Behaviour Change Technique Taxonomy V1 Research Articles

Does the design of the NHS Diabetes Prevention Programme intervention have fidelity to the programme specification? A document analysis.

AimsTo assess fidelity of the Healthier You: NHS Diabetes Prevention Programme (NHS‐DPP), a behavioural intervention for people in England at high risk of developing type 2 diabetes, to the specified programme features.MethodsDocument analysis of the NHS‐DPP programme specification, including National Institute for Health and Care Excellence (NICE) PH38 diabetes prevention guidance. This was compared with the intervention design (framework response documents and programme manuals) from all four independent providers delivering the NHS‐DPP. Documents were coded using the Template for Intervention Description and Replication framework (describing service parameters) and the Behaviour Change Technique Taxonomy v1.ResultsProviders demonstrated good fidelity to service parameters of the NHS‐DPP. The NHS‐DPP specification indicated 19 unique behaviour change techniques. Framework responses for the four providers contained between 24 and 32 distinct behaviour change techniques, and programme manuals contained between 23 and 45 distinct behaviour change techniques, indicating variation in behaviour change content between providers’ intervention documents. Thus, each provider planned to deliver 74% of the unique behaviour change techniques specified, and a large amount of behaviour change content not mandated.ConclusionsThere is good fidelity to the specified service parameters of the NHS‐DPP; however, the four providers planned to deliver approximately three‐quarters of behaviour change techniques specified by the NHS‐DPP. Given that behaviour change techniques are the ‘active ingredients’ of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS‐DPP programme specification at the intervention design stage.

Effect of implementation interventions on nurses\u2019 behaviour in clinical practice: a systematic review, meta-analysis and meta-regression\xa0protocol

BackgroundPractitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses’ behaviour in clinical practice and improve patients’ health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes—i.e. mechanisms of action—targeted by interventions to change nurses’ behaviour in clinical practice, and the constituent components—i.e. behaviour change techniques—included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses’ behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques.MethodsWe will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses’ behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International’s NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software.DiscussionThis review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses’ behaviour change in clinical practice. Results will provide key insights regarding which causal processes—i.e. mechanisms of action—should be targeted by these interventions, and which constituent components—i.e. behaviour change techniques—should be included in these interventions to increase their effectiveness.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).

Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review

ObjectivesModifying lifestyle can prevent the progression of chronic kidney disease (CKD) but the specific elements which lead to favourable behaviour change are not well understood. We aimed to identify and...

A Systematic Review of Digital Behaviour Change Interventions for More Sustainable Food Consumption

Food production and consumption present major sustainability challenges, and finding ways to reduce the environmental impact of food, for example through behavioural changes by consumers, is becoming increasingly important. In recent years, digital interventions have become important tools to change behaviours in many areas. In this review, we evaluate the status of current scientific knowledge of digital behaviour change interventions for sustainable food consumption practices. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for how to conduct systematic reviews, we searched multiple databases for papers containing terms related to food, sustainability and digital behaviour change interventions. Only studies where the digital interventions were actually implemented and evaluated from a behaviour change perspective were included, resulting in 15 primary studies in the final review. The quality of the studies was evaluated from a behaviour change perspective, and the approaches used were categorised using two intervention frameworks, the Behaviour Change Wheel and the Behaviour Change Technique Taxonomy v1. The results show that all of the included studies had major quality issues when evaluated from a behaviour change perspective. This means that we could not find any evidence regarding whether the digital behaviour change interventions examined worked or not. Most studies further lacked theoretical grounding or a clear approach to how or why they should be effective for behaviour change for more sustainable food consumption practices. Our main recommendation for future research in the field is to expand from the current exploratory phase to conducting scientifically rigorous studies of higher quality, more thoroughly grounded in behaviour change theory and methods. Furthermore, based on our study, we suggest changes to the Behaviour Change Technique Taxonomy v1.

