Abstract
Researchers, practitioners, and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic, and accessible method of linking BCTs with the processes through which they change behavior (i.e., their mechanisms of action [MoAs]) would advance the understanding of intervention effects and improve theory and intervention development. The purpose of this study is to triangulate evidence for hypothesized BCT–MoA links obtained in two previous studies and present the results in an interactive, online tool. Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modeling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool. The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 “nonlinks.” A further 55 links were resolved by consensus (total of 92 [37 + 55] hypothesized BCT–MoA links). Full data on 1,456 possible links was incorporated into the online interactive Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/). This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research.
Highlights
Behavior change interventions are the basis for addressing many current global health challenges
Results of comparison of matrices of behavior change techniques (BCTs)–MoA links to identify links and nonlinks found in both literature consensus and expert consensus studies Links exceeding preset criteria for both studies were examined: 37 BCT–MoA “links” reached the criterion for a link in both the literature synthesis and expert consensus studies, covering 28 BCTs and 18 MoAs
Inconclusive links (N = 179) were brought to the reconciliation study: evidence of a link in literature synthesis but “definitely no” link in expert consensus (n = 3); evidence of a link in literature synthesis and below-criterion level of evidence or link not included in expert consensus (n = 45); no evidence of a link in literature synthesis but “definitely” a link in expert consensus (n = 53); TBM
Summary
Behavior change interventions are the basis for addressing many current global health challenges. Implications Practice: Behavior change intervention designers can use the Theory and Technique Tool (TATT) to select behavior change techniques (BCTs) for inclusion based on expert evidence. These factors serve as the “mechanisms of action” (MoAs) mediating the effect of interventions on behavior change. In developing an intervention to change behavior, the researcher or practitioner typically has an explicit or implicit theory about the MoAs affecting the behavior and seeks to incorporate techniques within their intervention that will engage these mechanisms and thereby the target behavior. Further work is required to facilitate the choice of BCTs for targeting specific MoAs when designing interventions and to interpret the theoretical significance of BCTs that are part of effective interventions
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