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Background: There is a need to identify and analyse the range of models developed to\uddate for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and\udcost-effectiveness in improving the health and well-being of individuals and communities in\udthe UK, with particular reference to the reduction of inequalities.\ud\udObjectives: To identify the component intervention techniques of lifestyle advisors (LAs) in\udthe UK and similar contexts, and the outcomes of HRLA interventions.\ud\udData sources: Stakeholder views, secondary analysis of the National Survey of Health\udTrainer Activity, telephone survey of health trainer leads/coordinators. A search of a range\udof electronic databases was undertaken [including the Applied Social Sciences Index and\udAbstracts (ASSIA), EMBASE, NHS Economic Evaluation Database (NHS EED), MEDLINE,\udPsyc INFO, etc.], as well searching relevant journals and reference lists, conducted from\udinception to September 2008.\ud\udReview methods: Identified studies were scanned by two reviewers and those meeting the\udfollowing criteria were included: studies carrying out an evaluation of HRLA; those taking\udplace in developed countries similar to the UK context; those looking at adult groups;\udinterventions with the explicit aim of health improvement; interventions that involved paid\udor voluntary work with an individual or group of peers acting in an advisory role; advice\uddelivered by post, online or electronically; training, support or counselling delivered to\udpatients, communities or members of the public. After quality assessment, studies were\udselected for inclusion in the review. Data were abstracted from each study according to\udan agreed procedure and narrative, and realist and economic approaches were used to\udsynthesise the data. Cost-effectiveness analysis of interventions was undertaken.\ud\udResults: In total, 269 studies were identified but 243 were excluded. The 26 included\udstudies addressing chronic care, mental health, breastfeeding, smoking, diet and physical\udactivity, screening and human immunodeficiency virus (HIV) infection prevention. Overall,\udthere was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL), and thus uncertainty about the interventions’\udcost-effectiveness. However, the economic analysis showed that LA interventions were\udcost-effective in chronic care and smoking cessation, inconclusive for breastfeeding and\udmental health and not cost-effective for screening uptake and diet/physical activity. LA\udinterventions for HIV prevention were cost-effective, but not in a UK context.\ud\udLimitations: The wide variety of LA models, delivery settings and target populations\udprevented the reviewers from establishing firm causal relationships between intervention\udmode and study outcomes.\ud\udConclusions: Evidence was variable, giving only limited support to LAs having a positive\udimpact on health knowledge, behaviours and outcomes. Levels of acceptability appeared\udto be high. LAs acted as translational agents, sometimes removing barriers to prescribed\udbehaviour or helping to create facilitative social environments. Reporting of processes of\udaccessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent\udwith respect to the role and impact of lay and peer characteristics of the interventions.\udA future programme of research on HRLA could benefit from further emphasis on\udidentification of needs, the broadening of population focus and intervention aims, the\udmeasurement of outcomes and the reviewing of evidence.\udFunding: This study was funded by the Health Technology Assessment programme of the\udNational Institute for Health Research

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An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.