Effectiveness of a result-based motivational system to reduce the behavioral risk factors of Non-Communicable Diseases: A Field Trial Study

Background: Noncommunicable diseases behavioral risk factors are the most important modifiable risk factors. They can be improved as long as the relevant interventions are designed in accordance with the context of the health system and its resources in different regions. In this trial, the effectiveness of intervention packages focusing on increasing non-physician health workers’ motivation to reduce non-communicable diseases behavioral risk factors was evaluated.Methods: A randomized field trial study was conducted in 32 community health centers in 4 Iranian districts after a baseline population survey on 30−70-year-old individuals (n=1225). The interventions were performed to improve insufficient physical activity, fruit consumption, vegetable consumption, high salt intake, and tobacco use. Four packages of interventions were implemented in 24 community health centers; the other 8 centers were used as control groups. The non-physician health workers performed the interventions. The packages included different mixtures of 4 components: goal-setting, evidence-based education, operational planning, and incentive payments. A second survey was conducted one year after the start of the interventions to identify the effects on an independent random sample (n=1221). The difference-in-difference method was used to quantify the interventions’ effects.Results: The average age of participants in both surveys was about 49 years. Also, in both surveys, about half of the participants were female, and about 43% were either illiterate or had primary school education. The interventions had statistically significant effects only on decreasing the prevalence of insufficient physical activity. The package with all the intervention components decreased the odds of insufficient physical activity to 0.24(95% CI: 0.08, 0.72). The packages with operational planning but no performance-based financing did not change the odds of insufficient physical activity.Conclusions: This study highlighted the importance of components, design, and implementation details of interventions intended to reduce NCDs behavioral risk factors. Some risk factors such as physical activity seem to be more easily modifiable with limited low-cost interventions in a one-year horizon. However, risk factors related to the consumption of healthy food and tobacco use need larger, macro-level interventions.Trial Registration: This trial registered on the Iranian Registry of Clinical Trials (IRCT20081205001488N2) on 3 June 2018 (https://en.irct.ir/trial/774 ).