scholarly journals Improving Implementation of Smoking Cessation Guidelines in Pregnancy Care: Development of an Intervention to Address System, Maternity Service Leader and Clinician Factors

2020 ◽  
Author(s):  
Megan Passey ◽  
Catherine Adams ◽  
Christine Paul ◽  
Lou Atkins ◽  
Jo M. Longman
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Feasibility Study ◽  
Complex Interventions ◽  
Primary Data ◽  
Advisory Group ◽  
Behaviour Change Techniques ◽  
Smoking During Pregnancy ◽  
Maternity Services ◽  
Stakeholder Input

Abstract BackgroundSmoking during pregnancy increases the risk of multiple serious adverse infant, child and maternal outcomes, yet nearly 10% of Australian women still smoke during pregnancy. Despite evidence-based guidelines that recommend routine and repeated smoking cessation support (SCS) for all pregnant women, the provision of recommended SCS remains poor. Guidance on developing complex interventions to improve health care recommends drawing on existing theories, reviewing evidence, undertaking primary data collection, attending to future real-world implementation, and designing and refining interventions using iterative cycles with stakeholder input throughout. Here we describe using the Behaviour Change Wheel (BCW) to apply these principles in developing an intervention to improve provision of SCS in Australian maternity services.MethodsWorking closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways – as a core research team member, through a project Advisory Group, targeted meetings with policy makers, a large workshop to review potential components and the feasibility study. ResultsBarriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity, and in reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component. ConclusionsUsing the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialed in eight public maternity services in NSW.

scholarly journals Improving implementation of smoking cessation guidelines in pregnancy care: development of an intervention to address system, maternity service leader and clinician factors

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Megan E. Passey ◽  
Catherine Adams ◽  
Christine Paul ◽  
Lou Atkins ◽  
Jo M. Longman
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Feasibility Study ◽  
Complex Interventions ◽  
Theoretical Domains Framework ◽  
Primary Data ◽  
Advisory Group ◽  
Behaviour Change Techniques ◽  
Smoking During Pregnancy ◽  
Maternity Services

Abstract Background Smoking during pregnancy increases the risk of multiple serious adverse infant, child and maternal outcomes, yet nearly 10% of Australian women still smoke during pregnancy. Despite evidence-based guidelines that recommend routine and repeated smoking cessation support (SCS) for all pregnant women, the provision of recommended SCS remains poor. Guidance on developing complex interventions to improve health care recommends drawing on existing theories, reviewing evidence, undertaking primary data collection, attending to future real-world implementation and designing and refining interventions using iterative cycles with stakeholder input throughout. Here, we describe using the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework to apply these principles in developing an intervention to improve the provision of SCS in Australian maternity services. Methods Working closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways—as a core research team member, through a project Advisory Group, targeted meetings with policymakers, a large workshop to review potential components and the feasibility study. Results Barriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity and reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed the feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component. Conclusions Using the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialled in eight public maternity services in NSW.

scholarly journals Experts’ Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study

2020 ◽  
Vol 17 (21) ◽  
pp. 7729
Author(s):  
Fizzah B. Abidi ◽  
Libby Laing ◽  
Sue Cooper ◽  
Tim Coleman ◽  
Katarzyna A. Campbell
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Group Discussion ◽  
Behaviour Change Techniques ◽  
Visual Aids ◽  
Smoking During Pregnancy ◽  
Behavioural Support ◽  
Quit Attempts ◽  
The Family ◽  
In Pregnancy

Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women’s quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts’ views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important.

scholarly journals Characterising smoking cessation smartphone applications in terms of behaviour change techniques, engagement and ease-of-use features

2015 ◽  
Vol 6 (3) ◽  
pp. 410-417 ◽  
Author(s):  
Harveen Kaur Ubhi ◽  
Susan Michie ◽  
Daniel Kotz ◽  
Onno C. P. van Schayck ◽  
Abiram Selladurai ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Ease Of Use ◽  
Behaviour Change Techniques ◽  
Smartphone Applications

