Abstract

BackgroundUsing frameworks such as the Behaviour Change Wheel to develop behaviour change interventions can be challenging because judgement is needed at various points in the process and it is not always clear how uncertainties can be resolved. We propose a transparent and systematic three-phase process to transition from a research evidence base to a behaviour change intervention. The three phases entail evidence synthesis, stakeholder involvement and decision-making. We present the systematic development of an intervention to enhance the quality of psychological treatment delivered by telephone, as a worked example of this process.MethodIn phase 1 (evidence synthesis), we propose that the capabilities (C), opportunities (O) and motivations (M) model of behaviour change (COM-B) can be used to support the synthesis of a varied corpus of empirical evidence and to identify domains to be included in a proposed behaviour change intervention. In phase 2 (stakeholder involvement), we propose that formal consensus procedures (e.g. the RAND Health/University of California-Los Angeles Appropriateness Methodology) can be used to facilitate discussions of proposed domains with stakeholder groups. In phase 3 (decision-making), we propose that behavioural scientists identify (with public/patient input) intervention functions and behaviour change techniques using the acceptability, practicability, effectiveness/cost-effectiveness, affordability, safety/side-effects and equity (APEASE) criteria.ResultsThe COM-B model was a useful tool that allowed a multidisciplinary research team, many of whom had no prior knowledge of behavioural science, to synthesise effectively a varied corpus of evidence (phase 1: evidence synthesis). The RAND Health/University of California-Los Angeles Appropriateness Methodology provided a transparent means of involving stakeholders (patients, practitioners and key informants in the present example), a structured way in which they could identify which of 93 domains identified in phase 1 were essential for inclusion in the intervention (phase 2: stakeholder involvement). Phase 3 (decision-making) was able to draw on existing Behaviour Change Wheel resources to revisit phases 1 and 2 and facilitate agreement among behavioural scientists on the final intervention modules. Behaviour changes were required at service, practitioner, patient and community levels.ConclusionFrameworks offer a foundation for intervention development but require additional elucidation at each stage of the process. The decisions adopted in this study are designed to provide an example on how to resolve challenges while designing a behaviour change intervention. We propose a three-phase process, which represents a transparent and systematic framework for developing behaviour change interventions in any setting.

Highlights

  • The Behaviour Change Wheel [1] is a systematic method that is endorsed as a key theoretical framework by the National Institute for Health and Care Excellence (NICE) [2] for the development and evaluation of behaviour change interventions

  • The COM-B model was a useful tool that allowed a multidisciplinary research team, many of whom had no prior knowledge of behavioural science, to synthesise effectively a varied corpus of evidence

  • The RAND Health/University of California-Los Angeles Appropriateness Methodology provided a transparent means of involving stakeholders, a structured way in which they could identify which of 93 domains identified in phase 1 were essential for inclusion in the intervention

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Summary

Introduction

There is currently a lack of worked examples of how to identify and negotiate the likely numerous points at which judgement is needed to develop coherent and effective interventions This is important, because there are numerous examples of the Behaviour Change Wheel [1] being used to develop interventions that lack of transparency in how key decisions were made. The lack of specified opportunities for stakeholder involvement, a core philosophy of contemporary health care [4], has been acknowledged as a specific weakness in the implementation of the Behaviour Change Wheel approach [5] Using frameworks such as the Behaviour Change Wheel to develop behaviour change interventions can be challenging because judgement is needed at various points in the process and it is not always clear how uncertainties can be resolved. We present the systematic development of an intervention to enhance the quality of psychological treatment delivered by telephone, as a worked example of this process

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