The impact of social norms interventions on clinical behaviour change among health workers: protocol for a systematic review and meta-analysis

Background: Health workers routinely carry out clinical behaviours, such as prescribing, test-ordering or hand-washing, which impact on patient diagnoses, care, treatment and recovery. Social norms are the implicit or explicit rules that a group uses to determine values, beliefs, attitudes and behaviours. A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. This study aims to find out whether or not social norms interventions are effective ways of encouraging health workers to carry out desired behaviours and to identify which types of social norms intervention, if any, are most effective. Methods: A systematic review will be conducted. The inclusion criteria are a population of health professionals, a social norms intervention that seeks to change a clinical behaviour, and randomised controlled trials. Searches will be undertaken in MEDLINE, EMBASE, CINAHL, British Nursing Index, ISI Web of Science, PsycINFO and Cochrane trials. Titles and abstracts will be reviewed against the inclusion criteria to exclude any that are clearly ineligible. Two reviewers will independently screen all the remaining full texts to identify relevant papers. For studies which meet our inclusion criteria, two reviewers will extract data independently, code for behaviour change techniques and assess quality using the Cochrane risk of bias tool. The primary outcome measure will be compliance with desired behaviour. To assess the effect of social norms on the behaviour of health workers, we will perform fixed effects meta-analysis and present forest plots, stratified by behaviour change technique. We will explore sources of variation using meta-regression and may use multi-component-based network meta-analysis to explore which forms of social norms are more likely to be effective, if our data meet the necessary requirements. Discussion: The study will provide evidence regarding the effectiveness of different methods of applying social norms to change the clinical behaviour of health professionals. We will disseminate the research to academics, health workers and members of the public and use the findings from the review to plan future research on the use of social norms with health workers.