Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature

Abstract Researchers, practitioners, and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic, and accessible method of linking BCTs with the processes through which they change behavior (i.e., their mechanisms of action [MoAs]) would advance the understanding of intervention effects and improve theory and intervention development. The purpose of this study is to triangulate evidence for hypothesized BCT–MoA links obtained in two previous studies and present the results in an interactive, online tool. Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modeling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool. The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 “nonlinks.” A further 55 links were resolved by consensus (total of 92 [37 + 55] hypothesized BCT–MoA links). Full data on 1,456 possible links was incorporated into the online interactive Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/). This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research.

Download Full-text

Known Knowns and Known Unknowns on Behavior Change Interventions and Mechanisms of Action

10.31234/osf.io/djbvy ◽

2020 ◽

Author(s):

Martin S Hagger ◽

Susette Moyers ◽

Kaylyn McAnally ◽

Lauren Mckinley

Keyword(s):

Behavior Change ◽

Behavioral Intervention ◽

Mechanisms Of Action ◽

Intervention Research ◽

Current Evidence ◽

Future Research ◽

Study Quality ◽

Behavior Change Techniques ◽

Behavior Change Interventions ◽

Known Unknowns

Systematic reviews and meta-analyses play an important role in summarizing current research on the efficacy of behavior change interventions and their mechanisms of action. The reviews in this special issue represent a ‘step change’ in evaluating current evidence on behavior change interventions and mechanisms. This article outlines the findings and emerging issues identified in the reviews (‘known knowns’), and summarizes evidence gaps to be addressed in future research (‘known unknowns’). Findings indicate that tests of mechanisms of behavior change interventions are not routinely conducted in primary studies and research syntheses; reviews and studies do not sufficiently account for study quality; substantive variability exists in descriptions of intervention content and putative mediators implicated in their mechanisms of action; limited data is available on the efficacy of many behavior change techniques; and moderators of intervention effects and mechanisms are seldom taken into account. Possible solutions include testing effects of isolated behavior change techniques and mechanisms of action; routine evaluation of study quality in behavioral intervention research; development of an evidence base linking behavior change techniques with theory-based constructs that comprise mechanisms of action; adoption of fit-for-purpose methods for synthesizing behavioral intervention mechanisms of action; and routine testing of moderators in intervention research.

Download Full-text

Links Between Behavior Change Techniques and Mechanisms of Action: An Expert Consensus Study

Annals of Behavioral Medicine ◽

10.1093/abm/kay082 ◽

2018 ◽

Vol 53 (8) ◽

pp. 708-720 ◽

Cited By ~ 32

Author(s):

Lauren E Connell ◽

Rachel N Carey ◽

Marijn de Bruin ◽

Alexander J Rothman ◽

Marie Johnston ◽

...

Keyword(s):

Behavior Change ◽

Behavioral Interventions ◽

Nominal Group Technique ◽

Action Planning ◽

Mechanisms Of Action ◽

Expert Consensus ◽

Nominal Group ◽

Behavior Change Techniques ◽

The Matrix ◽

International Behavior

Abstract Background Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior. Purpose To elicit expert consensus on links between BCTs and MoAs. Methods In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links. Results Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1–4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as “definite” links, 464 (29.2 per cent) as “definitely not” links, and 1,032 (65.1 per cent) as “possible” or “unsure” links. No “definite” links were identified for 10 BCTs (e.g., “Action Planning” and “Behavioural Substitution”) and for six MoAs (e.g., “Needs” and “Optimism”). Conclusions The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies.

Download Full-text

Interactive Two-Way mHealth Interventions for Improving Medication Adherence: An Evaluation Using The Behaviour Change Wheel Framework (Preprint)

10.2196/preprints.9187 ◽

2017 ◽

Author(s):

Nicole Chiang ◽

Michael Guo ◽

K Rivet Amico ◽

Lou Atkins ◽

Richard T Lester

Keyword(s):