Behaviour change techniques and theory use in healthcare professional-delivered infant feeding interventions to prevent childhood obesity: a systematic review

ABSTRACTThe conceptual basis of early childhood feeding interventions for obesity prevention is poorly understood. The aim of this systematic review is to characterise these interventions’ use of behaviour change techniques (BCTs) and psychological theory, focusing on interventions delivered by healthcare professionals for children ≤ 2 years. We searched seven electronic databases from inception to January 2019 and identified 12 trials. BCTs and theory use were identified using the Behaviour Change Technique Taxonomy v1 and the Theory Coding Scheme respectively. Interventions used 19 BCTs, most commonly ‘Instruction on how to perform the behaviour’ (12 of 12 studies) and ‘Social support (unspecified)’ (8 of 12 studies). The mean number of BCTs used was 5.1. Six trials explicitly stated basing interventions on theory, most commonly social cognitive theory and responsive feeding (4 of 6 studies each). Links between theory use and BCTs were poor. Early childhood feeding interventions have insufficiently integrated psychological theories into their development and evaluation. We recommend greater consideration of psychological theory incorporating family and systems approaches and responsive feeding in future intervention development. Moreover, these theories should explicitly link with BCTs. These theories and BCTs should also be included in the evaluation phase.

Enhancing Behavior Change Technique Coding Methods: Identifying Behavioral Targets and Delivery Styles in Smoking Cessation Trials.

The behavior change technique (BCT) taxonomy v1 is often used in systematic reviews for identifying active components of interventions. Its utility could be enhanced by linking BCTs to specific target behaviors and qualifying BCT delivery style. To determine whether behavioral targets and delivery styles of BCTs can be coded reliably and to determine the utility of coding these characteristics. As part of a large systematic review of 142 smoking cessation trials, two researchers independently coded publicly and privately held intervention and comparator group materials, specifying the behavioral target (quitting, abstinence, medication adherence, or treatment engagement) and delivery style (tailored vs. not tailored; active participation vs. passive receipt) of each BCT. Researchers coded 3,843 BCTs, which were reliably attributed to behavioral targets (AC1 = 0.92, PABAK = 0.91). Tailoring (AC1 = 0.80, PABAK = 0.74) and participation (AC1 = 0.71, PABAK = 0.64) were also coded reliably. There was considerable variability between groups in quitting and abstinence BCTs (ranges: 0-41; 0-18) and in tailoring and participation (ranges: 0-20; 0-32), but less variability for medication adherence and treatment engagement (ranges: 0-6; 0-7). Behavioral targets and delivery styles of BCTs can be reliably identified and occur with sufficient frequency in smoking cessation trials for inclusion in quantitative syntheses (e.g., meta-regression analyses). Systematic reviewers could consider adopting these methods to evaluate the impact of intervention components targeting different behaviors, as well as the benefits of different BCT delivery styles.

What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

ObjectivesChanging public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action.MethodsThe project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions.ResultsOf 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’.ConclusionsWe identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR.Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse.Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour. What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described.Many interventions share common components, including core mechanisms of action and behaviour change techniques.The analysis suggests components of future interventions to engage the public with AMR.

Behavior Change Theory Taxonomy Analysis of Smartphone Apps for Fitness, Nutrition, and Weight Loss

