Breaking barriers: using the Behavior Change Wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

10.21203/rs.2.10405/v2 ◽

2019 ◽

Author(s):

Samson O Ojo ◽

Daniel P. Bailey ◽

Marsha L. Brierley ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Office Workers ◽

Sitting Time ◽

Mental Wellbeing ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Structured Interviews ◽

Behaviour Change Technique ◽

Break Up

Abstract Background: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. Methods: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD=10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation – Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. Results: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Reflective and automatic Motivation was highlighted as a core target for intervention. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. Conclusions: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease prolonged sitting in the workplace.

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Breaking barriers: using the Behavior Change Wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

10.21203/rs.2.10405/v4 ◽

2019 ◽

Author(s):

Samson O Ojo ◽

Daniel P. Bailey ◽

Marsha L. Brierley ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Office Workers ◽

Sitting Time ◽

Mental Wellbeing ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Structured Interviews ◽

Behaviour Change Technique ◽

Break Up

Abstract Background: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. Methods: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD=10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation – Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. Results: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Reflective and automatic Motivation was highlighted as a core target for intervention. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. Conclusions: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease prolonged sitting in the workplace.

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Breaking barriers: using the Behavior Change Wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

10.21203/rs.2.10405/v3 ◽

2019 ◽

Author(s):

Samson O Ojo ◽

Daniel P. Bailey ◽

Marsha L. Brierley ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Office Workers ◽

Sitting Time ◽

Mental Wellbeing ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Structured Interviews ◽

Behaviour Change Technique ◽

Break Up

Abstract Background: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. Methods: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD=10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation – Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. Results: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Reflective and automatic Motivation was highlighted as a core target for intervention. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. Conclusions: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease prolonged sitting in the workplace.

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A randomised-controlled feasibility study of the REgulate your SItting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: study protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00816-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Daniel P. Bailey ◽

Charlotte L. Edwardson ◽

Yannis Pappas ◽

Feng Dong ◽

David J. Hewson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Behaviour Change ◽

Sitting Time ◽

Feasibility Trial ◽

Musculoskeletal Symptoms ◽

Behaviour Change Techniques ◽

Tailored Intervention ◽

Break Up ◽

Randomised Controlled

Abstract Background People with type 2 diabetes mellitus (T2DM) generally spend a large amount of time sitting. This increases their risk of cardiovascular disease, premature mortality, diabetes-related complications and mental health problems. There is a paucity of research that has evaluated interventions aimed at reducing and breaking up sitting in people with T2DM. The primary aim of this study is to assess the feasibility of delivering and evaluating a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM. Methods This is a mixed-methods randomised controlled feasibility trial. Participants (n=70) with T2DM aged 18-85 years who sit ≥7 h/day and are able to ambulate independently will be randomly allocated to receive the REgulate your SItting Time (RESIT) intervention or usual care (control group) for 24 weeks. RESIT is a person-focused intervention that delivers a standardised set of behaviour change techniques to the participants, but the mode through which they are delivered can vary depending on the tools selected by each participant. The intervention includes an online education programme, health coach support, and a range of self-selected tools (smartphone apps, computer-prompt software, and wearable devices) that deliver behaviour change techniques such as self-monitoring of sitting and providing prompts to break up sitting. Measures will be taken at baseline, 12 and 24 weeks. Eligibility, recruitment, retention and data completion rates will be used to assess trial feasibility. Sitting, standing and stepping will be measured using a thigh-worn activity monitor. Cardiometabolic health, physical function, psychological well-being, sleep and musculoskeletal symptoms will also be assessed. A process evaluation will be conducted including evaluation of intervention acceptability and fidelity. Discussion This study will identify the feasibility of delivering a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM and evaluating it through a randomised controlled trial (RCT) design. The findings will inform a fully powered RCT to evaluate the effectiveness of the intervention. Trial registration ISRCTN, ISRCTN14832389; Registered 6 August 2020.

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Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00739-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

M. A. Arden ◽

M. Hutchings ◽

P. Whelan ◽

S. J. Drabble ◽

D. Beever ◽

...

Keyword(s):

Cystic Fibrosis ◽

Development Strategy ◽

Treatment Adherence ◽

Behaviour Change ◽

Multidisciplinary Team ◽

Treatment Plan ◽

Controlled Trial ◽

Intervention Development ◽

Evidence Base ◽

Behaviour Change Techniques

Abstract Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

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Applying the COM-B behaviour model to overcome barriers to heart failure self-care: A practical application of a conceptual framework for the development of complex interventions (ACHIEVE study)

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120957292 ◽

2020 ◽

pp. 147451512095729

Author(s):

Amanda Whittal ◽

Stefan Störk ◽

Barbara Riegel ◽

Oliver Rudolf Herber

Keyword(s):