Medication Adherence ◽

Antiretroviral Therapy ◽

Behavior Change ◽

Text Messaging ◽

Evidence Synthesis ◽

Mechanisms Of Action ◽

Behavior Change Techniques ◽

Therapy Adherence ◽

Antiretroviral Therapy Adherence ◽

Behavior Change Wheel

BACKGROUND Medication adherence is an important but highly complex set of behaviors, which for life-threatening and infectious diseases such as HIV carry critical consequences for individual and public health. There is growing evidence that mobile phone text messaging interventions (mHealth) connecting providers with patients positively impact medication adherence, particularly two-way engagement platforms that require bidirectional communication versus one-way in which responses are not mandatory. However, mechanisms of action have not been well defined. The Behavior Change Wheel is a comprehensive framework for behavior change that includes an all-encompassing model of behavior known as Capability Opportunity Motivation-Behavior and is complemented by a taxonomy of behavior change techniques. Evaluating mHealth interventions for medication adherence using these tools could provide useful insights that may contribute to optimizing their integration into the healthcare system and successful scaling-up. OBJECTIVE This study aimed to help address the current knowledge gap regarding how two-way mHealth interventions for medication adherence may work by applying the Behavior Change Wheel to characterize WelTel: an interactive digital health outreach platform with robust evidence for improving adherence to antiretroviral therapy. METHODS To characterize how WelTel may promote medication adherence, we applied the Behavior Change Wheel to systematically (1) generate a behavioral diagnosis through mapping known antiretroviral therapy adherence barriers onto the Capability Opportunity Motivation-Behavior model of behavior, (2) specify the behavior change techniques that WelTel delivers, (3) link identified behavior change techniques to corresponding intervention functions of the Behavior Change Wheel, and (4) connect these behavior change techniques and intervention functions to respective Capability Opportunity Motivation-Behavior influences on behavior to determine potential mechanisms of action. RESULTS Our evaluation of WelTel using the Behavior Change Wheel suggests that most of its impact is delivered primarily through its personalized communication component, in which 8 different behavior change techniques were identified and linked with 5 intervention functions (environmental restructuring, enablement, education, persuasion, and training). Its mechanisms of action in promoting antiretroviral therapy adherence may involve addressing all Capability Opportunity Motivation-Behavior influences on behavior (physical and psychological capability, physical and social opportunity, reflective and automatic motivation). CONCLUSIONS Systematically unpacking the potential active ingredients of effective interventions facilitates the creation and implementation of more parsimonious, tailored, and targeted approaches. Evaluating WelTel using the Behavior Change Wheel has provided valuable insights into how and why such interactive two-way mHealth interventions may produce greater impact than one-way in addressing both nonintentional and intentional forms of nonadherence. The application of the Behavior Change Wheel for evidence synthesis across mHealth interventions targeting various conditions would contribute to strengthening the knowledge base regarding how they may work to impact medication adherence behavior.

Download Full-text

Mapping behavior change techniques to characterize a social cognitive theory informed physical activity intervention for adults at risk of type 2 diabetes mellitus

Translational Behavioral Medicine ◽

10.1093/tbm/ibz008 ◽

2019 ◽

Vol 10 (3) ◽

pp. 705-715 ◽

Cited By ~ 4

Author(s):

Jessica E Bourne ◽

Elena Ivanova ◽

Heather L Gainforth ◽

Mary E Jung

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Behavior Change ◽

Social Cognitive Theory ◽

Social Cognitive ◽

Cognitive Theory ◽

Mechanisms Of Action ◽

Behavior Change Techniques ◽

Intervention Content

Abstract Behavior change techniques (BCTs) are used to target theoretical mechanisms of action predicted to bring about behavior change. Reporting BCTs and connecting them to mechanisms of action is critical to understanding intervention processes of change. This article identifies the BCTs associated with an exercise intervention for individuals at risk of type 2 diabetes and determines the extent to which these BCTs target associated mechanisms of action. BCTs were mapped onto social cognitive theory (SCT) and the theoretical domains framework (TDF) using published literature identifying links between BCTs and SCT/TDF and expert consensus. Two coders then used the 93-item BCT taxonomy (BCTTv1) to independently code BCTs within the intervention. The BCTs used in the current intervention enabled identification of the theoretical mechanisms of action targeted in the intervention. More than 70% of the intervention content incorporated at least one BCT. More than 50% of the BCTs used targeted SCT constructs and more than 70% of BCTs used targeted at least one of the 14 TDF domains. Five BCTs did not map onto either SCT or TDF. This research provides a systematic method of linking BCTs to mechanisms of action. This process increases the transparency of intervention content and identification of the mechanisms of action targeted in the current intervention. Reporting interventions in this manner will enable the most potent mechanisms of actions associated with long-term behavior change to be identified and utilized in future work. Trial Registration: ClinicalTrials.gov # NCT02164474. Registered on June 12, 2014.

Download Full-text

Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus

10.31234/osf.io/ur6kz ◽

2018 ◽

Cited By ~ 10

Author(s):

Marie Johnston ◽

Rachel Naomi Carey ◽

Lauren Connell Bohlen ◽

Derek W Johnston ◽

Alexander Rothman ◽

...

