Social cognitive theory-based health promotion in primary care practice: A scoping review

Abstract

Background

Using a theoretical perspective to guide research design and implementation can result in a coherent preventative intervention model. Among theoretical frameworks, Bandura's Social Cognitive Theory (SCT) is particularly useful for studies focused on behavior change in health promotion research.

Objective

This scoping review explored and summarized the current evidence on health promotion interventions that integrated constructs of Social Cognitive Theory and the outcome of those interventions in primary care settings.

Method

ology: We conducted this scoping review using the PRISMA scoping review guidelines; we reviewed articles from five electronic databases and additional sources that were peer-reviewed journal articles reporting interventions applying SCT constructs and synthesized the outcomes following the interventions.

Results

Among 849 retrieved from multiple sources, 39 articles met our eligibility criteria. Most studies (n = 19) were conducted in the United States. Twenty-six studies followed a randomized control trial design. Most studies (n = 26) recruited participants utilizing the primary care network. All 39 studies mentioned “self-efficacy” as the most utilized construct of SCT to determine how behavior change operates, followed by “observational learning” through role models. Twenty-three studies integrated individual (face-to-face) or peered group-based counseling-training programs; eight interventions used telephonic health coaching by a specialist; eight studies used audio-visual mediums. All included studies reported positive health outcomes following the intervention, including increased self-reported moderate-to-vigorous physical activity, increased Knowledge of dietary intake, high-risk behaviors such as STIs transmission, adapting to a healthy lifestyle, and adherence to post-transplant medication.

Conclusion

Current evidence suggests that SCT-based interventions positively impact health outcomes and intervention effectiveness. The results of this study indicate the importance of incorporating and assessing several conceptual structures of behavioral theories when planning any primary care health promotion practice.

1. Introduction

Primary health care (PHC) is well positioned as a foundational element of the public health system due to its accessibility of treatment and the consistency of care [1]. Over time, primary care has evolved to be seen as a crucial component of health promotion, which is described as defined as “the process of enabling people to increase control over and improve their health” [2]. To promote health and well-being, a variety of holistic approaches have been incorporated into primary care, including good nutrition, physical activity, and the recognition and treatment of chronic diseases [3,4]. However, it is not always easy to put health promotion and prevention (HPP) programs into practice and evaluate their success at the PHC level. Lifestyle modification programs are primarily designed to emphasize individual behavior while social, cultural, economic, and environmental perspectives of health behavior and disease remain unaddressed. The fact that health promotion initiatives frequently have a restricted focus on individual behavioral change and lack a thorough theoretical grounding contributes significantly to the ineffectiveness of these treatments [5].

Numerous social, cultural, and economic factors substantially impact an individual's determinants of health behavior and are crucial in the development of health behavior patterns [6]. Therefore, one of the first stages in successfully implementing a preventive strategy in primary care is identifying methods for optimal intervention implementation based on a good theoretical framework that considers all the determinants of health. In health promotion practice, constructs of the Social Cognitive Theory (SCT) are widely utilized and accepted [7]. This theory's constructs—observational learning, self-efficacy, behavioral capability, reinforcement, and self-control— illustrate the dynamic interaction among a person's behavior, environmental determinants, and personal factors and how those factors can affect or change one another [8]. According to this theory, individual learning is dependent not only on one's own experience but also on witnessing other people's behavior or the positive results of that behavior; hence this concept is regarded as one of the best-fit strategies to use in health promotion intervention [9].

Bandura's social cognitive theory (SCT) advocates a long-term framework for influencing and motivating human behavior; there is a substantial research vacuum linking theoretical stances in the dominant paradigm of health education/health promotion. Nonetheless, more evidence is needed to be synthesized on how SCT was employed within the context of health promotion in primary care practice. Scoping reviews are viewed as a helpful approach for determining the evidence currently available on particular subjects, analyzing knowledge gaps, and as a precursor to specific questions that might be addressed by a systematic review ([10]. Therefore, we carried out this scoping review to summarize and evaluate the available data about Social Cognitive theory-based health promotion interventions in primary care practices and how the SCT constructs are applied in health promotion interventions.

2. Methodology

2.1. Data sources and guidelines

In conducting this scoping review, we adhered to the reported standards of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Scoping review guidelines [11]. In addition, we followed the scoping review guidelines of the Joanna Briggs Institute (JBI) [12]. We systematically searched Medline, Academic Search Ultimate, APA PsycINFO, CINAHL, and Web of Science using specific keywords with appropriate Boolean operators (i.e., “OR,” “AND”), as shown in Table 1. The search queries were used across titles, abstracts, subject-specific keywords, and topics fields in respective databases. In the first stage of search, we used keywords for exposure: “social genitive theor*“, “social cognitive learning*” and “SCT”. For the second stage of searching keywords for primary care settings such as: “Primary care”, “primary health*“, “family medic*“, “family physician*“,“general practi*” and for the third stage we used outcome keywords: intervention*, program*, polic*, manag*, screen*, detect*, treat*, therap*, practice*, guideline*, service*, support. Finally, we combined all three keywords with appropriate Boolean operators, which is shown in Table 1. A complete full search strategy for Medline is provided in the appendix. All the databases were searched for the last time on July 29, 2022. A protocol for the scoping review was developed to conduct in the priory, which is available upon request.

Table 1.

Search strategy used in this scoping review.

Components	Review keywords
Population	Not required
Exposure/Intervention	“Social cognitive theor*” OR “Social cognitive learning” OR “SCT”
Comparator	Not required
Setting	“Primary care” OR “primary health*” OR “family medic*” OR “family physician*” OR “general practi*”
Outcome	intervention* or program* or polic* or manag* or screen* or detect* or treat* or therap* or practice* or guideline* or service* or support*
Complete search strategy	(“Social cognitive theor*” OR “Social cognitive learning” OR “SCT”) AND (“Primary care” OR “primary health*” OR “family medic*” OR “family physician*” OR “general practi*“) AND (“Primary care” OR “primary health*” OR “family medic*” OR “family physician*” OR “general practi*“)

2.2. Literature screening, inclusion, and exclusion criteria

Articles extracted through database searching and additional sources were screened using the cloud-based systematic review management portal Rayaan QCRI. Two authors independently conducted a blinded screening process, and a third reviewer assisted them in resolving potential eligibility conflicts through discussion. All citations eligible for full text were examined following the same process, and finally, included articles were retained for data extraction and synthesis.

We reviewed the literature and selected articles that met the following criteria: (a) empirical studies published in a peer-reviewed journal that was designed as a randomized control trial, quasi-experimental, pre-post evaluation, (b) studies that reported one or more interventions in primary care utilizing constructs of SCT, (c) studies which reported at least one health or health-related outcomes among the participants (d) and studies published in the English language only. Articles were excluded from this review if they conflicted with any of the above-mentioned inclusion criteria, such as articles that were not published as peer-reviewed pieces (e.g., editorials, commentaries, pre-prints, conference proceedings, or abstracts), policy papers, protocols, reviews, meta-analyses, or those without intervention designs (e.g., descriptive papers without outcome evaluation, reviews).

