Effective Behaviour Change Interventions Research Articles

Methodology for identification of healthstyles for developing effective behavior change interventions

Aim The health of the Hungarian population is not as good as it could be according to the socioeconomic development of the country. Since unhealthy behavior is widespread in the population, behavior change seems to be an appropriate tool to improve health in Hungary. To develop effective interventions, it is first necessary to identify homogeneous groups of people from the point of view of behavior change, i.e., healthstyles. Our aim was to develop a suitable survey methodology and segmentation procedure for identifying healthstyles in Hungary. In this article we present the results of our methodological developments.

Measuring leader behaviour: evidence for a “big five” model of leadership

PurposeThe purpose of this paper is to provide evidence for a “leadership big five”, a model of leadership behaviour integrating existing theories of leadership and conceptually aligned with the most established model of personality, the big five. Such a model provides researchers and practitioners with a common language to describe leadership behaviour in a field with a plethora of leadership models. The model also describes a wider range of leadership behaviour than other models of leadership, and presents dimensions that correlate with important organisational outcomes as demonstrated in this study.Design/methodology/approachIn total, 1,186 employees completed the Voice Leadership 360, a survey designed to measure the leadership big five, collectively rating 193 managers from a range of different sectors and industries, using a 360-degree survey methodology.FindingsConfirmatory factor analyses and internal reliability analyses provide evidence for 22 lower-order factors of leadership behaviour that aggregate into five higher-order factors of leadership aligned with the big five personality descriptors. Further evidence for the validity of the model is indicated by significant correlations between 360-degree survey ratings and raters’ judgements of leaders’ personality, and significant correlations between 360-degree survey ratings and both work unit engagement levels and manager reports of work unit performance.Research limitations/implicationsThe cross-sectional design is the main limitation of the present study, limiting conclusions that changes in leadership behaviours will lead to changes in organisational outcomes. The primary research implications of this study include the support for an integrating model of leadership behaviour that aligns with a large body of psychological research, as well as the development of a survey that can be used for future exploration of the model.Practical implicationsPractitioners may use the results of the study to rethink how they develop competency frameworks and measure leadership behaviour in organisation development contexts. This broad model of leadership and the familiarity of its dimensions could increase the effectiveness of behaviour change interventions, and the presented survey provides a reliable and valid tool for 360-degree assessments.Originality/valueThe study provides evidence that leadership can be described in a structurally similar way to human personality. It presents a leadership model that consists of a broader range of leadership behaviours related to organisational outcomes compared with previous models of leadership.

Abstract 020: Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life’s Simple 7 TM in African-Americans of the Jackson Heart Study

Background: Cardiovascular disease (CVD) remains the leading cause of death for African-American (AA) adults. There is a low prevalence of ideal cardiovascular health (CVH) (as defined by the American Heart Association’s Life’s Simple 7 TM (LS7)), especially diet, physical activity and obesity among AAs placing them at a disproportionately high risk for CVD. The identification of psychosocial stress that may influence ideal CVH could assist in the development of more effective behavior change interventions among AAs. Objectives: The aim of this study is to examine the associations of multidimensional stressors (chronic stress, minor stressors, and major life events - MLEs) with the LS7 components (classified as poor, intermediate and ideal) in AAs. We hypothesize that stress is negatively associated with the likelihood of achievement of intermediate/ideal levels of the LS7 components and LS7 composite score after adjusting for traditional socio-demographic factors. Methods: Using the Jackson Heart Study (JHS), a cohort of AAs based in Jackson, Mississippi (n=4383), we conducted a cross-sectional analysis of the association of stress measures with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol and glucose). This association was measured using logistic regression which assessed the odds ratios (OR, 95% confidence interval (CI)) of the achievement of intermediate/ideal levels of CVH with progressive adjustment for demographic, socioeconomic, behavioral and biomedical factors. A composite LS7 score was calculated [range 0-14; categorized as 0 to 6 (poor), 7 to 8 (intermediate) and 9 to 14 (ideal)]. We also constructed a cumulative stress score as a summation of tertiles of each stress measure (range 3-9). Results: Fewer participants achieved intermediate or ideal CVH for the LS7 components including diet (39%), physical activity (51%) and BMI (47%). Higher chronic stress and minor stressors scores were associated a decreased likelihood of achievement of ideal/intermediate levels for smoking [OR 0.80; 95% CI 0.73-0.88 and OR 0.84; 95% CI 0.75-0.94, respectively). Higher MLE scores were associated decreased likelihood of achievement of ideal/intermediate levels for smoking (OR 0.84; 95% CI 0.76-0.92) and glucose (OR 0.90; 95% CI 0.82-0.98). Those with higher minor stressors and MLE scores were less likely to achieve intermediate or ideal LS7 composite score categories (OR 0.89; 95% CI 0.81-0.97 and OR 0.91; 95% CI 0.84-0.98, respectively). There was no statistically significant association between LS7 composite scores and cumulative stress scores. Conclusions: Our results suggest that key stress measures may contribute adversely to CVH among AAs. These findings provide support for future lifestyle interventions which integrate a focus on alleviating stressors in this high risk population to improve CVH.

