Abstract
BackgroundMethodological guidelines for intervention reporting emphasise describing intervention content in detail. Despite this, systematic reviews of quality improvement (QI) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated. We aimed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 (BCTTv1) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients.MethodsThree psychologists independently coded a random sample of 23 trials of healthcare system, provider- and/or patient-focused implementation interventions from a systematic review that included 142 such studies. Intervention content was coded using the BCTTv1, which describes 93 behaviour change techniques (BCTs) grouped within 16 categories. We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature.ResultsLess than a quarter of possible BCTs within the BCTTv1 were identified. For implementation interventions targeting providers, the most commonly identified BCTs included the following: adding objects to the environment, prompts/cues, instruction on how to perform the behaviour, credible source, goal setting (outcome), feedback on outcome of behaviour, and social support (practical). For implementation interventions also targeting patients, the most commonly identified BCTs included the following: prompts/cues, instruction on how to perform the behaviour, information about health consequences, restructuring the social environment, adding objects to the environment, social support (practical), and goal setting (behaviour). The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour.ConclusionsThe BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels. Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions, which may help to better inform replication efforts. In addition, prospective use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0248-7) contains supplementary material, which is available to authorized users.
Highlights
Methodological guidelines for intervention reporting emphasise describing intervention content in detail
A) it confounds content, mode of delivery, and provider [2,5], e.g. an educational meeting is a mode of delivery which can involve a range of different behaviour change techniques delivered in different ways; b) categories provide variable levels of detail; and c) strategies in the EPOC taxonomy predominantly target changing resources and opportunities as means of implementing desired change
We aimed to explore whether the Behaviour Change Techniques Taxonomy version 1 (BCTTv1) can be used to identify the active ingredients of existing implementation interventions described at patient, provider, and system levels
Summary
Methodological guidelines for intervention reporting emphasise describing intervention content in detail. The Lancet review classified implementation intervention content into 12 strategies [audit and feedback, case management, clinician education, clinician reminders, continuous quality improvement (QI), electronic patient registry, facilitated relay, financial incentives, patient education, patient reminders, self-management, and team changes] organised into three broader categories (health system, healthcare provider, and patient). A) it confounds content, mode of delivery, and provider [2,5], e.g. an educational meeting is a mode of delivery which can involve a range of different behaviour change techniques delivered in different ways; b) categories provide variable levels of detail; and c) strategies in the EPOC taxonomy predominantly target changing resources and opportunities as means of implementing desired change
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