A majority of Americans do not meet physical activity or nutrition guidelines for health. Convenient interventions to support healthy behaviors may be beneficial. Smartphone use has become ubiquitous, with apps that are an integral part of life for many. The health and fitness category of apps is robust and growing, but the potential for these apps to affect health behavior change is poorly understood. PURPOSE: To evaluate top-ranked fitness, nutrition, and weight-loss smartphone apps for incorporation of evidence- based behavior change strategies. METHODS: Two investigators coded descriptions of the 150 top-ranked “free” apps in the health and fitness category of the US iOS app store for evidence of health behavior change strategies using the Behavior Change Technique (BCT) Taxonomy (v1). Prevalence of taxonomy items were calculated and Pearson correlations were estimated for the relationship between BCTs per app and customer ranking, as well as for the relationship between BCTs per app and app store ranking. Significance was set at p < 0.05. RESULTS: 71 app descriptions were identified as fitness, nutrition, and/or weight-loss focused. Of those, 45.1% incorporated goals and planning; 57.7% incorporated feedback and monitoring; 56.8% incorporated social support; 29.6% incorporated comparison of behavior; 29.6% incorporated shaping knowledge; 22.5% incorporated associations; 11.6% incorporated reward and threat; 9.9% incorporated antecedents; and 5.6% incorporated natural consequence. Only 17 of the 93 techniques in the BCT taxonomy were utilized across all coded apps. There was a trend towards a weak negative correlation between number of BCTs per app and app store ranking (r = -0.22, p = 0.06) and no significant correlation between number of BCTs and customer rating (r = -0.02, p = 0.87). 45.1% of the “free” apps offered a premium version, in addition, and 11.3% required a paid subscription after download. CONCLUSIONS: Goal planning, monitoring, feedback, and social support were the most common strategies found in the popular fitness, weight-loss, and nutrition apps, though more must be learned about their effectiveness. Furthermore, there is potential to incorporate a greater variety of health behavior change techniques.

Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions

Background: Goal-setting is recommended and widely used within diabetes self-management programmes. However, empirical evidence around its effectiveness lacks clarity. This review aims to evaluate the effectiveness of goal-setting interventions on diabetes outcomes and to determine which behaviour change techniques (BCTs) are frequently used within these interventions.Methods: A systematic search identified 14 studies, describing 12 interventions targeting diabetic-control which incorporated goal-setting as the main intervention strategy. Study characteristics, outcome measures and effect sizes of the included studies were extracted and checked by two authors. The BCT taxonomy v1 was used to identify intervention content. Meta-analyses were conducted to assess intervention effects on the primary outcome of average blood glucose levels (HbA1c) and on body-weight. Psycho-social and behavioural outcomes were summarised in narrative syntheses.Results: Significant post-intervention improvements in HbA1C were found (−.22, 95% CI, −.40, −.04) across studies. No other main effects were identified. The BCT ‘goal-setting (behaviour)’ was most frequently implemented and was identified in 84% of the interventions.Conclusions: Goal-setting interventions appear to be associated with reduced HbA1C levels. However, the low numbers of studies identified and the risk biases across studies suggest more research is needed to further explore goal-setting BCTs in diabetes self-management.

Investigating the behaviour change techniques and Motivational Interviewing techniques in Physical Activity Counselling sessions

ObjectivesThe present study investigated the content and relational style of a Physical Activity Counselling (PAC) intervention, taught in universities across Canada and applied by Kinesiologists working in primary care. The preliminary objective was to determine whether a new taxonomy of Motivational Interviewing (MI) techniques could be used as a reliable method for reporting interventions. The main purpose was to provide an initial description of PAC sessions through the identification of behaviour change techniques (BCTs) and MI techniques. DesignDescriptive observational study. MethodsTwenty-two videotaped PAC sessions delivered by 11 student-counsellors were double coded. The Behaviour Change Technique Taxonomy v1 and the table of MI techniques were applied to rate the presence of BCTs and MI techniques in PAC sessions. ResultsAnalyses revealed outstanding inter-rater agreement scores for the identification of BCTs (κ = .77, PABAK = .94) and MI techniques (κ = .81, PABAK = .85). Overall, 29 BCTs and 27 MI techniques were reliably identified across the sample, with an average of 5.7 BCTs and 9.5 MI techniques documented per session. The BCT categories of Goals and planning and Social support were emphasized, whereas the Engaging and Evoking techniques of MI predominated in the analysis. ConclusionsThis study shows that the table of MI techniques is a reliable method to report the components of MI interventions such as PAC. Moreover, the study offers a detailed account of content and relational techniques applied in PAC sessions. Findings are particularly relevant to PAC trainers and practitioners. Future directions are discussed.

Characterizing Active Ingredients of eHealth Interventions Targeting Persons With Poorly Controlled Type 2 Diabetes Mellitus Using the Behavior Change Techniques Taxonomy: Scoping Review.