2.3. Data extraction

We found 849 articles by searching five databases. Also, we found 26 additional articles from reference searches, consultations with domain experts, hand searching, and other sources (Fig. 1). Therefore, the total number of articles primarily considered in this review was 875. Further, 445 duplicate articles were removed, and the titles and abstracts of the remaining 430 articles were evaluated based on the described inclusion or exclusion criteria. After this step, we removed 348 articles that did not meet our criteria. The reasons for exclusion at this stage were: not having an empirical design, no interventions in primary care utilizing constructs of SCT, and reporting no health-related outcomes. At the next stage, we evaluated the full texts of the 46 remaining articles, among which 7 were excluded as the full-text study was unavailable or only the abstract was available. Finally, the remaining 39 articles were recruited for this scoping review.

Fig. 1.

PRISMA flow diagram of the scoping review.

A data extraction table was prepared before commencing the process. Several previous reviews of intervention trial studies were examined and evaluated [[13], [14], [15], [16], [17]]; three independent reviewers reviewed data extraction tables and associated individual items. Once the reviewers were convinced of the accuracy of the extraction tables and variables, we utilized them for the present scoping review. The data extraction table included the following domains: (a) location and time of the study, (b) design of the evaluation study, (c) sampling and recruitment strategies, (d) description and components of the intervention, (e) outcomes after the interventions, and (f) application SCT constructs. The coded data were reviewed by another author to ensure consistency and identify conflicts and resolve these based on consensus. We summarized the key findings obtained from individual studies in a tabulated format (Table 2), along with a brief narrative description of the interventions, characteristics of the study population, study or evaluation design, and the outcomes following the interventions presented in the result section.

Table 2.

Summary of the intervention based on the Social Cognitive Theory in primary healthcare.

