Developing a Nomenclature for Behaviour Change Interventions
Susan Michie PhD1, Marie Johnston PhD2, Charles Abraham PhD3, Jill Francis PhD2, Wendy Hardeman PhD4, Martin Eccles MD5 Diane Dixon PhD6 1UCL 2
Aberdeen University 3Sussex University 4Cambridge University 5Newcastle University 6Strathclyde University
BACKGROUND
RESULTS
We lack a shared language for describing the content,
Stage 1: Identifying BCTs in interventions to change
especially the ‘active ingredients’ of behaviour change
physical activity and healthy eating
interventions. By contrast, biomedical interventions are precisely
inter-coder reliability.79
specified.
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
‘.. the usage of the term cognitive
Resulting problems for
behavior therapy varies widely and
• Replicating effective interventions
may include self-instructions ...
relaxation or biofeedback,
• Synthesising evidence
development of coping strategies
• Understanding causal mechanisms
..goal setting.’ 2Gatchel et al (p 606)
• Cumulative science of behaviour change
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
Stage 3: Linking BCTs to theory: excerpt from matrix of 35
ingredients’ - and
BCTs x 11 domains of theoretical constructs
• Method of delivery including when, where, by whom the
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.
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
BCTs are delivered to the target person
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 (30BCTs)
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
[email protected]
‘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, FuchsPN, 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/getArticle.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.