BackgroundThe behavior change technique taxonomy v1 (BCTTv1; Michie and colleagues, 2013) is a comprehensive tool to characterize active ingredients of interventions and includes 93 labels that are hierarchically clustered into 16 hierarchical clusters.ObjectiveThe aim of this study was to identify the active ingredients in electronic health (eHealth) interventions targeting patients with poorly controlled type 2 diabetes mellitus (T2DM) and relevant outcomes.MethodsWe conducted a scoping review using the BCTTv1. Randomized controlled trials (RCTs), studies with or pre-post-test designs, and quasi-experimental studies examining efficacy and effectiveness of eHealth interventions for disease management or the promotion of relevant health behaviors were identified by searching PubMed, Web of Science, and PsycINFO. Reviewers independently screened titles and abstracts for eligibility using predetermined eligibility criteria. Data were extracted following a data extraction sheet. The BCTTv1 was used to characterize active ingredients of the interventions reported in the included studies.ResultsOf the 1404 unique records screened, 32 studies fulfilled the inclusion criteria and reported results on the efficacy and or or effectiveness of interventions. Of the included 32 studies, 18 (56%) were Web-based interventions delivered via personal digital assistant (PDA), tablet, computer, and/or mobile phones; 7 (22%) were telehealth interventions delivered via landline; 6 (19%) made use of text messaging (short service message, SMS); and 1 employed videoconferencing (3%). Of the 16 hierarchical clusters of the BCTTv1, 11 were identified in interventions included in this review. Of the 93 individual behavior change techniques (BCTs), 31 were identified as active ingredients of the interventions. The most common BCTs identified were instruction on how to perform behavior, adding objects to the environment, information about health consequences, self-monitoring of the outcomes and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided of a certain behavior Author: Please note that the journal discourages the use of parenthesis to denote either and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided “and/or” and prefers to be explicit to avoid ambiguity. Response: Checked and avoided, and feedback on outcomes of behavior.ConclusionsOur results suggest that the majority of BCTs employed in interventions targeting persons with T2DM revolve around the promotion of self-regulatory behavior to manage the disease or to assist patients in performing health behaviors necessary to prevent further complications of the disease. Detailed reporting of the BCTs included in interventions targeting this population may facilitate the replication and further investigation of such interventions.

Self-management support in routine primary care by nurses.

To examine how and to what extent self-management support, including behaviour change support, is provided by primary care nurses in routine consultations with chronically ill patients. Observational study design. Routine consultations of primary care nurses in the Netherlands with chronically ill patients were audio-taped and analysed. The analysis identified health topics addressed according to health care standards, self-management topics addressed using a validated set of topics, and behaviour change techniques (BCTs) using the Behaviour Change Techniques Taxonomy v1. Seventy-eight routine consultations of 17 primary care nurses with chronically ill patients were included in the analysis. Nurses addressed both health topics and self-management topics in brief, fragmented, and often inconsistent manners. Dietary intake and physical activity were the most frequently addressed topics. Nurses applied 21 BCTs to target behaviour change, but the use of these techniques was mainly inconsistent and implicit. The most consistently used BCTs were review behaviour goal(s) (56.4%) and feedback on behaviour (51.3%). Nurses addressed both health topics and self-management topics in their routine consultations. The duration, frequency, and number of addressed topics differed throughout the consultations. Nurses tended to prioritize the monitoring and optimization of patients' medical treatment and provided limited self-management support. Nurses seldom deepened their focus on behaviour change and infrequently used effective techniques to support this change. Adoption of self-management in primary care, including behaviour change, might be enhanced if nurses consistently and explicitly use effective BCTs in their consultations. Statement of contribution What is already known on this subject? Primary care nurses play a pivotal role in self-management support for patients with a chronic condition. Adequate self-management support requires nurses to activate patients and enhance behaviour change. Little is known regarding to what extent nurses provide self-management support in routine primary care. What does this study add? Self-management support is brief, fragmented, and inconsistently provided by nurses. Nurses tend to prioritize medical treatment optimization and seldom focus on behavioural change. Nurses' use of effective behaviour change techniques is low and should be enhanced.

