Aim
To develop a taxonomy (hierarchically structured
list) of BCTs that is useful to intervention
researchers and designers across disciplines,
health domains and countries
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Published Protocol
4
This Talk
1. Background
2. Developing the Taxonomy
3. Next steps
5
Background
• Problem of imprecise reporting of behaviour
change (BC) interventions
– Interventions typically complex
– No agreed framework for describing active
ingredients of behavior change techniques
• Calls for improved methods of specifying
intervention content
• Address this by developing taxonomies of
behaviour change techniques (BCTs)
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Definition of a BCT
a) aims to change behaviour
b) is the proposed "active ingredient" of interventions
c) is the smallest component compatible with retaining
the proposed active ingredients
d) can be used alone or in combination with other
BCTs
e) is observable and replicable
f) can have a measurable effect on a specified
behaviour
g) is the smallest unit that has the POTENTIAL (in the
right circumstances) to bring about behaviour
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change
Example of a Reliable Taxonomy:
to change physical activity and healthy eating behaviours
Involves detailed15.
planning
of what
the person will do
General
encouragement
1. General information
including, at least, a very specific definition of the behaviour
16. Contingent rewards
2. Information on consequences
e.g., frequency (such as how many times a day/week),
17. Teach
to use
intensity (e.g., speed)
or duration
(e.g.,cues
for how long for). In
3. Information about approval
addition, at least18.
one Follow
of the following
contexts i.e., where,
up prompts
4. Prompt intention formation
when, how or with whom must be specified.
19. Social comparison
5. Specific goal setting
20. Social support/ change
6. Graded tasks
21. Role model
7. Barrier identification
22. Prompt self talk
8. Behavioral contract
23. Relapse prevention
9. Review goals
24. Stress management
10. Provide instruction
The
person
is askedinterviewing
to keep a
25.
Motivational
11. Model/ demonstrate
record of specified behaviour/s.
26. Time management
12. Prompt practice
This could e.g. take the form of a
13. Prompt monitoring
diary or completing a
14. Provide feedback
questionnaire about their
behaviour.
Inter-rater agreement of 85-100% (Abraham and Michie, 2008)
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Further Taxonomies
• Smoking cessation: 53 BCTs
Michie et al, Annals of Behavioral Medicine, 2010; Addictive
Behaviors, 2011
• Physical activity & healthy eating: 40 BCTs
Michie et al, Psychology & Health, 2011
• Reducing excessive alcohol use: 42 BCTs
Under review
• General behaviour change: 137 BCTs
Michie et al, Applied Psychology: An International Review, 2008
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Development of BCT Taxonomy
Stage 1:
Online Delphi Consensus Exercise
Stage 2:
Stage 3:
Pilot coding
Feedback from International
Advisory Board (IAB)
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Development of BCT Taxonomy
Stage 1:
Online Delphi Consensus Exercise
Stage 2:
Stage 3:
Pilot Coding
Feedback from International
Advisory Board (IAB)
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Participants (n=14)
• Self reported expertise in delivering and/or designing
behaviour change interventions
• Aged 37-62 (M = 51; SD = 8)
• From five countries
UK; Australia; Netherlands; Canada and New Zealand
• From a range of disciplines
6 health psychologists; 1 clinical psychologist;
3 clinical & health psychologists; 1 educational
psychologist; 1 cognitive behaviour therapist; 1 health
sciences expert; 1 community health expert.
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Procedure
1. Synthesise existing taxonomies (94 BCTs)
2. Delphi consensus exercise (Round 1)
3. 1st refinement of taxonomy
4. Delphi consensus exercise (Round 2)
5. 2nd refinement of taxonomy
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Delphi Survey Questions (Round 1)
1. Active ingredient?
[1 ‘definitely yes’ - 5 ‘definitely no’]
2. conceptually unique/redundant/overlapping
[forced choice]
3. If redundant please state why …
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4. If overlapping,
a) with which BCT(s)?
b) Can they be separated?
c) If separable, how could the label or definition be
rephrased to reduce the overlap?
d) If duplicates which label and which definition
was better?
5. unnecessary characteristics and/or omitted
characteristics?
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1st Refinement of Taxonomy
• On basis of responses
– numerical ratings and qualitative feedback,
labels and definitions amended
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Delphi Survey Questions (Round 2)
1. a) clear b) precise c) distinct?
2. Would you feel confident in using this BCT to
describe the intervention?
3. Would you feel confident that two behaviour
change researchers or practitioners would
agree in identifying this BCT?
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Results of Delphi Exercise
94 BCTs
16 omitted;
4 split into two;
2 added
35 definitions and 7 labels amended
Post Delphi: 84 BCTs
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Development of BCT Taxonomy
Stage 1:
Online Delphi Consensus Exercise
Stage 2:
Stage 3:
Pilot Coding
Feedback from International
Advisory Board (IAB)
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Stage 2:
Pilot Coding
• 6 experts coded 45 transcripts of published
reports of BC interventions
• Each intervention was coded independently by a
pair of experts
• Inter-rater agreement calculated, discrepancies
noted, synthesised and source of disagreement
identified.
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Stage 2:
Pilot Coding
• 3 Sources of disagreement:
- Differing interpretations of labels and
definition
- Overlooked BCTs
- Misapplication of general coding principles
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Development of BCT Taxonomy
Stage 1:
Online Delphi Consensus Exercise
Stage 2:
Stage 3:
Pilot Coding
Feedback from International
Advisory Board (IAB)
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Stage 3:
Feedback from International
Advisory Board
•Arja Aro
•Paul Glasziou
•Miquel Porta
•David Barlow
•Gaston Godin
•Tony Roth
•Christine Barrowclough •Jeremy Grimshaw
•Rob Sanson-Fischer
•Nick Heather
•Neil Schneiderman
•Ron Borland
•Belinda Borrelli International
•Blair Johnson
•Ralf Schwarzer
Advisory Board
•Linda Collins
•Robert Kaplan
•Bonnie Spring
•Francis Keefe
•Karina Davidson
•Nick Tarrier
•Gerjo Kok
•Antti Uutela
•Joost Dekker
•Helen Lindner
•Hege Erikson
•Reinout Wiers
•Steve Pilling
•Redford Williams
•Jeff Fisher
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Stage 3:
IAB Feedback
• 30 members asked to provide feedback on the
post Delphi taxonomy
• General and specific feedback requested
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Stage 3:
Feedback from IAB Members (n = 16)
• Recommended grouping BCTs to enhance
usability
Online sort task
Experts Needed!!!
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Development of BCT Taxonomy
Stage 1:
Online Delphi Consensus Exercise
Stage 2:
Stage 3:
Pilot Coding
Feedback from International
Advisory Board (IAB)
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3rd Refinement of Taxonomy
Following Coding and IAB feedback
Post Delphi: 84 BCTs
5BCTs added
30 definitions and 15 labels amended
Post stage 2 & 3 : 89
BCTs
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Next Steps…
Phase 2: Evaluate the taxonomy
1. Training coders to code published intervention
reports: assess reliability
2. Using taxonomy to design interventions: assess
added value re. clarity and replicability
Phase 3: Disseminate the prototype taxonomy
1. Create a web-based users resource and basis
for further development, guided by an
international consortium
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For More Information …
Email [email protected]
Michie et al (2011) Implementation Science
http://www.ucl.ac.uk/health-psychology/BCTtaxonomy
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