Developing a Nomenclature for Behaviour Change Interventions Susan Michie Ph. D 1, Marie Johnston Ph. D 2, Charles Abraham Ph. D 3, Jill Francis Ph. D 2, Wendy Hardeman Ph. D 4, Martin Eccles MD 5 Diane Dixon Ph. D 6 1 UCL 2 Aberdeen University 3 Sussex University 4 Cambridge University 5 Newcastle University 6 Strathclyde University BACKGROUND RESULTS We lack a shared language for describing the content, especially Stage 1: Identifying BCTs in interventions to change the ‘active ingredients’ of behaviour change interventions. By physical activity and healthy eating contrast, biomedical interventions are precisely specified. inter-coder reliability. 79 In behaviour change interventions: • the same technique may be described by different labels e. g. “self-monitoring” may be labeled “daily diaries” and • the same labels may be applied to different techniques (e. g. ‘behavioural counselling’ may involve ‘educating patients’ or ‘feedback, self-monitoring and reinforcement Resulting problems for ‘. . the usage of the term cognitive • Replicating effective interventions behavior therapy varies widely and • Synthesising evidence may include self-instructions. . . relaxation or biofeedback, • Understanding causal mechanisms development of coping strategies • Cumulative science of behaviour change. . goal setting. ’ 2 Gatchel et al (p 606) Specifying an intervention requires clear descriptions of: • Behaviour Change Techniques (BCTs) - replicable components of an intervention designed to alter or redirect causal processes that regulate behaviour i. e. the’ active ingredients’ - and Stage 3: Linking BCTs to theory: excerpt from matrix of 35 • Method of delivery including when, where, by whom the BCTs x 11 domains of theoretical constructs BCTs are delivered to the target person motivation consequences capabilities METHODS Stage 1 Identifying BCTs in a systematic review of behaviour change interventions to increase physical activity and healthy eating. Resulted in an initial list of 26 BCTs with definitions and demonstrating reliability (2 coders). 1 Stage 2 Extending list of BCTs by: a) systematic text-book search & b) expert brain storming. Generating definitions for BCTs from textbooks and dictionaries: 2 judges with 74. 7% agreement on 53 BCTs. Stage 3 Linking BCTs to theoretical constructs 3. constructs Stage 4 Reframing BCTs operationally to specify behavioural competences required to implement the BCTs relevant to changing health behaviours. skills AIMS To develop a reliable method of specifying behaviour change techniques and then to: a) link behaviour change techniques to theory of behaviour change and b) specify the behaviours necessary to implement the behaviour change techniques. Examples shading = consensus knowledge This poster describes work to date on developing a nomenclature for behaviour change techniques ( BCTs) and describes planned future work. 4 judges had 71. 7% agreement across 385 judgements goal self-monitoring contract reward graded task Stage 4: BCTs as behavioural competences 1. BCTs used in behavioural support for the NHS Stop Smoking Services have been operationally specified as 94 competences (73 for individual support and an additional 21 for group support) 6, 7 2. Within a Generic Health Behaviour Change Competency Framework, 89 BCTs identified as relevant to health behaviour change have been mapped to one or more of three routes to behaviour change: Motivation development (21 BTCs); Action on motivation (30 BCTs) and Prompted or cued behaviour (48 BCTs) 8 CONCLUSIONS • Published descriptions of effective behaviour change interventions are not adequate for reliable replication – e. g. behavioural medicine researchers and practitioners report low confidence in their ability to replicate highly effective interventions for diabetes prevention • There is emerging international agreement that journals should require authors to provide good descriptions of behaviour change interventions before results of trials are published – (Workgroup for Intervention Development and Evaluation Research [WIDER]) 5. • The lists and definitions developed are incomplete and relatively untested. More systematic work is necessary, involving a large international group of behaviour change experts. 5 NEXT STAGES We have obtained funding from the UK Medical Research Council to invite: • Behaviour Change Experts to be involved in a Delphi process to refine the BCT list and definitions thus creating a ‘Preliminary Nomenclature’ and test it whether it improves the reliability of: • reporting of interventions • interpretation and coding of published interventions • International Advisory Board to comment at each stage of the work and to be involved in dissemination • Other interested individuals to join our mailing list to receive information about the project. • IF YOU ARE INTERESTED, PLEASE TAKE ONE OF THE SHEETS BELOW AND CONTACT US BY EMAIL s. michie@ucl. ac. uk ‘For research to flourish and develop into an increasingly cumulative basic science, there are some fundamental requirements. It's essential to develop and use common shared tools and a common language, so that replication, and building on solid work becomes accepted practice and is valued. " President APS Mischel 2008 References 1. Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychology. 2008; 27(3): 379 -387. 2. Gatchel, RJ, Peng YB, Peters ML, Fuchs. PN, Turk, DC (2007)The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions. Psych Bull, 133, 581– 624 3. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to BCTs. Applied Psychology: an International Review 2008; 57: 660 -680. 4. Mischel W. Presidential Address, Association for Psychological Science, 2008. www. psychologicalscience. org/observer/get. Article. cfm? id =2430. Accessed 26. 6. 09. 5. www. interventiondesign. co. uk/wp-content/uploads/2009/02/wider-recommendations. pdf 6. Michie S, Churchill S, West R (in press) Identifying evidence-based competences required to deliver behavioral support for smoking cessation. Annals of Behavioral Medicine. 7. www. ncsct. co. uk 8. Dixon, D. & Johnston, M. Generic Health Behaviour change: a comprehensive competency framework.
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