The use of behaviour change theories and techniques in research-informed coach development programmes: a systematic review

ABSTRACTCoaches are often targeted in interventions to enhance athlete outcomes. While coach development programmes (CDPs) may change coach behaviour, little is known about theories and techniques used to design and implement effective programmes. Examining the use of behaviour change theories and techniques (BCTs) can aid in understanding and improving CDPs. Adhering to PRISMA guidelines, the purpose of this research was to conduct a systematic review examining the use of behaviour change theories and BCTs in CDPs. In total, 29 CDPs met the inclusion criteria. Data were extracted using the Theory Coding Scheme and Behaviour Change Technique Taxonomy (v1). Only six CDPs were explicitly based on behaviour change theory, and no single theory or combination of theories was used more than once. The number of BCTs used per CDP ranged between one and nine. There was no significant difference between theory-based and non-theory-based CDPs concerning the number of BCTs used per CDP. Theoretical frameworks and techniques that have the potential to effectively change coach behaviours are not being used frequently or consistently in the design and implementation of CDPs. To design CDPs that change coach behaviours and facilitate positive outcomes, further research examining theoretical influences on coach behaviours is needed.

Development of SmokeFree Baby: a smoking cessation smartphone app for pregnant smokers.

Pregnant smokers may benefit from digital smoking cessation interventions, but few have been designed for this population. The aim was to transparently report the development of a smartphone app designed to aid smoking cessation during pregnancy. The development of a smartphone app (‘SmokeFree Baby’) to help pregnant women stop smoking was guided by frameworks for developing complex interventions, including the Medical Research Council (MRC), Multiphase Optimization Strategy (MOST) and Behaviour Change Wheel (BCW). Two integrative behaviour change theories provided the theoretical base. Evidence from the scientific literature and behaviour change techniques (BCTs) from the BCT Taxonomy v1 informed the intervention content. The app was developed around five core modules, each with a distinct intervention target (identity change, stress management, health information, promoting use of face-to-face support and behavioural substitution) and available in a ‘control’ or ‘full’ version. SmokeFree Baby has been developed as part of a multiphase intervention optimization to identify the optimum combination of intervention components to include in smartphone apps to help pregnant smokers stop smoking.Electronic supplementary materialThe online version of this article (doi:10.1007/s13142-016-0438-0) contains supplementary material, which is available to authorized users.

Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders.

BackgroundIn recent years, research within the field of health psychology has made significant progress in terms of advancing and standardizing the science of developing, evaluating and reporting complex behavioral change interventions. A major part of this work has involved the development of an evidence-based Behavior Change Technique Taxonomy v1 (BCTTv1), as a means of describing the active components contained within such complex interventions. To date, however, this standardized approach derived from health psychology research has not been applied to the development of complex interventions for the treatment of substance use disorders (SUD). Therefore, this paper uses Breaking Free Online (BFO), a computer-assisted therapy program for SUD, as an example of how the clinical techniques contained within such an intervention might be mapped onto the BCTTv1.MethodThe developers of BFO were able to produce a full list of the clinical techniques contained within BFO. Exploratory mapping of the BCTTv1 onto the clinical content of the BFO program was conducted separately by the authors of the paper. This included the developers of the BFO program and psychology professionals working within the SUD field. These coded techniques were reviewed by the authors and any discrepancies in the coding were discussed between all authors until an agreement was reached.ResultsThe BCTTv1 was mapped onto the clinical content of the BFO program. At least one behavioral change technique was found in 12 out of 16 grouping categories within the BCTTv1. A total of 26 out of 93 behavior change techniques were identified across the clinical content of the program.ConclusionThis exploratory mapping exercise has identified the specific behavior change techniques contained within BFO, and has provided a means of describing these techniques in a standardized way using the BCTTv1 terminology. It has also provided an opportunity for the BCTTv1 mapping process to be reported to the wider SUD treatment community, as it may have real utility in the development and evaluation of other psychosocial and behavioral change interventions within this field.