Childhood obesity: ‘Super Dynamic Food Dudes’ to the rescue

Globally, there are more than 42 million pre-school children who are overweight or obese (WHO, 2013). This highlights the urgent need to design effective behaviour change interventions that establish a healthy lifestyle where children enjoy eating fruit and vegetables, and being active, during early development. This paper will describe my PhD research of an intervention set to do just that!

Feasibility and preliminary efficacy of the \u2018HEYMAN\u2019 healthy lifestyle program for young men: a pilot randomised controlled trial

BackgroundIn young men, unhealthy lifestyle behaviours can be detrimental to their physical and/or mental health and set them on a negative health trajectory into adulthood. Despite this, there is a lack of evidence to guide development of effective health behaviour change interventions for young men. This study assessed the feasibility and preliminary efficacy of the ‘HEYMAN’ (Harnessing Ehealth to enhance Young men’s Mental health, Activity and Nutrition) healthy lifestyle program for young men.MethodsA pilot RCT with 50 young men aged 18–25 years randomised to the HEYMAN intervention (n = 26) or waitlist control (n = 24). HEYMAN was a 3-month intervention, targeted for young men to improve eating habits, activity levels and well-being. Intervention development was informed by a participatory research model (PRECEDE-PROCEED). Intervention components included eHealth support (website, wearable device, Facebook support group), face-to-face sessions (group and individual), a personalised food and nutrient report, home-based resistance training equipment and a portion control tool. Outcomes included: feasibility of research procedures (recruitment, randomisation, data collection and retention) and of intervention components. Generalized linear mixed models estimated the treatment effect at 3-months for the primary outcomes: pedometer steps/day, diet quality, well-being and several secondary outcomes.ResultsA 7-week recruitment period was required to enrol 50 young men. A retention rate of 94% was achieved at 3-months post-intervention. Retained intervention participants (n = 24) demonstrated reasonable usage levels for most program components and also reported reasonable levels of program component acceptability for attractiveness, comprehension, usability, support, satisfaction and ability to persuade, with scores ranging from 3.0 to 4.6 (maximum 5). No significant intervention effects were observed for the primary outcomes of steps/day (1012.7, 95% CI = −506.2, 2531.6, p = 0.191, d = 0.36), diet quality score (3.6, 95% CI = −0.4, 7.6, p = 0.081, d = 0.48) or total well-being score (0.4, 95% CI = −1.6, 2.5, p = 0.683, d = 0.11). Significant intervention effects were found for daily vegetable servings, energy-dense, nutrient-poor foods, MVPA, weight, BMI, fat mass, waist circumference and cholesterol (all p < 0.05).ConclusionsThe HEYMAN program demonstrated feasibility in assisting young men to make some positive lifestyle changes. This provides support for the conduct of a larger, fully-powered RCT, but with minor amendments to research procedures and intervention components required.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616000350426.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development.

Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. The study is registered as PROSPERO CRD42014009500. The National Institute for Health Research Health Technology Assessment programme.

Harnessing the power of emotional drivers to promote behaviour change.

Harnessing the power of emotional drivers to promote behaviour change.

Study protocol for a randomised controlled trial of brief, habit-based, lifestyle advice for cancer survivors: exploring behavioural outcomes for the Advancing Survivorship Cancer Outcomes Trial (ASCOT)

IntroductionPositive health behaviours such as regular physical activity and a healthy diet have significant effects on cancer outcomes. There is a need for simple but effective behaviour change interventions with...