Source	Study Location & Study period	Study design	Sample size	Intervention characteristics	Outcome of SCT derived intervention	Application of SCT in the intervention
Wilcox et al., 2008	US; Study period: From 2003 to 2007	Pre–post quasi-experimental design	n = 2503 (Active Choices participants) (n = 2503) and n = 3388(Active Living Every Day (ALED)	The AFL initiative: comprises a 6-month program that involves a single face-to-face meeting and up to eight one-on-one telephone counseling calls. On the other hand, Active Living Every Day (ALED) is a 20-week program designed for lifestyle behavior change that is group-based and aims to promote physical activity	Significant increases in moderate- to vigorous-intensity physical activity for ALED intervention (y1:2.2 & y4:2.7), and satisfaction with body appearance (y1: 3.3 (5.1) & y4: 3.1; y1: 2.7 & y4: 1.8) and function (y1: 3.4& y4: 2; y1: 3.1& y4: 1.2), and decreases in BMI (y1: 30.5 & y4: 31.1; y1:29.2 & y4:30.0) were seen for both programs.	Active choice involves providing counseling that is customized to the individual's level of preparedness for physical activity. On the other hand, ALED utilizes a curriculum that is based on the social cognitive theory
Clarkson et al., 2009	Scotland; Study Period: not reported	A patient-randomized controlled trial (RCT) and a cluster RCT, independently of each other	n = 778 participants from 87 dental practices (patient RCT- 37 dentists and 300 patients; cluster RCT- 50 dentists and 478 patients)	A series of procedures that require around 5 min to complete, which includes using a powered toothbrush and providing behavioral guidance on the timing, technique, and duration of toothbrushing	Individuals who underwent the intervention exhibited improved behavioral outcomes, such as better timing, duration, and method of toothbrushing, and enhanced cognitive outcomes, including increased confidence and planning. Clinical outcomes such as reduced plaque and gingival bleeding were also observed. *Brush twice a day (timing) n (%): Control:83 (71.6), Intervention:100 (85.5); p-value <.05	Self-efficacy or belief in one's ability to perform a task, observing someone else performing the task (vicarious example/modeling), and receiving verbal encouragement to perform the task (verbal persuasion) are all factors that can influence behavior
Mayor et al., 2010	US; Study period between February 2006 through December 2008.	Pre and post intervention design	n = 110	The intervention was developed using Power-Point software and includes text, cartoons, pictures and an audio tutorial. Each session was designed to be completed within 25–35 min.	Knowledge regarding viral distribution in body fluids, slight increase HCV infection associated risk behaviors (Reuse of syringes during drug injection: pre-99.1, post- 97.2, p-value: 0.63; Sharing paraphernalia for cocaine sniffing: pre-56.9 & post-84.4, p-value:0.01) and the misconceptions that coughing (pre-35.8 & post-14.7; p-value: 0.01*), sharing food (pre-13.9 & post-5.6; p-value: 0.04*)or utensils (pre-45.9 & post-21.1; p-value: 0.01*), contributes to the spread of HCV decreased significantly. And increased level of Knowledge regarding HCV clinical manifestations	Self-efficacy& motivation.
Whittaker et al., 2011	New Zealand; Study Period: between November 2007 and February 2009 over the whole part of the New Zealand	Randomized controlled trial	n = 226, Intervention (n = 110) Control (n = 116)	The “STUB IT” intervention employed observational learning by providing the intervention group with short video diary messages from role models who were going through the quitting process to teach behavioral change techniques. Over a period of six months, the intervention group received a tailored package of video and text messages that were automated and based on their self-selected quit date, role model, and timing of messages. Additional messages were available on demand to help overcome cravings and address lapses. In comparison, the control group also set a quit date but only received a general health video message sent to their phone every two weeks	There was no significant difference in the rate of continuous abstinence between the intervention group and the control group at 6 months, with 26.4% (29 out of 110) and 27.6% (32 out of 116) respectively (P = .8)	The intervention involved using short video messages from role models to provide observational learning
Mason et al., 2012	UK; Study Period: between November 2008 and May 2010.	Randomized controlled trial (Single blinded)	n = 1758, Intervention (n = 877) Control (n = 881)	Web-based tailored cessation advice: To provide personalized advice for quitting smoking, a web-based program used a questionnaire to assess participants' smoking-related beliefs, personal characteristics, smoking patterns, self-efficacy, and outcome expectations. Messages were then tailored based on these factors.	The group that received the intervention did not show any significant difference compared to the control group in terms of the primary outcome, which was 3 months of continuous abstinence (9.1% versus 9.3%). The odds ratio was 1.02 with a 95% confidence interval of 0.73–1.42. No significant differences observed between the two groups in terms of secondary outcomes such as 1 month, 7-day, and 24-h abstinence	Self-efficacy: The content of the messages that made up the tailored advice report
Peterson et al., 2012	US; Study period: From 2003 to 2007	Randomized controlled trial	n = 211, Papanicolaou Test: Intervention (n = 61) control (n = 35); Mammography: Intervention (n = 92), control (n = 80)	The Promoting Access to Health Services (PATHS) program: The PATHS program is a small-group workshop that lasts for 90 min and is followed by six months of structured telephone support. Participants in the workshop receive an activity workbook, informational brochures, and a copy of the training presentation. The written materials use pictures and verbal messages that are easy to understand, making them accessible to people with low literacy	There was no significant distinction observed in the number of mammograms conducted between the intervention group (49%) and the control group (42%) during the posttest, with a p-value of .45. Additionally, there were no variations between the intervention and control groups in the theoretical mediators for Pap tests or mammography subgroups when comparing pretest to posttest changes	Self-efficacy: workshop messaging
Bravender et al., 2013	US; study period: not reported	Randomized clinical trial	n = 22	Teen CHAT online educational intervention: Tailored interactive communication training web site to be used by physicians & tailored summary report of nutrition, physical activity and risk behaviors. The modules consisted of several components, such as written text with a professional narrator, still images, interactive exercises, and video vignettes. The videos showed examples of behaviors to adopt, such as using open questions, providing reflections and praise, as well as behaviors to avoid, such as giving unsolicited advice, confronting and showing disapproval	Motivational interviewing techniques of physicians. 81% physicians reported learning how to ask open ended rather than closed ended questions,67% reported this website would impact their understanding of the importance of counseling about nutrition and physical activity	SCT was utilized to overcome physicians' often lack of Knowledge, skills, and self-efficacy to motivate adolescents to change behaviors
Milos et al., 2013	Sweden; Study period: From December 2011 to February 2012	Randomized controlled trial	n = 22	Questionnaire-based behavior change interventions. All groups received a questionnaire assessing attitudes, beliefs, and subjective norms. The control group received only this questionnaire. The first intervention group also received the graded task intervention (GTI)addressing the GP's belief in his/her capabilities to manage URTIs without prescribing an antibiotic. The second intervention group received the questionnaire and also the persuasive communication intervention (PCI)	No significant differences were seen in the prescription rates before and after the interventions when patients of all ages were analyzed together	Self-efficacy construct measures the confidence in the physicians' ability to manage patients with URTIs. Also risk perception, outcome expectancies are measured through SCT constructs
Steed et al., 2014	UK; Study Period: not reported	Randomized controlled trial	n = 124,Intervention (n = 65) Control (n = 59)	University College London-Diabetes Self-management Program (UCL-DSMP): this program aims to help individuals manage their diabetes. The program consists of five weekly sessions that focus on changing the beliefs individuals have about their illness using self-regulatory theory and improving their self-efficacy using social cognitive theory.	Self-efficacy related to exercise was a significant mediator for changes in exercise behavior at the three-month follow-up (B = .03; .01, p < .05). Similarly, self-efficacy related to monitoring behavior was a mediator for changes in monitoring behavior at both the three-month (B = .04; .01, p < .01) and nine-month (B = 5.97; 1.01, p < .01) follow-up	Self-efficacy in session content
Benitez et al., 2015	US; Study period: Fall of 2013 and continued through December 2013.	Pre-posttest design (One-month single-arm)	n = 24	Individually tailored physical activity counseling messages based on the response of psychosocial measure. The study website had extra features such as videos of Latinas exercising to Latin music and links for physical activity information. Participants were provided with pedometers to monitor their activity daily on the website and set weekly goals on a calendar. They were also able to produce graphs comparing their actual physical activity to their goals	During the one-month assessment, participants reported a significant increase (p = .001) in self-reported moderate-to-vigorous physical activity compared to baseline. The median for physical activity at baseline was 12.5 min per week, which increased to 67.5 min per week at one month	The website provided two methods for improving self-efficacy for physical activity: vicarious experience through exercise videos of Latinas exercising to Latin music and mastery experience through individually tailored messages that provided information on how to increase physical activity, such as explaining that everyday activities like cleaning and walking can count towards physical activity goals, and offering verbal encouragement and motivation
Ihwanudin et al., 2015	Indonesia; study period: From second week of August to the first week of September 2014.	Quasi experimental (with two groups, pre and post- test design)	n = 58, Intervention (n = 29) Control (n = 29)	5 activities: Brainstorming, provide Knowledge about lifestyle modifications, group discussion, presenting role model, demonstration and self-monitoring of gymnastic fitness and daily DASH eating plan and practicing gymnastic fitness three times a week with duration 60 min within 7 weeks.	Both the intervention group and the comparison group showed significant improvements in knowledge and situational perception, as well as decreases in blood pressure and total cholesterol after completing the program (p < .001). Specifically, the participants' knowledge score increased from 5.24 before participating in the program to 10.79 after participating	Motivation, self-efficacy