Identifying content-based and relational techniques to change behaviour in motivational interviewing

ABSTRACT Motivational interviewing (MI) is a complex intervention comprising multiple techniques aimed at changing health-related motivation and behaviour. However, MI techniques have not been systematically isolated and classified. This study aimed to identify the techniques unique to MI, classify them as content-related or relational, and evaluate the extent to which they overlap with techniques from the behaviour change technique taxonomy version 1 [BCTTv1; Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., … Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95]. Behaviour change experts (n = 3) content-analysed MI techniques based on Miller and Rollnick’s [(2013). Motivational interviewing: Preparing people for change (3rd ed.). New York: Guildford Press] conceptualisation. Each technique was then coded for independence and uniqueness by independent experts (n = 10). The experts also compared each MI technique to those from the BCTTv1. Experts identified 38 distinct MI techniques with high agreement on clarity, uniqueness, preciseness, and distinctiveness ratings. Of the identified techniques, 16 were classified as relational techniques. The remaining 22 techniques were classified as content based. Sixteen of the MI techniques were identified as having substantial overlap with techniques from the BCTTv1. The isolation and classification of MI techniques will provide researchers with the necessary tools to clearly specify MI interventions and test the main and interactive effects of the techniques on health behaviour. The distinction between relational and content-based techniques within MI is also an important advance, recognising that changes in motivation and behaviour in MI is a function of both intervention content and the interpersonal style in which the content is delivered.

Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol.

BackgroundSystematic reviews of behaviour change interventions for smoking cessation vary in scope, quality, and applicability. The current review aims to generate more accurate and useful findings by (1) a detailed analysis of intervention elements that change behaviour (i.e. behaviour change techniques (BCTs)) and potential moderators of behaviour change (i.e. other intervention and sample characteristics) and (2) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials.MethodsA systematic review will be conducted of randomized controlled trials of behaviour change interventions for smoking cessation in adults (with or without pharmacological support), with a minimum follow-up of 6 months, published after 1995. Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register. Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups. All data will be independently coded by two researchers. The BCT taxonomy v1 (tailored to smoking cessation interventions) and template for intervention description and replication criteria will be used to code intervention characteristics. Data collection will further include sample and trial characteristics and outcome data (smoking cessation rates). Multilevel mixed-effects meta-regression models will be used to examine which BCTs and/or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms (and effect sizes) and what key moderators of behaviour change are. Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support (i.e. low, medium, and high levels). Multi-disciplinary advisory board members (policymakers, health care providers, and (ex-)smokers) will provide strategic input throughout the project to ensure the review’s applicability to policy and practice.DiscussionBy capturing BCTs in intervention and comparison groups, this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions, the most promising BCTs and/or BCT clusters associated with smoking cessation rates in intervention and comparison arms, and important moderators of behaviour change. The results could set new standards for conducting meta-analyses of behaviour change interventions and improve research, service delivery, and training in the area of smoking cessation.Systematic review registrationPROSPERO CRD42015025251Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0253-1) contains supplementary material, which is available to authorized users.

Integration of BCTs in a Companion App to Support and Motivate Teenagers in the Adoption of Healthy Lifestyle Behaviours

Integration of BCTs in a Companion App to Support and Motivate Teenagers in the Adoption of Healthy Lifestyle Behaviours

Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement "Sepsis Six".