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial.

BackgroundIncreasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions.Methods/designThis cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention “dose”, website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.DiscussionThe study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a ‘points’ based loyalty platform, whereby local businesses ‘sponsor’ the incentive (retail vouchers) in return for increased footfall to their business.Trial registrationISRCTN17975376 (Registered 19/09/2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3244-1) contains supplementary material, which is available to authorized users.

How lay health workers tailor in effective health behaviour change interventions: a protocol for a systematic review.

BackgroundLay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to ‘tailoring to individuals’ needs or characteristics’ as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals’ needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions.MethodHealth and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a ‘cluster searching’ technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients’ needs and the ways in which messages or actions are tailored to these individual criteria by LHWs.DiscussionThis systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW.Systematic review registrationPROSPERO CRD42015030071Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0271-z) contains supplementary material, which is available to authorized users.

Some current dimensions of the behavioral economics of health-related behavior change

Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed.

Perceptions and Experiences of Overweight among Women in the Ga East District, Ghana.

Overweight and obesity are a growing public health challenge among women of reproductive age. While cultural norms suggest preference for an overweight body image, limited evidence exists regarding women's beliefs and experiences of overweight in Ghana. The current study explored beliefs, perceptions, experiences, and practices concerning overweight among women living in suburban Accra, Ghana. Four focus group discussions, and 10 in-depth interviews (IDI) were implemented among 42 adult women (>18 years) seeking preventive child health services in Dome, Accra. All the women in the IDI were overweight. In addition to notes, interviews and discussions were audio-recorded and transcribed for systematic content and narrative analysis. Overweight was considered undesirable by most women. Overweight individuals were often stigmatized using uncomplimentary names, such as cargo, obolo, and so on. However, some weight gain was admired and expected by women and their family and friends. Weight gain that was considered beautiful was believed to "evolve naturally." Weight gain that is either medically induced perceived as excessive was not viewed positively. Weight gain by women was perceived as a sign of financial prosperity and good care by a spouse. Overweight was perceived to be linked with heredity, childbirth, gluttony, and contraception. Adverse experiences of overweight included poor self-image, declining social lifestyle, increased disease risk, and feeling tired always. Strategies that had been used in order to lose weight included skipping meals, avoiding carbohydrate-based foods, and drinking herbal teas. There is admiration for some weight gain among women but when it is excessive, overweight is stigmatized. Misperceptions regarding partner expectations, determinants of overweight, and weight reduction strategies require effective behavior change interventions in Ghana.

Effectiveness of interventions to reduce ordering of thyroid function tests: a systematic review

ObjectivesTo evaluate the effectiveness of behaviour changing interventions targeting ordering of thyroid function tests.DesignSystematic review.Data sourcesMEDLINE, EMBASE and the Cochrane Database up to May 2015.Eligibility criteria for selecting studiesWe included...

Effect of behaviour change-intervention on hand washing practices and knowledge about hand washing among school students, Perambalur district, Tamil Nadu, India, 2014-2015

Effect of behaviour change-intervention on hand washing practices and knowledge about hand washing among school students, Perambalur district, Tamil Nadu, India, 2014-2015

Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis: Synthesis of the Literature Using Behavior Change Theory.

Exercise is recommended for hip and knee osteoarthritis (OA). Patient initiation of, and adherence to, exercise is key to the success of managing symptoms. This study aimed to (1) identify modifiable barriers and facilitators to participation in intentional exercise in hip and/or knee OA, and (2) synthesize findings using behavior change theory. A scoping review with systematic searches was conducted through March 2015. Two reviewers screened studies for eligibility. Barriers and facilitators were extracted and synthesized according to the Theoretical Domains Framework (TDF) by two independent reviewers. Twenty-three studies (total of 4633 participants) were included. The greatest number of unique barriers and facilitators mapped to the Environmental Context and Resources domain. Many barriers were related to Beliefs about Consequences and Beliefs about Capabilities, whereas many facilitators were related to Reinforcement. Clinicians should take a proactive role in facilitating exercise uptake and adherence, rather than trusting patients to independently overcome barriers to exercise. Strategies that may be useful include a personalized approach to exercise prescription, considering environmental context and available resources, personalized education about beneficial consequences of exercise and reassurance about exercise capability, and use of reinforcement strategies. Future research should investigate the effectiveness of behavior change interventions that specifically target these factors.