Marcus et al., 2016	US; Study period: From 2011 to 2014	Randomized controlled trial	n = 205, Intervention (N = 104) and Control (N = 101)	The program provided several features to support physical activity including self-monitoring of activity and steps, setting goals with graphical representation of progress, a message board to encourage social support, an “ask the expert” feature to ask anonymous questions to a Ph.D. researcher, and access to online resources such as walking routes and exercise videos. Monthly questionnaires were also completed to generate personalized physical activity reports	self-reported Moderate to Vigorous Physical Activity (MVPA) at 6-month follow-up (adjusting for baseline values). On aver-age, participants in the Intervention Group increased their min/week of MVPA from 8.0 (SD = 15.0), Median = 0 at baseline to 112.8 (SD = 97.1)	The program focused on building participants' confidence (self-efficacy) and providing them with behavioral strategies to increase their activity levels. These strategies included goal setting, self-monitoring, problem-solving barriers, increasing social support, and rewarding oneself for meeting physical activity goals
Coultas et al., 2018	US; study period: not reported	Randomized-controlled trial (single-site, parallel)	n = 325, Intervention = 149 and Control = 156	The intervention: COPD self-management education delivered by a trained health coach telephonically during a 6-week run-in period and behavioral intervention to promote lifestyle and physical activity	Results of Intervention on Physical activity: Among participants who completed the 18-month follow-up, 73.6% of those in the intervention group reported consistently engaging in physical activity during the trial, compared to 57.8% in the usual care group (a difference of 15.8%, with a 95% confidence interval of 4.0%–27.7%). With regard to healthcare utilization, there were no significant differences between the intervention and usual care groups in terms of both lung-related and non-lung-related healthcare utilization over the 18 months of the trial (60.5% for the behavioral intervention group and 61.1% for the usual care group, with an absolute difference of 0.7% and a 95% confidence interval of −11.1%–12.4%)	Development of standardized scripts to determine self-efficacy, goal setting, pedometer self-monitoring, barrier identification, and problem-solving to tailor messages to promote adherence to their physical activity goals
Jolly et al., 2018	England; study period:March 18, 2014 and February 5, 2015	Randomized-controlled trial	n = 577, Intervention (n = 289) and Control (n = 288).	The usual care group received a standard information leaflet about self-management of COPD.The intervention consisted of telephone health coaching delivered by a nurse with supporting written documents, a pedometer, and a self-monitoring diary	There was no difference in Health-related quality of life SGRQ-C total score at 12 months (mean difference −1.3, 95% confidence interval −3.6 to 0.9, P = .23)	Self-efficacy: SCT guided education, monitoring, and assessment of progress, and taught skills
Knowlden & Conrad, 2018	USA; Study period: March and May of 2013	Randomized Control Trial	n = 57, Intervention (n = 29) and Control (n = 28)	the experimental EMPOWER intervention: educational modalities include 10- to 15-min audio-visual presentations, interactive worksheets, and online discussion board postings. Interventions contained five modules, with one dedicated to each of the four child behaviors. A fifth booster session was delivered 2 weeks after the intervention was over (Week 6). The booster session is designed to reinforce the content of the previous four modules.	Significant group-by-time interaction of small effect size for child fruit and vegetable consumption (p = .033; Cohen's f = 0.139). Significant main effects for child physical activity (p = .024; Cohen's f = 0.124); sugar-free beverage intake (p < .001; Cohen's f = 0.321); and screen time (p < .001; Cohen's f = 0.303), suggesting both groups improved in these behaviors over time.	Intervention was designed to actualize five constructs of social cognitive theory (environment, emotional coping, expectations, self-control, and self-efficacy)
Y. Wang et al., 2018	USA; Study period: 2007–2010	Randomized Control Trial	n = 277, Intervention (n = 91) and control group (n = 186)	safety promotion intervention: eight sessions (four group, three telephone and a final review/celebration group). Group activities (eg, sharing cabinet locking strategies). Mothers and health educators had discussions during telephone sessions about safety goals, barriers, and factors that facilitate safety. An attention-control group was given an intervention with a similar design that focused on promoting either maternal diet/physical activity or toddler feeding behavior. All groups were provided with child-care, healthy snacks, and transportation compensation	The safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the12-month follow-up	Health educators led the sessions using SCT principles, including self-monitoring, goal setting, feedback, self- instruction and social support in a friendly, supportive context and build self-efficacy
Bookhart et al., 2019	USA; Study period: not reported	Quasi-experimental (with pre and posttest design)	n = 113	Monthly clinic visits including nutrition education and individualized goal setting. Participants were offered six weekly Cooking Matters courses	Food insecurity scores declined by −0.24 (95%)	This program was designed to improve cooking skills and food resource management skills based on Social Cognitive Theory.
Meurer et al., 2019	BRAZIL; study period: between October of 2014 and July of 2015.	Randomized Controlled Community Trial	n = 291, Intervention (n = 135) and Control (n = 156)	The VAMOS strategy: Both the Intervention and Control groups engaged in the same 60-min PA HAP activities (aerobic and anaerobic exercises three times a week), which were supervised by physical education professionals. In addition, the Intervention group members participated in the VAMOS strategy for 12 consecutive weeks, which consisted of weekly 60-min sessions	The participants in the intervention group (IG) increased the amount of time they spent engaged in moderate-vigorous physical activity on a daily basis and the frequency with which they consumed raw vegetables. In addition, they decreased their consumption of ultra-processed foods. Participants in the intervention group who were classified as overweight or obese at the beginning of the study also experienced weight loss, which was not observed in the control group	The primary social cognitive theory (SCT) concepts discussed during weekly sessions were self-efficacy, which was improved through regular feedback to boost confidence, and setting individual goals for physical activity and dietary habits
Morales et al., 2019	Colombia; study period: not reported	A systematic cultural adaptation process utilizing a mixed methods approach	n = 100	COMPAS is a program implemented in schools that includes activities such as group games, role-playing, and group discussions. It addresses sexual diversity by featuring at least one role-playing activity that involves same-sex couples and focuses on improving communication skills. The program consists of five 50-min sessions that cover topics such as sexuality and health, risk awareness, decision making, sex communication training, and decision commitment	The participants rated their perceived utility and satisfaction with the program, with a mean score of 9.28 and a standard deviation of 1.06 for perceived utility, and a mean score of 9.05 and a standard deviation of 1.42 for satisfaction. Both perceived utility and satisfaction were rated very highly by the participants	Performance mastery, modeling, interpretation of symptoms, and social persuasion.
Zakirsson et al., 2019	Sweden; Study period: September 2013 to September 2015	Randomized Control Trial	n = 162, Intervention (n = 79) and Control (n = 83)	The participants attended six meetings that lasted one and a half hours each at Primary Health Care (PHC) every other week to foster a positive and encouraging environment within the group	There were no statistically significant differences between the intervention and control groups in terms of functional capacity (measured by 6 MWD), self-efficacy related to exercise and fatigue (measured by S-ESES and PSEFSM), functional limitations due to fatigue (measured by FIS), anxiety, depression (measured by HADSA/D), and health, except for the social function domain of the health measure	Self-efficacy through educational content in group session
Fritz et al., 2019	Sweden; study period: not reported	Quasi experimental study (mixed-methods approach)	n = 24, Intervention (n = 15) and Control (n = 9)	The methods used for facilitation intervention include outreach visits, peer coaching (which can be formal or informal discussions with other participating physiotherapists at the clinic), educational materials such as nine web lectures, individual goal-setting, video feedback, self-monitoring through diary entries, two telephone calls from a researcher to provide manager support during the implementation period, and an information leaflet provided to patients.	According to the physiotherapists, the most beneficial facilitation method was outreach visits, followed by peer coaching and educational materials	Self-efficacy for r clinical behavior change
Kim et al., 2020	South Korea; study period: not reported	quasi-experimental design with pretest–posttest	n = 69, Intervention (n = 37) and Control (n = 32) in	The RIPEP-SCT training program consisted of four sessions held once a week over the course of four weeks, each lasting 50 min. Additionally, a reinforcement session was conducted between one to six months after the initial training. During each session, a specific topic was covered, such as respiratory infection symptoms, proper cough etiquette, hand washing techniques, mask-wearing, dental hygiene, and healthy walking habits. To increase motivation and engagement, a game format was utilized, culminating in a completion ceremony with prizes and certificates for participants	The educational program led to improved knowledge and practices related to respiratory infection prevention and increased social capital among the elderly residents who took part in it, as demonstrated by the study's results.	The content of the sessions reflected the four observational learning processes.
Dobbles et al., 2017	Belgium; study period: not reporte	Randomized Control Trial	n = 205, Intervention (n = 103) and Control (n = 102)	In the MAESTRO-Tx trial, the intervention group received staged multicomponent tailored behavioral interventions, which included methods like electronic monitoring feedback and motivational interviewing. On the other hand, the control group received usual care and attended visits	The intervention group showed a 16% increase in dosing adherence compared to the control group (95.1% in the intervention group versus 79.1% in the control group; p < .001). This resulted in the odds of adherence being 5 times higher in the intervention group compared to the control group	Self-efficacy and motivational interviewing formed the core components of the interventions that were provided
James et al., 2017	Australia; Study period: from 2011 to 2014.	Randomized Control Trial (Three-armed pragmatic)	n = 203, Intervention group 1 (n = 68) or Intervention group 2 (n = 64); control group (n = 71)	Expert Physical Activity Counseling Intervention [1]:5 face-to-face counseling sessions by an exercise specialist [2], one face-to-face counseling session followed by four telephone calls by an exercise specialist, or [3] a generic mailed physical activity brochure (usual care).	The estimated mean difference between usual care and the combined intervention groups at 12 months was 1002 steps/day (95% CI1⁄4244, 1,759, p1⁄40.01). When comparing face-to-face with predominantly telephone counseling, the telephone group had a non-significant higher mean daily step count (by 619 steps) at 12 months.	The counseling sessions: self-efficacy & motivation
