title: Identification of behaviour change components in swallowing interventions for head and neck cancer patients: protocol for a systematic review.
abstract: BACKGROUND
  Dysphagia (difficulty in swallowing) is a predictable consequence of head and neck cancer and its treatment. Loss of the ability to eat and drink normally has a devastating impact on quality of life for survivors of this type of cancer. Most rehabilitation programmes involve behavioural interventions that include swallowing exercises to help improve swallowing function. Such interventions are complex; consisting of multiple components that may influence outcomes. These interventions usually require patient adherence to recommended behaviour change advice. To date, reviews of this literature have explored whether variation in effectiveness can be attributed to the type of swallowing exercise, the use of devices to facilitate use of swallowing muscles, and the timing (before, during or after cancer treatment). This systematic review will use a behavioural science lens to examine the content of previous interventions in this field. It aims to identify (a) which behaviour change components are present, and (b) the frequency with which they occur in interventions deemed to be effective and non-effective.
  
  
  METHODS
  Clinical trials of behavioural interventions to improve swallowing outcomes in patients with head and neck cancers will be identified via a systematic and comprehensive search of relevant electronic health databases, trial registers, systematic review databases and Web of Science. To ascertain behaviour change intervention components, we will code the content for its theory basis, intervention functions and specific behaviour change techniques, using validated tools: the Theory Coding Scheme, Behaviour Change Wheel and Behaviour Change Technique Taxonomy v1. Study quality will be assessed for descriptive purposes only. Given the specialisation and focus of this review, a small yield of studies with heterogeneous outcome measures is anticipated. Therefore, narrative synthesis is considered more appropriate than meta-analysis. We will also compare the frequency of behavioural components in effective versus non-effective interventions, where effectiveness is indicated by statistically significant changes in swallowing outcomes.
  
  
  CONCLUSIONS
  This review will provide a synthesis of the behaviour change components in studies that currently represent best evidence for behavioural swallowing interventions for head and neck cancer patients. Results will provide some guidance on the choice of optimal behavioural strategies for the development of future interventions.
  
  
  BACKGROUND
  PROSPERO CRD42015017048.
authors.affiliation: Head and Neck Cancer Centre, University College London Hospital and Health Behaviour Research Centre, University College London, 250 Euston Road, London, NW1 2PQ, UK. Roganie.Govender@uclh.nhs.uk.
authors.forename: Roganie
authors.initials: R
authors.lastname: Govender
authors.affiliation: Division of Psychology and Language Sciences, University College London, London, UK. Christina.smith@ucl.ac.uk.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Smith
authors.affiliation: Centre for Medical Imaging, University College London, London, UK. Stuart.taylor1@nhs.net.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Bloomsbury Healthcare Library, London, UK. Daphne.Grey@uclh.nhs.uk.
authors.forename: Daphne
authors.initials: D
authors.lastname: Grey
authors.affiliation: Health Behaviour Research Centre, University College London, London, UK. j.wardle@ucl.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK. Benjamin.gardner@kcl.ac.uk.|UCL Centre for Behaviour Change, University College London, London, UK. Benjamin.gardner@kcl.ac.uk.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gardner
mesh_terms: D002985:Clinical Protocols; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D006258:Head and Neck Neoplasms / Q000150:complications*; D015438:Health Behavior; D006801:Humans; D010349:Patient Compliance; D012107:Research Design; D000078202:Systematic Reviews as Topic