Effect of behaviour change-intervention on hand washing practices and knowledge about hand washing among school students, Perambalur district, Tamil Nadu, India, 2014-2015

Background: Diarrhoeal diseases among school children could be prevented by proper hand washing practices. Health education interventions will help in improving hand washing practices among school children. We conducted behavioural change intervention among middle school students, to compare adequate hand washing before and after intervention in rural area of Perambalur district, Tamilnadu, India. Methods & Materials: We did intervention study between November 2014 and April 2015 among 6th to 8th grade students in Ammapalayam block. We recruited 200 students, assuming proportion of hand washing with soap among the children is 17.5% and expecting proportion of hand washing with soap among the same children about 30%, after intervention, with one tail, level of significance of 5%, 90% power and 10% loss to follow up. We selected students through simple random sampling as matched pair. The intervention included oral and poster presentations, demonstration and competition on proper washing procedures to all students at first visit during the baseline survey. Outcomes were collected by semi-structured questionnaire at base line and at two follow up visits (one month and two months after the intervention). We compared the proportions before and after intervention by Mc-Nemars chi-square test. Results: At one month, proportion of adequate hand washing improved from 0% at baseline to 7% with Mc-Nemars chi-square=13.07, P-value=<0.001. Knowledge about importance of hand washing improved from 45% to 61% with Mc-Nemars chi-square=16, P-value<0.001. Knowledge about 6-steps in hand washing improved from 0% to 78.5% with Mc-Nemars chi-square=156, P-Value<0.001. At two month, proportion of adequate hand washing was improved to 5.5% with Mc-Nemars chi-square=10.08, P-Value<0.001. Knowledge about importance of hand washing was improved to 61% with Mc-Nemars chi-square= 138.69, P-Value<0.001 and knowledge about 6-steps in hand washing improved to 86% with Mc-Nemars chi-square= 171, P-Value<0.001. Conclusion: After intervention, there was an improvement in adequate hand washing, knowledge about importance of hand washing and knowledge about steps of hand washing at the end of one and two months. We recommend that same intervention may be done in schools to improve the knowledge and hand washing practices among school children.

Shedding light on research participation effects in behaviour change trials: a qualitative study examining research participant experiences.

BackgroundThe sequence of events in a behaviour change trial involves interactions between research participants and the trial process. Taking part in such a study has the potential to influence the behaviour of the participant, and if it does, this can engender bias in trial outcomes. Since participants’ experience has received scant attention, the aim of this study is thus to generate hypotheses about which aspects of the conduct of behaviour change trials might matter most to participants, and thus have potential to alter subsequent behaviours and bias trial outcomesMethodsTwenty participants were opportunistically screened for a health compromising behaviour (unhealthy diet, lack of exercise, smoking or alcohol consumption) and recruited if eligible. Semi structured face to face interviews were conducted, after going through the usual processes involved in trial recruitment, baseline assessment and randomisation. Participants were given information on the contents of an intervention or control condition in a behaviour change trial, which was not actually implemented. Three months later they returned to reflect on these experiences and whether they had any effect on their behaviour during the intervening period. Data from the latter interview were analysed thematically using a modified grounded theory approach.ResultsThe early processes of trial participation raised awareness of unhealthy behaviours, although most reported having had only fleeting intentions to change their behaviour as a result of taking part in this study, in the absence of interventions. However, careful examination of the accounts revealed evidence of subtle research participation effects, which varied according to the health behaviour, and its perceived social acceptability. Participants’ relationships with the research study were viewed as somewhat important in stimulating thinking about whether and how to make lifestyle changes.ConclusionThese participants described no dramatic impacts attributable to taking part in this study. This study demonstrates the likely value of well conducted qualitative studies of subtle research participation effects, which may be particularly important to explore for alcohol. Separating unintended influences in trial participation from the effects of behaviour change interventions being evaluated therein is necessary for valid estimates of intervention effects.

Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data).