BackgroundSepsis has a mortality rate of 40 %, which can be halved if the evidence-based “Sepsis Six” care bundle is implemented within 1 h. UK audit shows low implementation rates. Interventions to improve this have had minimal effects. Quality improvement programmes could be further developed by using theoretical frameworks (Theoretical Domains Framework (TDF)) to modify existing interventions by identifying influences on clinical behaviour and selecting appropriate content. The aim of this study was to illustrate using this process to modify an intervention designed using plan-do-study-act (P-D-S-A) cycles that had achieved partial success in improving Sepsis Six implementation in one hospital.MethodsFactors influencing implementation were investigated using the TDF to analyse interviews with 34 health professionals. The nursing team who developed and facilitated the intervention used the data to select modifications using the Behaviour Change Technique (BCT) Taxonomy (v1) and the APEASE criteria: affordability, practicability, effectiveness, acceptability, safety and equity.ResultsFive themes were identified as influencing implementation and guided intervention modification. These were:(1) “knowing what to do and why” (TDF domains knowledge, social/professional role and identity); (2) “risks and benefits” (beliefs about consequences), e.g. fear of harming patients through fluid overload acting as a barrier to implementation versus belief in the bundle’s effectiveness acting as a lever to implementation; (3) “working together” (social influences, social/professional role and identity), e.g. team collaboration acting as a lever versus doctor/nurse conflict acting as a barrier; (4) “empowerment and support” (beliefs about capabilities, social/professional role and identity, behavioural regulation, social influences), e.g. involving staff in intervention development acting as a lever versus lack of confidence to challenge colleagues’ decisions not to implement acting as a barrier; (5) “staffing levels” (environmental context and resources), e.g. shortages of doctors at night preventing implementation.The modified intervention included six new BCTs and consisted of two additional components (Sepsis Six training for the Hospital at Night Co-ordinator; a partnership agreement endorsing engagement of all clinical staff and permitting collegial challenge) and modifications to two existing components (staff education sessions; documents and materials).ConclusionsThis work demonstrates the feasibility of the TDF and BCT Taxonomy (v1) for developing an existing quality improvement intervention. The tools are compatible with the pragmatic P-D-S-A cycle approach generally used in quality improvement work.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0376-8) contains supplementary material, which is available to authorized users.

Reporting behaviour change interventions: do the behaviour change technique taxonomy v1, and training in its use, improve the quality of intervention descriptions?

BackgroundBehaviour change interventions are likely to be reproducible only if reported clearly. We assessed whether the behaviour change technique taxonomy version 1 (BCTTv1), with and without training in identifying BCTs, improves the clarity and replicability of written reports of observed behaviour change interventions.MethodsThree studies assessed effects of using and training in the use of BCTTv1 on the clarity and replicability of intervention descriptions written after observing videos of smoking cessation interventions. Study 1 examined the effects of using and not using BCTTv1. Study 2 examined the effects of using BCTTv1 and training in use of BCTTv1 compared no use and no training. Study 3 employed a within-group design to assess change in descriptions written before and after training. One-hundred and 66 ‘writers’ watched videos of behaviour change interventions and wrote descriptions of the active components delivered. In all studies, the participants’ written descriptions were evaluated by (i) 12 ‘raters’ (untrained in BCTTv1) for clarity and replicability and (ii) 12 ‘coders’ (trained in BCTTv1) for reliability of BCT coding. Writers rated the usability and accessibility of using BCTTv1 to write descriptions.ResultsRatings of clarity and replicability did not differ between groups in study 1 (all ps > 0.05), were poorer for trained users in study 2 (all ps < 0.01) and improved following training in study 3 (all ps < 0.05). BCT identification was more reliable from descriptions written by trained BCTTv1 users (p < 0.05; study 2) but not simple use of BCTTv1 (p = 0.93; study 1) or by writers who had written a description without BCTTv1, before training (p = 0.50; study 3). Writers reported that using BCTTv1 was difficult but ‘useful’, ‘good’ and ‘desirable’ and that their descriptions would be clear and replicable (all means above mid-point of the scale).ConclusionsEffects of training to use BCTTv1 on the quality of written reports of observed interventions were mixed, with some suggestion of improved clarity and replicability of reporting in the within- (study 3) but not the between-group studies (studies 1 and 2). Potential benefits of using BCTTv1 may have been limited by the artificial nature and time constraints of the task.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0448-9) contains supplementary material, which is available to authorized users.