Estabrooks et al., 2017	USA; Study period: between 2011 and 2014.	Longitudinal pre–post Quasi-experiment without control.	n = 40,308 adults	Community-based weight loss program = WAW program: The WAW program is designed to span 12 months and includes several features such as a website, objective weight assessment, daily social cognitive theory-based email and text message support, online access to health coaches, and small financial incentives aimed at enhancing program participation and retention	The mean (SD) weight loss was 2.1 (6.5) kg, and approximately 46% of the participants lost weight. 47% percent of participants weighed in more than once, and 70% of these lost weights.	self-efficacy & motivation: educational material (text message & email)
Johnson et al., 2015	CANADA; study period: not reported	Controlled implementation trial	n = 198, intervention (n = 102) or control group (n = 96)	The HEALD (Healthy Eating and Active Living for Diabetes) intervention: In the pedometer-based walking program, participants were provided with Yamax SW-200 pedometers to be worn during waking hours. They were then asked to maintain a log of their total daily step counts for three consecutive days, including at least one weekend day at baseline, three months, and six months.	Daily pedometer-determined steps increased for the intervention group compared to the usual care control at six months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p = .002)	Self-efficacy, goal setting, self-monitoring
Bouma et al., 2018	Netherland; study period: between May 2011 and September 2014	Randomized controlled trial	n = 245, Intervention group 1 (n = 123) or Intervention group 2 (n = 122), Control group (n = 36)	1.The standardized lifestyle intervention (SLI): Interactive presentation: Duration 2 × 45-min individual sessions, 5 regular 90-min group meetings for 6 months 2. The barrier-belief counseling intervention (BBCI): Counseling sessions: 12 45-min individual sessions, for 6 months	The BBCI was more effective on PA compared with the SLI (p < .01): in the short term all PA outcomes improved (p < .05), and in the long-term moderate-to-vigorous PA outcomes improved (p < .05), all with small effect sizes	Comparison of behavior, comparison of outcome) was utilized to increase motivation
H.-y.Wang et al., 2018	USA; Study Period: From October 2008 to December 2011.	Cluster Randomized trial	n = 25, Intervention (n = 13) and Control (n = 12)	Physician-focused communication Intervention: The intervention was comprised of three components [1]: a printed guide for communication, (2) two structured in-office training sessions involving simulated patients, and [3] auxiliary materials like a flip chart summarizing the key points from the guide, FOBT instruction sheets for patients, and information sheets on free or low-cost screening opportunities available locally.	Screening rates were slightly higher in the intervention vs.the control arm (24.4% vs. 17.7%, p = .24).	Self-efficacy: formed the basis for development of the intervention
Pinto et al., 2001	USA; Study period: not reported	Randomized controlled trial	n = 355 Intervention (n = 181), Control (n = 174)	Physician-Based Activity Counseling: it involved training for physicians in the intervention group, which consisted of a 1-h session held in their office. During the session, the counseling strategy was explained, and role-playing scenarios were used to practice skills. The counseling strategy was based on the “5 As” approach, which involved addressing the agenda, assessing the patient, providing advice, assisting in setting goals, and arranging follow-up	At 6 weeks, the intervention had significant effects on decisional balance, self-efficacy, and behavioral processes, but these effects were not maintained at 8 months	self-efficacy & motivational readiness
Pinto et al., 2002	USA; Study period: not reported	Randomized controlled trial	n = 298, Intervention (n = 150), Control (n = 148)	TLC-PA: TLC technology employs computer technology and digitized human speech to communicate with patients through automated telephone conversations. The system asks questions, provides comments on the user's responses to those questions, records the value of the user's daily pedometer reading from the day before the call, and educates and counsels patients on targeted health behaviors. In addition, at the end of each conversation, the system negotiates a task that applies one of the processes of change. This approach is also employed in TLC-PA	TLC-PA group was more likely to meet recommendations for MI- or vigorous-intensity PA (VI-PA) compared to the comparison (TLC-Eat) group (TLC-PA26% vs TLC-Eat19.6%, p0.04)	Self-efficacy: motivational readiness for PA adoption
Miura et al., 2004	Japan; Study period: not reported	Randomized controlled trial	n = 57, Intervention Group 1 (n = 18) and Intervention Group 2 (n = 20) and control group (n = 19)	Patient-catered assessment and counseling for exercise plus nutrition [PACE + Japan]:PACE + Japan program, which consists of an evaluation of lifestyle, determination of a behavior plan through action plan-sheet, and physician counseling. In the Japanese version, action plan was modified by taking into account factors unique to the Japanese diet (increased fruit consumption was deleted, and salt intake was added)	The decrease in systolic blood pressure (SBP) (ΔSBP = SBP at 24 weeks minus that at 0 weeks) in the PACE + Japan follow-up group was significantly greater than that in the control group. In addition, the Percentage of Fat (%Fat) and Urinary sodium extraction (U–Na) in the PACE + Japan follow-up group was significantly greater than the control group	motivational readiness
Norr et al., 2004	Southern Africa; Study period: not reported	Quasi experimental, post and pre test	n = 300, Intervention (n = 261), delayed control (n = 142) [initial pretest]; Intervention (n = 207), Delayed control (n = 71) [post-test]	Peer group HIV prevention intervention: The intervention occurred over six 90-min weekly or biweekly sessions. Each session included role plays to build communication skills related to that session's content	Significant post-test differences in knowledge about HIV transmission (IG-6.57, CG-6.29*), STIs (IG-7.49, CG-6.73***), and prevention behaviors (IG-90%, CG-62%***) [*p<,.05,***p < .001]	positive attitudes toward condoms and greater condoms use self-efficacy
Anderson et al., 2005	USA; Study period: from 1995 to 1997	Randomized controlled trial	n = 395 Female, n = 479 Male	Activity Counseling Trial (ACT): Advice-only arm: physician provided advice with written educational materials+ and referral to an onsite health educator for general education. Assistance arm: involved physician advice and extended time with an onsite health educator who provided a 30- to 40-min behavioral counseling session. This session included an instructional videotape, a review of the patients' specific physical activity goals, and the development of an individualized plan. In contrast, the Counseling arm included both physician advice and health educator assistance, as described earlier, as well as bi-weekly telephone calls from the health educator and group meetings	At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms.	Self-efficacy to exercise
Alder et a., 2005	USA; Study period: August to December 2000.	Randomized controlled trial	n = 80, Intervention Group 1 (n = 20), Intervention Group 2 (n = 20),Intervention Group 3 (n = 20) and control group (n = 20)	Communication intervention)-questionnaire & role-playing: researcher taking on the role of a parent and the parent of the physician and switching the roles 2) an information-only intervention: educational pamphlet & fact sheet 3) a combination of the communication promotion and antibiotic education interventions and 4) a control condition based on nutrition for children: unrelated to antibiotic use	reported a significantly higher sense of efficacy to communicate with their child's provider (p = .021) than control group	Self-efficacy, mastery experience through role-playing
Artz et al., 2005	USA; Study period: July 1995 to September 1997	Pretest-posttest design	n = 1159	The intervention includes a promotional videotape (10 min); a skills-oriented counseling session with a nurse clinician (30–45 min)[ partner communication, method selection, safe sex information]; assorted take-home items- flip charts, brochure, a videotape for men; and free supplies of female and male condoms.	Fully, 79% of participants for whom there were follow-up data used the female condom at least once and often multiple times. Use of barrier protection increased significantly after the intervention, and high use was maintained during the 6-month follow-up period.35% percent of participants used either a male or female condom every time they had vaginal inter course for the entire study duration. Intervention proved to be replicable	Outcome expectations and efficacy expectations for a skills-oriented intervention
Glasgow et al., 2006	USA; Study period: not reported	Randomized controlled trial	n = 335, Intervention (n = 174), Control (n = 161)	Theory-based self-management (TSM) or computer-aided enhanced usual care (UC): In the study, participants were randomly assigned to either Theory-based self-management (TSM) or computer-aided enhanced usual care (UC) groups. The TSM group received computer-assisted self-management assessment and feedback, tailored goal setting, barrier identification, and problem-solving. This was followed by health counselor interaction and follow-up calls	TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up	Self-efficacy
Doerksen & Estabrooks, 2007	USA; Study period: not reported	Randomized controlled trial	n = 86	Fruit & Vegetable Intervention (FVI): physical activity promotion program with nine weekly newsletters. The newsletter was designed to promote fruit and vegetable consumption and included a message based on social-cognitive theory. This message was featured prominently on the front page of each of the nine newsletters under the heading ‘The 5-A-Day Corner.’ Each newsletter included messages that were approximately 500 words long and provided strategies to increase self-efficacy and outcome expectations related to fruit and vegetable consumption. These strategies included information on preparation techniques and descriptions of fruits and vegetables	Participants in the FVI condition increased in their fruit and vegetable consumption by approximately one to one and one-third servings per day.	Participant outcomes and self-efficacy expectations related to fruit and vegetable consumption.
Lopez et al., 2007	SPAIN; Study period:2001–2002	Randomized controlled trial	n = 3031, intervention (n = 1490) and Control (n = 1541)	A health counseling intervention: Four individual face-to-face counseling interventions with booklets and posters were used as reinforcement materials	Families with cancer experiences significantly changed five cancer risk behaviors more (p < .01) in the EG than in the CG: Smoking (OR = 0.662), drinking (OR = 0.504), diet (OR = 0.542), weight (OR = 0.698), and sun (OR = 0.389).	Self-efficacy enhancing information and skills to be able to change.
Richards et al., 2022	US; Study period: January 2019 and January 2021.	Pre-posttest	n = 875	Get WalkIN’: The “Get WalkIN‴ program is a walking promotion program that operates through email communication	Participants found the intervention emails to be easily readable (with a mean score of 4.5 out of 5 and a standard deviation of 0.7), understandable (also with a mean score of 4.5 out of 5 and a standard deviation of 0.7), and motivating to walk more (with a mean score of 4.1 out of 5 and a standard deviation of 0.9). Additionally, participants expressed a desire to connect and interact with other participants and educators	Self-efficacy pertains to an individual's belief in their capability to carry out a particular behavior despite any obstacles that may arise.

