Cancer Institute, 2005). However, there is dearth of literature on the extent to which researchers utilize SCT in such interventions while simultaneously developing equitable partnerships that empower disadvantaged groups to improve their health outcomes. Thus, the purpose of this systematic search and critical review is to understand the application of SCT in health promotion interventions guided by CBPR. In addition, this review explores how researchers describe collective efficacy and collective agency within health promotion interventions, as these constructs are extensions of SCT and understanding how to cultivate such processes for collective action may help in reducing health disparities (Butel &amp; Braun, 2019). METHODS This review follows the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline checklist (Page et al., 2021). As a systematic search and critical review, this study will not require human subjects, informed consent, or institutional review board approval as human subjects will not be involved. Eligibility Criteria To be included in this review, studies need to meet the following criteria: (1) discuss the development of a health promotion intervention; (2) apply CBPR as an approach; (3) utilize SCT in the intervention; (4) be written in English; and (5) have a publication date between January 2010 and December 2021. Dissertations and theses are also eligible to be included. (1) discuss the development of a health promotion intervention The unit of analysis for this review is the design of health promotion interventions; no specific outcomes will be assessed. Since health behavior theory is chosen and applied during the intervention design stage, only articles that describe this phase will be evaluated (DiClemente et al., 2019). For the purpose of this review, health promotion interventions are defined as primary (i.e., efforts to prevent mental and physical illness) or secondary (i.e., efforts to reduce the impact of an illness in its early stages). Tertiary interventions (i.e., efforts to treat an illness in its later stages) will be excluded. (2) apply CBPR as an approach For studies to be included, they must explicitly state and use CBPR as an approach. All other types of CEnR (e.g., participatory action research) will be excluded as CBPR has been predominantly applied within health disciplines (Collins et al., 2018). (3) utilize SCT in the intervention Studies will also need to explicitly state SCT and utilize the theory to inform intervention design. (4) be written in English All geographical locations (U.S. and international) and racial/ethnic groups will be eligible. However, to be included, the articles need to be written in English. (5) have a publication date between January 2010 and December 2021 Because application of CBPR increased exponentially beginning in 2010 (Ortiz et al., 2020), January 2010 was specified as the minimum year for this review. Information Sources The following databases will be searched independently for studies published between January 2010 and December 2021: Embase (Elsevier), APA PsycINFO (EBSCO), CINAHL Complete (EBSCO), MEDLINE Complete (EBSCO), ProQuest’s Dissertations and Theses Global, and the CDC’s Prevention Research Centers (PRC) project database (n.d.). For a thorough assessment to find other articles from the same study describing the intervention design, backward searching of reference lists of studies that meet this review’s eligibility criteria will be done. Additionally, forward searching in Google Scholar of included studies will be conducted. This will be done to identify other articles not obtained from the initial sample. While some CBPR partnerships may have conducted several studies or projects through the years, this review focuses only on the studies that incorporated SCT to a health promotion intervention. No study authors will be contacted or interviewed for this review. Search Strategy A pilot search strategy was tested in MEDLINE (EBSCO) and retrieved 26 articles. Prior research also informed the finalized search syntax that will be used for this systematic search and critical review (Campbell et al., 2020; Rodriguez Espinosa &amp; Verney, 2021; Seleznova et al., 2021). Key terms will be used and restricted to the title, abstract, and/or MeSH, such as health promotion, health intervention, health education, health behavior, social cognitive theory, SCT, community-based participatory research, and CBPR (see Table 1 for complete search strings and key terms). CDC’s PRC project database (n.d.) will be searched by selecting “all” for all 10 categories listed except under the “funding source” category. Under the funding source category, only the 10 items listed under “CDC - National Center for Chronic Disease Prevention and Health Promotion” will be selected as well as the one item listed under “CDC - Center for Global Health.” The studies (both active and non-active under project status) will be exported to a Word document where the abstracts will be screened. The same screening processes described for scholarly articles will be used. Selection Process All retrieved articles from each database search will be uploaded to EndNote 20 where duplicates will be reviewed and removed. After duplication removal, articles will be uploaded to Covidence wherein a second screening of duplicates will be performed. Studies retrieved from CDC’s PRC project database (n.d.) will be exported into Word for review. Two rounds of screening will be conducted in Covidence. In the first round, titles and abstracts of retrieved articles will be screened independently by four trained co-investigators. Articles that meet the eligibility criteria will undergo a second round of screening where the full-text will be examined. In the full-text review, these same criteria will be further assessed to determine whether SCT was utilized in the health promotion intervention. Due to limitations with searching occurring only within titles, abstracts, and/or MeSH, it is plausible that SCT may not appear in the title or abstract of a health promotion intervention guided by CBPR. Thus, to ensure that fewer studies are missed during the first round of screening, SCT will be screened in the full-text review. However, there may be some abstracts where SCT and CBPR are stated but it is unclear if it was a health promotion intervention. These articles will also be retained for the full-text review. Four trained co-investigators will independently complete the second round of screening. Team members will meet to resolve any differences in screening for both the first and second rounds. When unanimous agreement cannot be reached, a fifth team member will help to resolve disagreements. Data Collection Process Within identified eligible studies, data extraction will only involve articles that describe the design and development process of a health promotion intervention. The outcomes of the interventions (effect measures) will not be measured because intervention outcomes are not the focus of this critical review. For this critical review, design and development of a health promotion intervention is defined as descriptions about how SCT informed the design of the intervention including if pre-testing or pilot testing was performed (Fernandez et al., 2019). Per recommendations in the literature (Büchter et al., 2020, 2021; Taylor et al., 2021), this review’s data extraction tool was pilot tested on a sample of three articles (i.e., Patchen et al., 2020; Trujillo et al., 2020; White et al., 2019) out of the twenty-six articles retrieved from the pilot search, and several modifications were made to the tool. Two team members will independently extract data from the studies. Data extraction will be recorded in a standardized Google form. Team members will meet to resolve any discrepancies in data extraction. When agreement cannot be reached, a third team member will help to settle disagreements. Data Items This review will extract data on eight SCT constructs. Principally, five SCT constructs that Bandura has identified pertinent for health promotion: (1) knowledge, (2) self-efficacy, (3) outcome expectations, (4) goal formation, and (5) sociostructural factors (Bandura, 2004; DiClemente et al., 2019). Additionally, application of triadic reciprocal causation (i.e., reciprocal determinism) will be measured since it has also been identified as a core SCT construct for health promotion (DiClemente et al., 2019; Glanz &amp; Bishop, 2010). Descriptions of collective efficacy and collective action will also be explored. Although collective agency fosters collective action, this review focuses on collective action because it is a measurable result of group collaboration, more likely to be described in retrieved articles, and evidence of group action being taken. Thus, descriptions about collective action will be measured with the understanding that collective agency (i.e., collective decision) led to the group’s collective action. All of the SCT constructs will be measured on a scale of “yes, fully described”, “somewhat described”, and “unclear” (see Table 2 in extraction tool document). Other items such as, geographic location, sample size, population characteristics, and targeted health problems are also included in the data extraction tool. Quality of Community Engagement A risk of bias assessment is not applicable since this review is focusing on the utilization of SCT within the design of health promotion interventions and not on intervention outcomes. Instead, quality of community engagement will be assessed. Of the 11 CBPR principles (Minkler et al., 2012), five principles that are applicable to intervention design were selected to measure quality of community engagement (see Table 3 in extraction tool document). Within the five selected CBPR principles, there are multiple components; therefore, this review focuses on the components that pertain to community engagement and whether fully described, somewhat described, or unclear. 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