Keyword(s):

Behavior Change ◽

Design Research ◽

Intervention Development ◽

Multilevel Modelling ◽

Mechanisms Of Action ◽

Expert Consensus ◽

Full Data ◽

Behavior Change Techniques ◽

Change Behavior ◽

Literature Synthesis

Background: Researchers, practitioners and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic and accessible method of linking BCTs with the processes through which they change behavior (i.e. their mechanisms of action (MoAs)) would advance understanding of intervention effects, and improve theory and intervention development. Purpose: To triangulate evidence for hypothesized BCT-MoA links obtained in two previous studies and present the results in an interactive, online tool.Methods: Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modelling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool.Results: The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 ‘non-links’. A further 55 links were resolved by consensus (total of 92 (37+55) hypothesized BCT-MoA links). Full data on 1456 possible links was incorporated into the online interactive Theory and Technique Tool (url link removed for anonymity peer-review).Conclusions: This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research

Download Full-text

Behavior change techniques in mobile apps targeting self-harm in young people: a systematic review

Translational Behavioral Medicine ◽

10.1093/tbm/ibaa131 ◽

2021 ◽

Author(s):

Elena Panagiotopoulou ◽

Celeste Peiris ◽

Daniel Hayes

Keyword(s):

Young People ◽

Behavior Change ◽

Dialectical Behavior Therapy ◽

Mobile Apps ◽

Mental Healthcare ◽

Future Research ◽

Active Components ◽

Behavior Change Techniques ◽

Other Information ◽

Self Harm

Abstract Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was “Distraction” (54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were “Social Support (unspecified)” (27.0%) and “Behavior Substitution” (10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present.

Download Full-text

Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2021.01.071 ◽

2021 ◽

Author(s):

Stephanie L. Silveira ◽

Trinh Huynh ◽

Ariel Kidwell ◽

Dena Sadeghi-Bahmani ◽

Robert W. Motl

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Behavior Change ◽

Behavior Change Techniques ◽

Physical Activity Interventions

Download Full-text

Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Qualitative Health Research ◽

10.1177/1049732321993443 ◽

2021 ◽

pp. 104973232199344

Author(s):

Oladunni Oluwoye ◽

Elizabeth Fraser

Keyword(s):

Substance Use ◽

Behavior Change ◽

Theoretical Domains Framework ◽

First Episode Psychosis ◽

Barriers And Facilitators ◽

First Episode ◽

Evidence Based ◽

Behavior Change Techniques ◽

Episode Psychosis ◽

And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

Download Full-text

Integrating Exercise Counseling Into the Medical School Curriculum: A Workshop-Based Approach Using Behavior Change Techniques

American Journal of Lifestyle Medicine ◽

10.1177/1559827617722754 ◽

2017 ◽

Vol 15 (1) ◽

pp. 84-107 ◽

Cited By ~ 1

Author(s):

Andrea M. Brennan ◽

Katrina A. D’Urzo ◽

Alyssa M. Fenuta ◽

Robyn L. Houlden ◽

Jennifer R. Tomasone

Keyword(s):

Medical Students ◽

Behavior Change ◽

Repeated Measures ◽

School Curriculum ◽

Learning Opportunities ◽

Subjective Norms ◽

Social Cognitions ◽

Behavior Change Techniques ◽

Exercise Counseling ◽

Perceived Behavior Control

Objective. Physician physical activity (PA) counseling remains low due partly to lack of knowledge, emphasizing the importance of providing learning opportunities to develop competency, given the strong associations between PA and health. This study aimed to describe the behavior change techniques (BCTs) used in an “Exercise Expo” workshop and examine the workshop’s effectiveness for improving social cognitions to discuss exercise with patients. Methods. Second-year medical students (N = 54; Mage ± SD = 25.4 ± 2.95 years) completed questionnaires assessing attitudes, perceived behavior control (PBC), subjective norms, and intentions to provide PA counseling pre- and postworkshop. Repeated-measures analyses of variance evaluated changes in these theory of planned behavior constructs. Results. The most used BCTs included presenting information from credible sources, with opportunities for practicing the behavior and receiving feedback. Significant increases in attitudes, PBC and intentions to discuss PA were observed from pre-post Exercise Expo ( P ≤ .01). No statistically significant differences in subjective norms were observed ( P = .06). Conclusions. The Exercise Expo significantly improved social cognitions for PA counseling among medical students. Future interventions should target improvements in subjective norms to increase the likelihood the workshop improves PA counseling behavior. The evidence supports the usefulness of a workshop-based educational strategy to enhance medical students’ social cognitions for PA counseling.

Download Full-text