3. Results

From a total of 875 articles derived from multiple databases and additional resources, 39 articles were finally included in this scoping review that met our inclusion criteria (Table 2). Summarized findings are discussed below.

3.1. Study period and study location

The majority (n = 19, 48%) of the 39 studies included in this review were carried out in the United States [[18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36]]. There were five studies conducted in the UK [[37], [38], [39], [40], [41]] and three in Sweden [[42], [43], [44]], and one each from New Zealand [45], Brazil [46], Colombia [47], Belgium [48], Australia [49], Netherland [50], Canada [51], Spain [52], and Botswana [53]. Only three of the included studies were conducted in Asia; one each from Japan [54], Indonesia [55], and South Korea [56]. Twenty-three [[18], [19], [20],25,[27], [28], [29], [30],[33], [34], [35], [36], [37],39,40,[43], [44], [45], [46],49,50,52,55].

Nearly half of the studies included in the analysis provided information on the study period during which they were conducted. The highest number of studies (n = 12) were conducted between 2010 and 2020 [25,27,28,33,37,39,43,44,46,49,50,55]. The first study that conducted an intervention utilizing the constructs of Social Cognitive Theory (SCT) to promote the female condom to sexually transmitted disease clinic patients was in July 1995 [20]. The most recent study on the evaluation of an email-based intervention program by Richards et al., 2022 was conducted in 2019 and published in 2022 [33].

3.2. Study design, recruitment strategy, and participants

Ninety-seven percent of the included studies (n = 38) were intervention studies, and twenty-six of them were randomized control trials with intervention and control groups [18,19,[22], [23], [24],26,27,[29], [30], [31], [32],34,35,38,40,41,[43], [44], [45], [46],[48], [49], [50], [51], [52],54]. Seven of the studies followed a quasi-experimental design [21,25,36,42,53,55,56], and four of the studies had pre and post-test designs [20,29,33,37]. For instance, Marcus et al., 2016 randomly assigned eligible Latinas to the Intervention (N = 104) and Control (N = 101) group for the internet-delivered physical activity intervention, whereas Benitez et al., 2015 assigned the one-month trial of the physical activity promotion website intervention to 24 Latina adults assessed pre-and post-outcomes of the intervention group. The sole study that utilized a methodical cultural adaptation process adopted a mixed methods approach to adopt a Spanish-based sexual health promotion intervention (COMPAS) for 100 Colombian adolescents aged 15–19 years old [47].

Among the included studies, sample sizes ranged from 24 to 40,308 participants. The eligibility criteria of the participants varied across study designs. Two of the studies [26,41] included patients with Type-2 diabetes, and three studies [23,39,44] included patients with physician-diagnosed chronic obstructive pulmonary disease (COPD), and two studies [54,55] included patients with hypertension. Only one study of the included 39 studies recruited young adolescents aged 15–19 as the study participant [47]. Two studies each included biological mothers [27,35], and elderly patients [55,56] as their study populations, respectively. Four studies included physicians as the study population. For example, Fritz et al., 2019 included primary healthcare physiotherapists, and Milos et al., 2013 recruited general physicians from PHCCs as their study participants.

Over half of the study's (n = 25) participants were recruited utilizing the primary care network [18,[20], [21], [22], [23],26,29,31,32,35,38,39,[41], [42], [43], [44],46,[48], [49], [50], [51], [52], [53],55,56]. For example, Meurer et al., 2019 recruited participants from frequent attendees of the PHC service named Health Academy Program (HAP); Wang et al., 2018 recruited biological mothers of toddlers from a Special Supplemental Nutrition Program from urban/semi-urban low-income communities in the US; hypertensive elderly patients from Primary Health Centers (PHCs) in Indonesia [55]. For the other studies, individuals were enrolled through various methods such as the distribution of informational letters, flyers, brochures, and leaflets within the community, using opportunistic media like newspaper and television coverage, Craiglist.org, through word-of-mouth recommendations, and face-to-face announcements.

3.3. Characteristics of the interventions

All the 39 included studies in this scoping review integrated constructs of Social Cognitive Theory (SCT) in developing and delivering the intervention in the primary health care setting. “Self-efficacy: the degree of confidence an individual has in his/her ability to perform a behavior despite barriers” was the most utilized construct of SCT in these studies. For example, Coultas et al., 2018, a randomized controlled trial, developed standardized self-management health coaching scripts and tailored messages guided by SCT to increase confidence and adherence to physical activity goals. In addition to self-efficacy, five of the studies [37,44,45,47,56] also integrated the construct of “performance mastery or observational learning: Learning by watching others” to design and deliver their intervention. As an example, Benitez et al. (2015) allocated a web-based intervention that comprised exercise videos featuring Latinas exercising to Latin music (such as salsa, merengue, etc.) to exhibit the mastery of the experience/observational learning process and enhance the desire to engage in physical activity; Whittaker et al., 2011 used observational learning where short video diary messages from role models teaching behavioral change techniques helped participants going through the quitting process.

All the included studies mentioned incorporating multiple components in their intervention package. Most of the studies (n = 20) integrated individual (face-to-face) or peered group-based counseling training programs [[19], [20], [21],28,32,[34], [35], [36], [37], [38],41,42,44,47,49,[52], [53], [54], [55], [56]]. As an instance, Anderson et al. (2005) allocated participants to an intervention where they were given guidance by a physician, engaged in an extended conversation with an on-site health educator who conducted a 30–40 min behavioral counseling session that incorporated an instructional video, review of the patient's specific physical activity goals, and devising an individualized plan; Another intervention by Norr et al. (2004) involved six weekly or bi-weekly counseling sessions conducted in peer groups for 90 min, with a focus on raising awareness about the AIDS epidemic, educating about sexuality and sexually transmitted infections, developing practical condom-use skills, fostering communication and partner-negotiation abilities, and promoting HIV prevention measures in the community.

