Table 1 Inclusion table with effect estimates and behavior change techniques

Beach et al, 2016 [34]

Australia

Experimental post-test design

Examine whether the presentation of hearing health information would result in increased use of earplugs, or whether provision of earplugs alone would be sufficient to change behavior.

Experimental group (high level information) vs control group (low level information)

Age range: 20–39

Median age: 26, Average age: 27.1

Initial recruitment: 14 females and 37 males

3.2. Social support (practical)

4.1. Instruction on how to perform a behavior

5.1. Information about health consequences

5.2. Salience of consequences

6.1. Demonstration of the behavior

9.1. Credible source

10.1. Material incentive (behavior)

10.2. Material reward (behavior)

12.5. Adding objects to the environment

Main: earplug use in music venues

Time point:

16 week follow up

Earplug use:

Control: 85.7%

Experimental: 94.4%

RR = 1.1

95% CI = 0.9–1.36

Z = 0.916

Cohen’s d = 0.3 (small to medium effect)

Cha et al, 2015 [35]

Canada

Experimental post-test design

To provide information at three rock concerts (150–300 capacity) advertising free orange foam earplugs (intervention). With comparison to three other concerts with no earplugs available (control). The study wanted to measure and compare prevalence of earplug use at baseline (control) and when earplugs were available (intervention).

No age provided

955 participants; 318 intervention group (218 males, 100 females)

637 control group (410 males, 227 females)

7.1. Prompts/cues

10.1. Material incentive

12.5. Adding objects to the environment

Main: earplug use at Rock and Roll concerts

Time point:

In real time during concerts

Earplug use:

Control: 1.3%

Intervention: 8.2%

RR = 6.51

95% CI = 2.98–14.22

Z = 4.702

Cohen’s d = 0.31 (small to medium effect)

Gilles & Van de Heyning, 2014 [36]

Belgium

Single group pretest-posttest design

Governmental preventive campaign (PrevC) to help prevent hearing damage caused by noise exposure. It was promoted via various ways such as television and radio commercials, social network sites (Facebook/Twitter), posters and a website. The campaign wanted to make young people more aware of the risks of loud music and therefore increase the use of hearing protection in noisy environments.

547 school children aged between 14 and 18 years

Mean age = 16.8

5.1. Information about health consequences

Main: hearing protection use in noisy recreational environments

Time point:

6 months post intervention

Earplug use:

Baseline: 3.7%

Follow up: 14.3%

RR = 3.9

95% CI = 2.42–6.28

Z = 5.594

Cohen’s d = 0.34 (small to medium effect)

Keppler et al, 2015 [37]

Belgium

Single group pretest-posttest design

The study aim was to evaluate the effect of a hearing education program, including: attitudes and beliefs toward noise, hearing loss, and hearing protection device use in young adults.

18 years - 30 years

Median age = 21.01

68 females; 10 males

2.6. Biofeedback

4.1. Instruction on how to perform a behavior

5.1. Information about health consequences

5.3. Information about social and environmental consequences

9.1. Credible source

9.2. Pros and cons

Main: hearing protection use during noisy recreational activities

Time point:

6 months post intervention

Answers on 5 point Likert scale; closer to 1 equals improvement

Baseline:

mean score = 3.40

S.D. = 1.36

Follow up:

mean score = 2.94

S.D. = 1.37

Cohen’s d = 0.34 (small to medium effect)

Baseline and follow up data supplied by authors

Marlenga et al, 2011 [38]

USA

Experimental post-test design

This paper is the 16 year longitudinal follow up of the rural hearing conservation intervention that is also the basis of the Berg et al. (2009**) study. The aim was to assess if the prevalence of hearing loss was reduced and that the use of hearing protection was maintained over the 16 year period.

Berg et al. (2009**) described the historic intervention in more detail and it is from this paper that the behavior change techniques were coded.

Intervention group:

200 total

74.3% Male

Median age = 31.2

Control group:

192 total

61.9% Male

Median age = 30.8

5.1. Information about health consequences

5.2. Salience of consequences

6.1. Demonstration of the behavior

8.1. Behavioral practice/rehearsal

8.3. Habit formation

9.1. Credible source

12.5. Adding objects to the environment

Main: Earplug use during all recreational activities and gunfire. Stereo volume control for personal stereos

Time Point:

16 year follow up

Earplug use all recreational activities:

Control: 16.9%

Intervention: 20.4%

Personal stereos:

Control: 60.1%

Intervention: 62.3%

Earplug use gunfire:

Control: 41.6%

Intervention: 56.2%

All recreational activities:

RR = 1.15

95% CI = 0.75–1.78

Z = 0.62

Cohen’s d = 0.07 (no effect)

Personal stereos:

RR = 1.03

95% CI = 0.81–1.30

Z = 0.23

Cohen’s d = 0.03 (no effect)

Gunfire:

RR = 1.37

95% CI = 1.04–1.80

Z = 2.23

Cohen’s d = 0.3 (small to medium effect)

Neyen, 2003 [39]

Germany

Single group pretest-posttest design

To assess music listening habits using questionnaires before and after a teaching unit; “hearing damage caused by loud music”. The study wanted to assess the extent of the transfer of knowledge and if there are any changes in awareness and behavior, including use of hearing protection at loud music events.

1674 participants in study; 873 male; 801 female

5.1. Information about health consequences

5.2. Salience of consequences

9.3. Comparative imaging of future outcomes

Main: hearing protection use at loud events

Time point:

5/6 weeks post teaching session

Hearing protection use:

Baseline: 14.8%

Follow up: 19.8%

RR = 1.34

95% CI = 1.41–1.58

Z = 3.614

Cohen’s d = 0.14 (no effect)

Weichbold & Zorowka, 2003 [40]

Austria

Single group pretest-posttest design

To measure the effects of a hearing campaign on the frequency of attendance of high school children at discotheques and whether they used hearing protection.

Baseline: 54 male and 115 female (169)

Post intervention: 34 male and 93 female (136)

Pre mean age = 16.9

Post mean age = 17.9

4.1. Instruction on how to perform a behavior

5.1. Information about health consequences

5.2. Salience of consequences

6.1. Demonstration of the behavior

Main: earplug use at discotheques

Time point:

1 year post intervention

Earplug use:

Baseline: 0%

Follow up: 3.8%

RR = 14.17

95% CI = 0.8–253.9

Z = 1.80

Cohen’s d = 0.21 (small effect)

Weichbold & Zorowka, 2007 [41]

Austria

Single group pretest-posttest design

The study aims were the same as the previous study (Weichbold & Zorowka, 2003) with additional target behavior on taking regeneration breaks when exposed to noise at music events.

1757 participants at baseline

1535 at follow up

Age pre-campaign: 16.2 +/−  1.3 years. Age post campaign: 17.0 +/−  1.2 years.

4.1. Instruction on how to perform a behavior

5.1. Information about health consequences

6.1. Demonstration of the behavior

8.1. Behavioral practice/rehearsal

9.1. Credible source

12.1. Restructuring the physical environment

Main: earplug use and taking regeneration breaks at discotheques

Time point:

1 year post intervention

Earplug use:

Baseline: 3.5%

Follow up: 6.5%

Regeneration breaks:

Baseline: 89.9%

Follow up: 91.7%

Hearing protection:

RR = 1.84

95% CI = 1.36–2.52

Z = 3.885

Cohen’s d = 0.14 (no effect)

Regeneration breaks:

RR = 1.02

95% CI = 1–1.04

Z = 1.772

Cohen’s d = 0.06 (no effect)