The Effectiveness of Transtheoretical Model-Based Educational Interventions on Drug Cessation; A GRADE-Assessed Systematic Review and Dose-Response Meta-Analysis

The trans-theoretical model (TTM) is a popular framework for guiding behavioral interventions in substance use disorders. However, the optimal duration and intensity of these interventions are not yet known. This study used the GRADE approach and a dose-response meta-analysis to confirm the robustness of the evidence and to evaluate the effectiveness of TM-based educational interventions for drug discontinuation. In line with the PRISMA ۲۰۲۰ guidelines, systematic searches have been carried out in the databases PubMed, Scopus, the Web of Science and Embase until August ۲۰۲۵. Randomized controlled trials (RCTs) evaluating interventions based on TTM-based drug discontinuation were included in the quality of evidence assessment using the GRADE tool. A meta-analysis of dose responses was conducted to investigate the relationship between duration of treatment (weeks) and efficacy at the end of treatment. Of the ۹۴۷ identified studies, ۵۰ randomized controlled trials (RCTs) involving ۹,۲۴۵ participants met the inclusion criteria. Pooled analysis showed that TTM interventions significantly improved the rate of discontinuation compared with standard care (risk ratio [RR]: ۱.۵۸; ۹۵-CI: ۱.۲۱-۲.۰۶; P<۰.۰۰۱), with modest heterogeneity (I۲ = ۵۵). The dose-response analysis revealed a significant non-linear relationship (Pnon−linearity​<۰.۰۱); interventions showed a steep increase in efficacy up to ۱۲ weeks and reached a plateau after ۲۴ weeks, whereas brief interventions (<۴ weeks) showed limited effects. Analyses of the dose response revealed a significant non-linear relationship (Pnon−linearity<۰.۰۱) with a rapid increase in efficacy up to ۱۲ weeks and plateau after ۲۴ weeks, while short-term treatment (less than ۴ weeks) had limited effectThe trans-theoretical model (TTM) is a popular framework for guiding behavioral interventions in substance use disorders. However, the optimal duration and intensity of these interventions are not yet known. This study used the GRADE approach and a dose-response meta-analysis to confirm the robustness of the evidence and to evaluate the effectiveness of TM-based educational interventions for drug discontinuation. In line with the PRISMA ۲۰۲۰ guidelines, systematic searches have been carried out in the databases PubMed, Scopus, the Web of Science and Embase until August ۲۰۲۵. Randomized controlled trials (RCTs) evaluating interventions based on TTM-based drug discontinuation were included in the quality of evidence assessment using the GRADE tool. A meta-analysis of dose responses was conducted to investigate the relationship between duration of treatment (weeks) and efficacy at the end of treatment. Of the ۹۴۷ identified studies, ۵۰ randomized controlled trials (RCTs) involving ۹,۲۴۵ participants met the inclusion criteria. Pooled analysis showed that TTM interventions significantly improved the rate of discontinuation compared with standard care (risk ratio [RR]: ۱.۵۸; ۹۵-CI: ۱.۲۱-۲.۰۶; P<۰.۰۰۱), with modest heterogeneity (I۲ = ۵۵). The dose-response analysis revealed a significant non-linear relationship (Pnon−linearity​<۰.۰۱); interventions showed a steep increase in efficacy up to ۱۲ weeks and reached a plateau after ۲۴ weeks, whereas brief interventions (<۴ weeks) showed limited effects. Analyses of the dose response revealed a significant non-linear relationship (Pnon−linearity<۰.۰۱) with a rapid increase in efficacy up to ۱۲ weeks and plateau after ۲۴ weeks, while short-term treatment (less than ۴ weeks) had limited effect

کلیدواژه ها:

Transtheoretical Model (TTM) ، Drug Cessation ، Health Education ، Dose-Response Meta-Analysis ، GRADE Assessment.