Few of the included studies (n = 8) reported delivering tailored educational materials (informational brochures, activity workbooks, flipcharts, booklets, posters, newsletters, facts sheets, graphs, web-based advice, and feedback) along with training/counseling sessions to reinforce learning [25,33,34,40,42,48,52,56]. For instance, the intervention by Huei-yu-wang et al., 2018 included a printed communication guide, auxiliary materials, including a desk-style flip chart summarizing key points from the guideline, fecal occult blood test (FOBT) instruction sheets for patients, and local free/low-cost screening information sheets during the training sessions.

Among the 39 studies, n = 8 mentioned telephonic counseling call/telephonic health coaching by specialists as their intervention modalities [19,23,30,31,35,36,39,49]. For instance, Pinto et al. (2002) incorporated a TLC-PA intervention that employed computer technology and digitized human speech to interact with patients through automated telephone conversations. The intervention involves asking questions, providing feedback on the user's responses, and offering education and counseling related to specific health behaviors. Utilizing the “role model” technique was another reported intervention mode (n = 6) [18,28,45,47,53,55]. For example, the intervention provided by Alder et al., 2005 included role-playing components where researchers took the role of a parent and the parent of the physician and switched the roles to promote communication and antibiotic education.

Eight studies [19,22,[27], [28], [29],37,42,45] used audio-visual mediums (power-point presentations, cartoons, pictorials, music, exercise videos, videotape, diary message, graphs, still photos, website links, and exemplar video vignettes) as one of their intervention components. Four interventions [22,25,37,45] incorporated text messages or emails for promotional and reminder purposes. For example, the participants of the “Community-based weight loss program = WAW program” received an automated package of text messages over 12 months of the intervention period. Three of the studies indicated that the intervention group was given “pedometers” to wear during their waking hours and directed to record the number of steps taken each day, as well as compare their actual physical activity to the pre-set goals [37,39,51].

Only two of the included studies [25,56] reported providing financial incentives or certificates to the participants to ensure the program's reach and retention. For example, Kim et al., 2020 incorporated a game format for the participants with a completion ceremony and acknowledgment with a prize and certificate to enhance their interest and motivation. Three studies [28,37,54] reported integrating the cultural or language specification in their intervention modalities. For example, in the [PACE + Japan] nutrition program by Miura et al., 2004 action plan was modified by considering factors unique to the Japanese diet (i.e., Increased fruit consumption was deleted, and salt intake was added).

3.4. Outcomes of the interventions

Among all the 39 included studies, most of them (n = 16) reported specific outcomes related to the rate of moderate to vigorous physical activity [19,23,24,28,31,32,36,37,39,41,46,[48], [49], [50], [51],55]. For example, Benitez et al., 2015 reported a significant increase (p = .001) in self-reported moderate-to-vigorous physical activity from baseline (median = 12.5 min per week) to the one-month assessment (median = 67.5 min per week). Four studies [26,46,54,55] reported increased Knowledge of dietary intake and changes in adapting to a healthy lifestyle. For instance, Ihwanudin et al., 2015 registered participants attending the lifestyle modification program had a significant increase in Knowledge, before participating: 5.24 vs. after participating: 10.79; a reduction in Total cholesterol (231.34 vs. 221.86).

Two of the studies [40,45] evaluated the participants’ intention to quit or the smoking cessation habit. Though Whittaker et al., 2011 noticed continuous abstinence at six months with a rate of 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8), there was no difference recorded in the intervention and control group outcomes in the RCT by Mason et al., 2012. Out of the 39 included studies, four of them examined SCT-derived intervention to assess the health-related quality of life. For instance, Jolly et al., 2018 reported that participants of the intervention group had greater physical activity; women receiving counseling or assistance significantly reduced daily stress and improved body function satisfaction compared to the control group [19].

Evaluation of Knowledge on varying risky behaviors such as Knowledge on STIs transmission & HCV, understanding sexual health and unhealthy sexual behaviors, modifying false beliefs, problem-solving techniques to solve sexual risk situations, and assessing short- and long-term consequences to make responsible decisions were reported by four of the 39 included studies [20,29,47,53]. Moreover, two studies [30,34] focused on evaluating patients’ screening rates. For example, in the Physician-focused communication Intervention by Huei-yu-wang et al., 2018 screening rates were slightly higher in the intervention group compared to the control group (24.4% vs. 17.7%, p = .24).

Two studies assessed the rate of using antibiotics by both physicians and Parents, out of which Alder and colleagues reported that patients who received the communication intervention, either alone or in conjunction with the antibiotic information intervention, reported a significantly higher sense of efficacy in communicating with their child's provider (p = .021) before using antibiotics [18]. Nevertheless, there were no noteworthy distinctions observed in the prescription rates before and after the interventions by general practitioners (GPs) when patients of all ages were assessed together [43]. The Remaining reported outcomes from the included studies are motivational interviewing techniques of physicians [22], post-transplant adherence to the medication [48], reduced home-safety problems [35], and declined food insecurity [21].

4. Discussion

Scoping reviews offer a simplified synthesis of relevant information on a particular topic promptly to inform research findings and bottlenecks [57]. This scoping review aimed to synthesize the existing literature on targeted primary health care intervention based on Social Cognitive Theory (SCT) constructs to identify successful strategies for making positive health outcomes and behavior changes.

Incorporating a theoretical framework in research provides guidance for a particular study and establishes a connection with previous and future studies that follow the same framework [58]. Linking research with a theoretical viewpoint enhances knowledge development by encouraging researchers and clinicians to connect more effectively. From our scoping review, we identified that all the included articles viewed and adapted the construct of self-efficacy (an individual's perception of their ability to perform a behavior) as an ideal framework for understanding how determinants of behavior operate together to explain actions and to bring about a specific behavior change among the target population. This result aligns with many other studies that have used self-efficacy to identify how a behavior change occurs in various populations. Examples include promoting new behaviors such as condom use among adolescents, stopping existing behaviors like smoking, resuming health promotion behaviors such as physical activity after an injury [59], implementing a food safety education program for the elderly [60], providing a web-based hip fracture prevention program for the elderly [61], and an eye health program for children [62].

In this review, we also identified observational learning (i.e., attention, memory, retention, and motivation) derived from SCT through video-recorded role-play, peer coaching, and role models that contributed to achieving desired behavior change in a promotional healthcare setting. These results support previous studies showing interventions focusing on action, experience, and peer support to effectively promote behavior change among healthcare professionals. Adopting new behaviors can often lead to anxiety and frustration, requiring emotional support, initiative, and sustainability, all of which can be facilitated by social influence from role models [42,56,[63], [64], [65]]. These findings corroborate the need for integrating audio-visual and interactive approaches in interventions that can function as speedier and more dynamic processes in a time-constrained healthcare environment.