Heart Failure ◽

Behaviour Change ◽

Complex Interventions ◽

Self Care ◽

Intervention Development ◽

Heart Association ◽

Barriers And Facilitators ◽

Behaviour Change Techniques ◽

Anticipated Regret ◽

Management Interventions

Background: Effective interventions to enhance adherence to self-care recommendations in patients with heart failure have immense potential to improve health and wellbeing. However, there is substantial inconsistency in the effectiveness of existing self-management interventions, partly because they lack theoretical models underpinning intervention development. Aim: To outline how the capability, opportunity and motivation behaviour model has been applied to guide the development of a theory-based intervention aiming to improve adherence to heart failure self-care recommendations. Methods: The application of the capability, opportunity and motivation behaviour model involved three steps: (a) identification of barriers and facilitators to heart failure self-care from two comprehensive meta-studies; (b) identification of appropriate behaviour change techniques to improve heart failure self-care; and (c) involvement of experts to reduce and refine potential behaviour change techniques further. Results: A total of 119 barriers and facilitators were identified. Fifty-six behaviour change techniques remained after applying three steps of the behaviour model for designing interventions. Expert involvement ( n=39, of which 31 were patients (67% men; 45% New York Heart Association II)) further reduced and refined potential behaviour change techniques. Experts disliked some behaviour change techniques such as ‘anticipated regret’ and ‘salience of consequences’. This process resulted in a final comprehensive list consisting of 28 barriers and 49 appropriate behaviour change techniques potentially enhancing self-care that was put forward for further use. Conclusion: The application of the capability, opportunity and motivation behaviour model facilitated identifying important factors influencing adherence to heart failure self-care recommendations. The model served as a comprehensive guide for the selection and design of interventions for improving heart failure self-care adherence. The capability, opportunity and motivation behaviour model enabled the connection of heart failure self-care barriers to particular behaviour change techniques to be used in practice.

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Developing a behavioural intervention package to identify and amend incorrect penicillin allergy records in UK general practice and subsequently change antibiotic use

BMJ Open ◽

10.1136/bmjopen-2019-035793 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035793 ◽

Cited By ~ 1

Author(s):

Marta Santillo ◽

Marta Wanat ◽

Mina Davoudianfar ◽

Emily Bongard ◽

Sinisa Savic ◽

...

Keyword(s):

General Practice ◽

Behaviour Change ◽

Controlled Trial ◽

Intervention Development ◽

Penicillin Allergy ◽

Feasibility Trial ◽

Rapid Review ◽

Behavioural Intervention ◽

Behaviour Change Techniques ◽

Intervention Package

ObjectivesTo develop a behavioural intervention package to support clinicians and patients to amend incorrect penicillin allergy records in general practice. The intervention aimed to: (1) support clinicians to refer patients for penicillin allergy testing (PAT), (2) support patients to attend for PAT and (3) support clinicians and patients to prescribe or consume penicillin, when indicated, following a negative PAT result.MethodsTheory-based, evidence-based and person-based approaches were used in the intervention development. We used evidence from a rapid review, two qualitative studies, and expert consultations with the clinical research team to identify the intervention ‘guiding principles’ and develop an intervention plan. Barriers and facilitators to the target behaviours were mapped to behaviour change theory in order to describe the proposed mechanisms of change. In the final stage, think-aloud interviews were conducted to optimise intervention materials.ResultsThe collated evidence showed that the key barriers to referral of patients by clinicians were limited experience of referral and limited knowledge of referral criteria and PAT. Barriers for patients attending PAT were lack of knowledge of the benefits of testing and lack of motivation to get tested. The key barriers to the prescription and consumption of first-line penicillin following a negative test result were patient and clinician beliefs about the accuracy of PAT and whether taking penicillin was safe. Intervention materials were designed and developed to address these barriers.ConclusionsWe present a novel behavioural intervention package designed to address the multiple barriers to uptake of PAT in general practice by clinicians and patients. The intervention development details how behaviour change techniques have been incorporated to hypothesise how the intervention is likely to work to help amend incorrect penicillin allergy records. The intervention will go on to be tested in a feasibility trial and randomised controlled trial in England.

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Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162903 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2903 ◽

Cited By ~ 6

Author(s):

Samson O. Ojo ◽

Daniel P. Bailey ◽

David J. Hewson ◽

Angel M. Chater

Keyword(s):

Behaviour Change ◽

Theoretical Domains Framework ◽

Perceived Barriers ◽

Barriers And Facilitators ◽

Office Workers ◽

Sitting Time ◽

Future Research ◽

Behaviour Change Techniques ◽

Organisational Support ◽

Sitting Behaviour

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.

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Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study

Health Services and Delivery Research ◽

10.3310/hsdr09010 ◽

2021 ◽

Vol 9 (1) ◽

pp. 1-168

Author(s):

Susan Michie ◽

Marie Johnston ◽

Alexander J Rothman ◽

Marijn de Bruin ◽

Michael P Kelly ◽

...

