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Michie S, Wood CE, Johnston M, et al. 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). Southampton (UK): NIHR Journals Library; 2015 Nov. (Health Technology Assessment, No. 19.99.)

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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).

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Chapter 1General introduction

Behaviour change interventions: purpose and reporting

Preventable behaviours, such as smoking, physical inactivity, eating unhealthy diets and excessive alcohol consumption, have been identified as leading causes of morbidity and mortality.14 Behaviour change interventions (BCIs) are typically complex, involving many interacting components.5 This can make them challenging to replicate in research, to implement in practical settings and to synthesise in systematic literature reviews.

Behaviour change interventions are ‘Coordinated sets of activities designed to change specified behaviour patterns’.6 The development, implementation and evaluation of effective BCIs are fundamental for advancing behavioural science and its application.7,8 However, both science and practice depend on having a good understanding of the nature and content of interventions. This includes knowing what was delivered in the intervention [i.e. the ‘active ingredients’ or behaviour change techniques (BCTs)] and how it was delivered (i.e. who delivered, to whom, how often, for how long, in what format, and in what context).911 Poorly described interventions in research protocols and published reports mean that the precise content of interventions is difficult to establish, with the possibility of the same labels (e.g. behavioural counselling) meaning different things to different researchers/implementers and different labels being used to describe the same BCTs. As a result, the content delivered in practice often deviates from that specified in the intervention protocol12 presenting a barrier to scientific progress and effective translation.

Guidance documents have been published aimed at improving methods of specifying and reporting interventions. For example, Consolidated Standards of Reporting Trials guidelines for reporting randomised controlled trials (RCTs)13 advise researchers to report the ‘precise details’ of the intervention as ‘actually administered’, and the Transparent Reporting of Evaluations with Nonrandomized Designs statement for reporting non-randomised trials14 emphasises the reporting of content and context and full description of comparison and intervention conditions. The UK Medical Research Council (MRC) guidance for developing and evaluating complex interventions calls for the specification of the active ingredients as a necessary step for investigating how interventions exert their effect and, therefore, for designing more effective interventions and applying them appropriately across target population group and setting.5 The Workgroup for Intervention Development and Evaluation Research group has had some success in encouraging journal editors to ensure that transparent and accessible intervention descriptions are available before publication of intervention outcomes.15 The Template for Intervention Description and Replication (TIDieR)16 provides a checklist of the minimum data required to report interventions, including surgical, pharmacological, psychotherapeutic as well as behavioural interventions. Although progress has been made in improving how intervention content is reported, if descriptions of BCIs are to be communicated effectively and successfully replicated, a shared and standardised method of classifying intervention content is needed.17

Behaviour change techniques

A BCT is defined as an observable and replicable component designed to change behaviour. It is the smallest component compatible with retaining the postulated active ingredients and can be used alone or in combination with other BCTs. To enable interventions to be evaluated and effective interventions (i.e. those which bring about the desired change in the target behaviour or behaviours) to be implemented, a BCT should be well specified. BCTs are descriptors and vary in the extent to which they have been empirically investigated and the extent to which they bring about the desired change to behaviour(s) in different situations. BCT definitions used for coding have to be practical, non-overlapping and useful in the reliable reporting of interventions.

Specification of interventions according to component BCTs is beneficial for conducting primary research, implementing effective interventions and for conducting evidence syntheses. A comprehensive list of BCTs facilitates primary research, as intervention developers can draw on a wider range of BCTs than is likely to be considered without such a list. Specification of intervention and control conditions using BCTs can increase accurate replication of interventions found to be efficacious in RCTs. BCT methodology is also useful in assessing the fidelity of implementation of interventions. For systematic reviewers, BCTs provide a reliable method for extracting and coding information about intervention content. Reviewers can identify and synthesise discrete, replicable, potentially active ingredients associated with efficacy and multivariate statistical analysis can then be used to identify BCTs and BCT combinations associated with efficacy. By linking BCTs with theories of behaviour change, researchers and reviewers can investigate possible effect modifiers and/or mechanisms of action. There are some intervention components that can be thought of as ‘modifier BCTs’ in that they add value to BCTs but do not in themselves change behaviour, for example, tailoring, giving choice and homework tasks. Specifying intervention content with this degree of precision helps to maximise scientific as well as practical benefits of research investment into the development and evaluation of complex interventions.

Behaviour change technique taxonomies

To provide a more rigorous methodology for characterising intervention content, methods have been developed for specifying the potentially active ingredients in terms of BCTs.1820 Abraham and Michie’s20 taxonomy of 22 BCTs and four BCT packages observed in BCIs was demonstrated to have good intercoder reliability (i.e. the extent to which coders agreed on the presence/absence of BCTs) among the taxonomy developers and trained coders across 221 intervention descriptions in papers and manuals. This, and subsequent taxonomies developed for specific behavioural domains, have been widely used internationally to report interventions, synthesise evidence2124 and design interventions.25,26 BCT taxonomies have been developed in relation to smoking,27 physical activity and healthy eating,28 excessive alcohol use29 and condom use.30 Taxonomies of BCTs have also been used to assess the extent to which published reports reflect intervention protocols12 and to assess fidelity of delivery.31 They have enabled the specification of professional competences for delivering BCTs32,33 and as a basis for a national training programme.34,35 Guidance has also been developed for incorporating BCTs in text-based interventions.36

Previous classification systems have either been in the form of an unstructured list or have been linked to, or structured, according to theories and/or theoretical mechanisms19,20,32,33 judged to be the most appropriate by the authors.

A hierarchically structured list provides the advantage of making it more coherent to, and useable by, those applying it.37 There are at least five potential benefits of developing a cross-domain, hierarchically structured and internationally supported taxonomy for specifying intervention content:

  1. To promote the accurate replication of interventions and control conditions in comparative efficacy research, a key activity in accumulating scientific knowledge and investigating generalisability across behaviours, populations and settings.
  2. To specify intervention content to facilitate faithful implementation of intervention protocols in research and, in practice, of interventions found to be effective.
  3. To extract and synthesise information about intervention content in systematic reviews. BCT taxonomies, combined with the statistical technique of meta-regression or classification and regression tree (CART), have allowed reviewers to synthesise evidence from complex, heterogeneous interventions to identify effective component BCTs and BCT combinations.21,23,24,38,39
  4. To draw on a comprehensive list of BCTs in developing interventions (rather than relying on the limited set that can be brought to mind).
  5. To investigate possible mechanisms of action by linking BCTs with theories of behaviour change and component theoretical constructs.8,19,21,23

In this monograph, we present the development and evaluation of Behaviour Change Technique Taxonomy version 1 (BCTTv1): a cross-domain, hierarchically structured taxonomy based on interdisciplinary consensus as a method for the accurate and reliable reporting of interventions to change behaviour.40

Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Michie et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK327617

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