A variety of interventions were designed within the core of SCT derivatives for behavior modification and healthcare promotion. Individual (face-to-face) or peer group-based counseling-training programs [37,41], tailored educational programs [33,52], telephonic counseling call/telephonic health coaching [19,31], “role model” technique [53], audio-visual mediums, text messages or emails for promotional and reminder purposes [45], providing “pedometers [51], financial incentivizing, language, and context-specific messaging were found to be the practical mode of interventions. Integrating social influence, peer support with education materials, and digital technology-based initiatives created notable guiding principles for preventive, promotive, and curative health behaviors among target populations worldwide. Evidence from the review demonstrated that the strengths of the evaluated intervention came from their adaptive theoretical foundation, which concretized their design, made the process clear, and accounted for the fundamental mechanisms underpinning their effectiveness [66,67]. According to the standpoint of health promotion and disease prevention, the term theory is used to denote a connected set of ideas that explain health behavior or provide a systematic approach to guiding the health promotion practice [68]. Therefore, each theory has at least one central concept and several supporting constructs that describe how the notion is applied in that theory. Given the chronological nature of the constructs and valid, reliable measures of the constructs, we discovered in this review that a significant number of studies mentioned SCT constructs were attained to deliver the interventions but failed to explicitly demonstrate the temporal precedence of the variables in the causal chain. Although Larsen and colleagues (2021) included a web-based intervention that was based on SCT and the Trans theoretical model (TTM) theoretical constructs and concentrated on giving participants tools to integrate home-based MVPA into their daily lives, they neglected to expressly state which constructs were included in analyses [69]. To enable greater clarity on the role of theory in the development of an intervention and reflect the underlying mechanism of action of intervention components, intervention strategies, however, are increasingly demanding a rigorous checklist for evaluating the extent to which an intervention is a theory-based [27]. Patton and colleagues underlined the necessity for more thorough research because, even when planned and mentioned in the design protocol, the theory frequently appears to be underutilized when developing interventions (2017). Only then can conclusive judgments about the efficacy of theory-based interventions be made.

Most of the recruited studies in this review applied a randomized control design; others were quasi-experimental and pre-post-intervention approaches. To understand how these interventions affected the physical, nutritional, and psychosocial adherence to a healthy lifestyle and medication, level of Knowledge and awareness of risky behaviors, and health-related quality of life of target populations, numerous peer counseling, web-based educational and motivational behavioral, and learning-based approaches were evaluated. The results of this review indicate that improving self-efficacy and motivation can lead to immediate improvements in various areas of behavior in the target population. For example, participants showed increased daily time spent in moderate to vigorous physical activity, frequency of raw vegetable intake [46], knowledge about HIV transmission [53], awareness of respiratory infection prevention, respiratory infection prevention practices, and social capital after the intervention [56]. However, it is unclear whether these improvements were sustained over time. Additionally, the intervention did not have a consistent effect on the maintenance of the behaviors. This finding emphasizes the fact that a variety of factors influence the effectiveness of interventions, including behavior change techniques, intervention delivery methods, duration, how and to what extent authors apply the theory in interventions, and how well they work together to maintain effectiveness [70]. According to Rusk et al. numerous paths, such as outreach meetings and individual goal-setting techniques, have synergistic benefits that encourage skill training because they lead to mastery experiences and higher self-efficacy [71]. However, we must be aware, though, that if external implementation support were to cease, the synergistic effects might as well too, and in that situation, self-efficacy by itself would appear to be insufficient to produce the tipping effect necessary for clinical behavior change to be sustained [72,73]. Our research shows that simply mentioning or using a theoretical framework in an intervention does not necessarily ensure its effectiveness. It is crucial to have empirical evidence to support the effectiveness of an intervention and ensure that positive effects can continue even after the intervention is completed.

The effectiveness of interventions also differs depending on delivery methods (face-to-face vs. phone, Internet, print), assessment and reporting of results (self-reported vs. objective), sample size inclusion, methodological consideration, cultural and linguistic appropriateness, and study cost-effectiveness [69,74,75]. Many studies in this review, such as Whittaker and colleagues' web-based smoking cessation intervention from 2011, reported an immediate positive change in behavior expectations but need more participant recruitment to reach the desired sample size and lack generalizability. Hence, notably, it is recommended to describe theoretical domains coupled with the context in which interventions were delivered, durability, practicality, the ability to replicate to corroborate findings from a specific study, and consensus regarding the efficacy of that particular research.

Lastly, in this review, we found that while most studies were conducted in the United States, the UK, Sweden, New Zealand, Belgium, Australia, the Netherlands, and Spain, there were relatively few instances of such SCT constructs embedded in health promotion research conducted in the South Asian region. Despite growing global concerns about behavioral change, particularly in populations with low socioeconomic status and the adoption of digitalized health care, the gap in evidence-based evaluation research in the South Asian region highlights the social cognitive theory framework's lack of consideration for cultural and economic factors [70].

Primary care providers often interact with the majority of the population, understand the patient's social circumstances, offer ongoing treatment, and have access to referral service options both within the healthcare system and in the community; health promotion in primary care settings necessitates a comprehensive approach that focuses on factors of the social system in addition to personal determinants [76]. Therefore, designing an integrated health promotion intervention based on a rigorous theoretical foundation ideally make primary care centers the logical venue for professionals to intervene quickly, help address the contextual factors and perform health promotion to improve any unhealthy habits of at-risk patients and the general community.

However, in practice, primary health care prevention programs often lack a precise theoretical grounding and instead have a focused focus on individual behavioral change [5]. Additionally, there is a substantial research vacuum linking theoretical stances in the dominant paradigm of health education/health promotion. The results of this review demonstrated how the use of evidence-based behavior theories in health promotion might strengthen behavioral modification and the prevention of chronic and non-communicable diseases by fostering a greater understanding of the cognitive, social, and behavioral perspectives related to human health and well-being [7]. Therefore, it is time, for professionals to accept the task of pursuing health education/health promotion reform in a practical, exacting, and long-term way through theory intervention in the clinical practice [77].

As far as we know, this review is among the first to combine Social Cognitive Theory with primary healthcare promotion and examine its theoretical implications for the intervention's effectiveness. However, it is essential to recognize some of this review's limitations. For this review, our method of extracting literature from credible databases facilitated the inclusion of peer-reviewed materials. A wide range of unpublished interventions or evaluation reports unavailable across databases remained beyond the scope of our review. This may allow for biases and compromise the current output's informed quality. Additionally, we relied on the author's description of the intervention and constructs domain to synthesize the findings on theory, use, and applicability, introducing the subjectivity of the researcher's interpretation. These concerns should be considered in future evidence synthesis attempts to support appropriate and generalized results in this area of research.

5. Conclusion

A theory-based framework in designing and implementing an intervention in health care makes it possible to identify the “active components of the initiative,” understand why, when, and how self-management behavior occurs or does not, and provide guidance for future improvements. Theory-based interventions can still be used to identify what works and what does not. More importantly, they can be used better to understand the underlying mechanisms of action of intervention components, even if they cannot have a beneficial effect. Although limited, our scoping review has summarized a wide range of evidence on health care interventions and outcomes embedded in the Social Cognitive Theory constructs. To formalize theoretical approaches in intervention development, it is essential to understand that successful integration, assessment, and completion of theoretical components call for sophistication, professional support, bolstered cultural and contextual consideration, and a standardized guiding manual on divulging the outcomes and effectiveness of the intervention.

Author contribution statement

All authors listed have significantly contributed to the development and the writing of this article.

Data availability statement

Data included in article/supp. Material/referenced in article.

Appendix.

Search strategies for Medline

Search engine	Search terms
Medline	1. “Primary care”
	2. “Primary health*”
	3. “Family medic*”
	4. “Family physician*”
	5. “General practi*”
	6.1 OR 2 OR 3 OR 4 OR 5
	7. “Intervention*”
	8. “Program*”
	9. “Polic*”
	10. “Manag*”
	11. “Screen*”
	12. “Detect*”
	13. “Treat*”
	14. “Therap*”
	15. “Practice*”
	16. “Guideline*”
	17. “Service*”
	18. “Support*”
	19.7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18
	20. “Social cognitive theor*”
	21. “Social cognitive learning”
	22. “SCT”
	23.20 OR 21 OR 22
	24.6 AND 19 AND 19
	25. English language/human studies only/Until July 29, 2022