Behavioral change techniques and patient co-design in programs for hand osteoarthritis: a scoping review with directed content analysis.

backgroundHand osteoarthritis (HOA) is a common and disabling condition that impairs hand function. Traditional joint protection programs (JPPs) are recommended for reducing pain and deformity and potentially slowing disease progression. While JPPs are supported by trials, programs are outdated, not co-designed and poorly implemented. Behavioral science frameworks and patient co-design methodologies may enhance relevance, adherence, effectiveness, and sustainability. PURPOSE: This study aimed to map and characterize the behavioral components of JPPs for adults with HOA and to examine the extent of patient co‑design.

methodsWe conducted a scoping review with directed content analysis following Arksey and O'Malley's framework. We used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Six databases and 1 clinical-trial registry were searched from inception to April 3, 2025. Eligible studies included any empirical design that included interventions described as "joint protection" or clearly aligned with its core components for adults with HOA. Two reviewers independently coded intervention content using the Behavior Change Technique Taxonomy version 1 and assessed the presence of patient co-design with criteria derived from Experience-Based Co-Design frameworks. Discrepancies were resolved by consensus.

resultsA total of 32 studies met the inclusion criteria. We identified 22 unique behavioral change techniques across 11 clusters. "Instruction on how to perform the behavior" was the most common item (32 studies, 100%), followed by "Behavior substitution" (23 studies, 72%) and "Restructuring the Physical Environment" (17 studies, 53%). Patient co-design was explicitly integrated in 8 studies, with varying methods and levels of engagement. In most cases, patient input was included during the intervention design stage, while only a few studies involved patients in iterative feedback and refinement. Only 1 study combined theoretically informed behavioral content with active patient co-design, highlighting a substantial gap in the development of JPPs for HOA.

conclusionsMost JPPs for HOA incorporate behavioral change techniques but rarely systematically apply behavior change theory, clearly articulate behavioral change mechanisms or engage patients meaningfully in co-design. Integrating established behavioral frameworks with authentic patient co‑design could yield interventions that are both relevant and sustainable. Future programs development should embed systematic behavioral theory and genuine patient partnership from conception through refinement to support durable behavior change in people with HOA.