Abstract
INTRODUCTION: Extreme heat is the leading cause of weather-related deaths. Prevention includes personal practices and emergency procedures. Behavioral interventions to improve prevention of heat-related illnesses are a priority. METHODS: Utilizing systematic review methodology, a comprehensive search strategy was deployed to identify studies reporting evaluations of behavioral heat-illness prevention interventions. Data sources included prominent bibliographic databases and relevant grey literature searches. Inclusion criteria indicated that studies that enrolled adult participants, assessed heat-related outcomes quantitatively, and were published in English from January 2000 to October 2023 be included. Data on study design, intervention features, and outcomes from the retained studies were extracted. A narrative synthesis was conducted, given the small number of studies and heterogeneous features. RESULTS: Seventeen articles reporting on results from 13 studies were retained. Samples included outdoor workers, professional athletes, or community members (total participants = 20,154). Study quality was variable, with only two studies classified as good quality. Outcomes assessed were cognitive variables (e.g., knowledge, attitudes, and intentions), behaviors (e.g., water intake and dehydration), and clinical indicators (e.g., kidney function). Seven studies evaluated a health education intervention, two studies tested warning messages, and two studies focused on provision of personal protection equipment (PPE). Interventions improved self-reported heat-illness knowledge and prevention behaviors, and reduced deaths. Kidney function and health were improved in two studies. CONCLUSIONS: The published literature on behavioral heat-related illness prevention interventions was limited, despite frequent periods of high heat. The published evidence suggested that interventions can improve prevention knowledge and behavior and possibly reduce heat injury. Study designs need substantial improvement by including larger samples and randomized designs with comparison groups to avoid threats to internal and external validity in existing data. Policy efforts should be considered along with health education and provision of PPE to ensure populations are adequately protected.