Keyword(s):

Behaviour Change ◽

Mechanism Of Action ◽

Behavioural Change ◽

Complex Interventions ◽

Mechanisms Of Action ◽

Behaviour Change Techniques ◽

Active Components ◽

Behaviour Change Technique ◽

Policy Makers ◽

Change Technique

Background Many global health challenges may be targeted by changing people’s behaviour. Behaviours including cigarette smoking, physical inactivity and alcohol misuse, as well as certain dietary behaviours, contribute to deaths and disability by increasing the risk of cancers, cardiovascular diseases and diabetes. Interventions have been designed to change these health behaviours with a view to reducing these health risks. However, the effectiveness of these interventions has been quite variable and further information is needed to enhance their success. More information is needed about the specific processes that underlie the effectiveness of intervention strategies. Aim Researchers have developed a taxonomy of 93 behaviour change techniques (i.e. the active components of an intervention that bring about behavioural change), but little is known regarding their potential mechanisms of action (i.e. the processes through which a behaviour change technique affects behaviour). We therefore aimed to examine links between behaviour change techniques and mechanisms of action. Method First, we conducted a literature synthesis study of 277 behaviour change intervention studies, from which we extracted information on links, described by authors, between behaviour change techniques and mechanisms of action, and identified an average of 10 links per intervention report. Second, behaviour change experts (n = 105) were engaged in a three-round consensus study in which they discussed and rated their confidence in the presence/absence of ‘links’ and ‘non-links’ between commonly used behaviour change techniques (n = 61) and a set of mechanisms of action (n = 26). Ninety links and 460 ‘non-links’ reached the pre-set threshold of 80% agreement. To enhance the validity of these results, a third study was conducted that triangulated the findings of the first two studies. Discrepancies and uncertainties between the studies were included in a reconciliation consensus study with a new group of experts (n = 25). The final results identified 92 definite behaviour change technique–mechanism of action links and 465 definite non-links. In a fourth study, we examined whether or not groups of behaviour change techniques used together frequently across interventions revealed shared theoretical underpinnings. We found that experts agreed on the underlying theory for three groups of behaviour change techniques. Results Our results are potentially useful to policy-makers and practitioners in selecting behaviour change techniques to include in behaviour change interventions. However, our data do not demonstrate that the behaviour change techniques are effective in targeting the mechanism of action; rather, the links identified may be the ‘best bets’ for interventions that are effective in changing mechanisms of action, and the non-links are unlikely to be effective. Researchers examining effectiveness of interventions in either primary studies or evidence syntheses may consider these links for further investigation. Conclusion To make our results usable by researchers, practitioners and policy-makers, they are available in an online interactive tool, which enables discussion and collaboration (https://theoryandtechniquetool.humanbehaviourchange.org/); accessed 1 March 2020. This work, building on previous work to develop the behaviour change technique taxonomy, is part of an ongoing programme of work: the Human Behaviour Change Project (www.humanbehaviourchange.org/; accessed 1 March 2020). Funding This project was funded by the Medical Research Council via its Methodology Panel: ‘Developing methodology for designing and evaluating theory-based complex interventions: an ontology for linking behaviour change techniques to theory’ (reference MR/L011115/1).

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Developing a theory-informed complex intervention to improve nurse–patient therapeutic engagement employing Experience-based Co-design and the Behaviour Change Wheel: an acute mental health ward case study

BMJ Open ◽

10.1136/bmjopen-2020-047114 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047114

Author(s):

Sarah McAllister ◽

Alan Simpson ◽

Vicki Tsianakas ◽

Nick Canham ◽

Vittoria De Meo ◽

...

Keyword(s):

Mental Health ◽

Behaviour Change ◽

Design Process ◽

Complex Interventions ◽

Intervention Development ◽

Behaviour Change Techniques ◽

Service Users ◽

Therapeutic Engagement ◽

Behaviour Change Wheel

ObjectivesOur objectives were threefold: (1) describe a collaborative, theoretically driven approach to co-designing complex interventions; (2) demonstrate the implementation of this approach to share learning with others; and (3) develop a toolkit to enhance therapeutic engagement on acute mental health wards.Design and participantsWe describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Our case study was informed by the results of a systematic integrative review and guided by this integrated approach. We undertook 80 hours of non-participant observations, and semistructured interviews with 14 service users (7 of which were filmed), 2 carers and 12 clinicians from the same acute ward. The facilitated intervention co-design process involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development.SettingThis study was conducted over 12 months at an acute mental health organisation in England.ResultsThe co-designed Let’s Talk toolkit addressed four joint service user/clinician priorities for change: (1) improve communication with withdrawn people; (2) nurses to help service users help themselves; (3) nurses to feel confident when engaging with service users; (4) improving team relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design-behaviour change approach with service users, carers and clinicians to develop a toolkit to improve nurse–patient therapeutic engagement.ConclusionsOur theory-driven approach enhanced both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.

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