Meeting global health challenges requires effective behaviour change interventions (BCIs). This depends on advancing the science of behaviour change which, in turn, depends on accurate intervention reporting. Current reporting often lacks detail, preventing accurate replication and implementation. Recent developments have specified intervention content into behaviour change techniques (BCTs) - the 'active ingredients', for example goal-setting, self-monitoring of behaviour. BCTs are 'the smallest components compatible with retaining the postulated active ingredients, i.e. the proposed mechanisms of change. They can be used alone or in combination with other BCTs' (Michie S, Johnston M. Theories and techniques of behaviour change: developing a cumulative science of behaviour change. Health Psychol Rev 2012;6:1-6). Domain-specific taxonomies of BCTs have been developed, for example healthy eating and physical activity, smoking cessation and alcohol consumption. We need to build on these to develop an internationally shared language for specifying and developing interventions. This technology can be used for synthesising evidence, implementing effective interventions and testing theory. It has enormous potential added value for science and global health. (1) To develop a method of specifying content of BCIs in terms of component BCTs; (2) to lay a foundation for a comprehensive methodology applicable to different types of complex interventions; (3) to develop resources to support application of the taxonomy; and (4) to achieve multidisciplinary and international acceptance for future development. Four hundred participants (systematic reviewers, researchers, practitioners, policy-makers) from 12 countries engaged in investigating, designing and/or delivering BCIs. Development of the taxonomy involved a Delphi procedure, an iterative process of revisions and consultation with 41 international experts; hierarchical structure of the list was developed using inductive 'bottom-up' and theory-driven 'top-down' open-sort procedures (n = 36); training in use of the taxonomy (1-day workshops and distance group tutorials) (n = 161) was evaluated by changes in intercoder reliability and validity (agreement with expert consensus); evaluating the taxonomy for coding interventions was assessed by reliability (intercoder; test-retest) and validity (n = 40 trained coders); and evaluating the taxonomy for writing descriptions was assessed by reliability (intercoder; test-retest) and by experimentally testing its value (n = 190). Ninety-three distinct, non-overlapping BCTs with clear labels and definitions formed Behaviour Change Technique Taxonomy version 1 (BCTTv1). BCTs clustered into 16 groupings using a 'bottom-up' open-sort procedure; there was overlap between these and groupings produced by a theory-driven, 'top-down' procedure. Both training methods improved validity (both p < 0.05), doubled the proportion of coders achieving competence and improved confidence in identifying BCTs in workshops (both p < 0.001) but did not improve intercoder reliability. Good intercoder reliability was observed for 80 of the 93 BCTs. Good within-coder agreement was observed after 1 month (p < 0.001). Validity was good for 14 of 15 BCTs in the descriptions. The usefulness of BCTTv1 to report descriptions of observed interventions had mixed results. The developed taxonomy (BCTTv1) provides a methodology for identifying content of complex BCIs and a foundation for international cross-disciplinary collaboration for developing more effective interventions to improve health. Further work is needed to examine its usefulness for reporting interventions. This project was funded by the Medical Research Council Ref: G0901474/1. Funding also came from the Peninsula Collaboration for Leadership in Applied Health Research and Care.

Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews

ObjectivesTranslating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions...

A "Common Factors" Approach to Developing Culturally Tailored HIV Prevention Interventions.

The current dominant model of HIV prevention intervention dissemination involves packaging interventions developed in one context, training providers to implement that specific intervention, and evaluating the extent to which providers implement it with fidelity. Research shows that providers rarely implement these programs with fidelity due to perceived incompatibility, resource constraints, and preference for locally generated solutions. In this study, we used the concept of "common factors," or broad constructs shared by most evidence-based HIV prevention interventions, to train service providers to develop their own programs. We recruited eight Ukrainian HIV prevention organizations from regions with HIV epidemics concentrated among people who inject drugs. We trained staff to identify HIV risk behaviors and determinants, construct behavior change logic models, and develop and manualize an intervention. We systematically reviewed each manual to assess intervention format and content and determine whether the program met intervention criteria as taught during training. All agencies developed programs that reflected common factors of effective behavior change HIV prevention interventions. Each agency's program targeted a unique population that reflected local HIV epidemiology. All programs incorporated diverse pedagogical strategies that focused on skill-building, goal-setting, communication, and empowerment. Agencies struggled to limit information dissemination and the overall scope and length of their programs. We conclude that training service providers to develop their own programs based on common elements of effective behavior change interventions can potentially transform existing processes of program development, implementation, and capacity building. Expanding this model will require committed training and support resources.