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)

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.

scholarly journals Guidance on how to develop complex interventions to improve health and healthcare

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029954 ◽  
Author(s):  
Alicia O'Cathain ◽  
Liz Croot ◽  
Edward Duncan ◽  
Nikki Rousseau ◽  
Katie Sworn ◽  
...  
Keyword(s):  
Research Evidence ◽  
Qualitative Interviews ◽  
Complex Interventions ◽  
Intervention Development ◽  
Primary Data ◽  
Programme Theory ◽  
Key Points ◽  
Stakeholder Input ◽  
Published Research ◽  
Improve Health

ObjectiveTo provide researchers with guidance on actions to take during intervention development.Summary of key pointsBased on a consensus exercise informed by reviews and qualitative interviews, we present key principles and actions for consideration when developing interventions to improve health. These include seeing intervention development as a dynamic iterative process, involving stakeholders, reviewing published research evidence, drawing on existing theories, articulating programme theory, undertaking primary data collection, understanding context, paying attention to future implementation in the real world and designing and refining an intervention using iterative cycles of development with stakeholder input throughout.ConclusionResearchers should consider each action by addressing its relevance to a specific intervention in a specific context, both at the start and throughout the development process.

scholarly journals Towards Implementing Exercise Into the Prostate Cancer Care Pathway: Development of a Theory and Evidence-Based Intervention to Change Healthcare Professional Behaviour

2021 ◽  
Author(s):  
Rebecca Turner ◽  
Madelynne Arden ◽  
Sophie Reale ◽  
Eileen Sutton ◽  
Stephanie Taylor ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Healthcare Professional ◽  
Behaviour Change ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Randomised Trial ◽  
Complex Interventions ◽  
Theoretical Domains Framework ◽  
Behaviour Change Techniques ◽  
Training Package

Abstract BackgroundTwice-weekly supervised aerobic and resistance exercise for 12 weeks reduces fatigue and improves quality of life in men on Androgen Deprivation Therapy for prostate cancer. Despite the National Institute for Health and Care Excellence (NICE) proposing this as standard of care, it does not routinely take place in practice. Healthcare professionals are in a prime position to deliver and integrate these recommendations. A change in the behaviour of clinical teams is therefore required.In this paper, we describe the development of a training package for healthcare professionals using theory and evidence to promote delivery of such recommendations as standard care.MethodsThe intervention development process was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. Target behaviours were identified from the literature and thirty-five prostate cancer care healthcare professionals were interviewed to understand influences on these behaviours. The Theoretical Domains Framework was used to identify theoretical constructs for change. Behaviour change techniques were selected based on theory and evidence and were translated into intervention content. The intervention was refined with the input of stakeholders including healthcare professionals, patients, and exercise professionals in the form of rehearsal deliveries, focus groups and a workshop.ResultsSeven modifiable healthcare professional target behaviours were identified to support the delivery of the NICE recommendations including identifying eligible patients suitable for exercise, recommending exercise, providing information, exercise referral, providing support and interpret and feedback on progress. Ten domains from the Theoretical Domain’s Framework were identified as necessary for change, including improving knowledge and skills, addressing beliefs about consequences, and targeting social influences. These were targeted through twenty-two behaviour change techniques delivered in a half-day, interactive training package. Based on initial feedback from stakeholders, the intervention was refined in preparation for evaluation.ConclusionsWe designed an intervention based on theory, evidence, and stakeholder feedback to promote and support the delivery of NICE recommendations. Future work will aim to test this training package in a multi-centre randomised trial. If proven effective, the development and training package will provide a template for replication in other clinical populations, where exercise has proven efficacy but is insufficiently implemented.Trial registrationN/A

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

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).

scholarly journals PARIS: protocol for a prospective single arm, theory-based, group-based feasibility intervention study to increase Physical Activity and reduce sedentary behaviouR after barIatric Surgery

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051638
Author(s):  
Jennifer James ◽  
Wendy Hardeman ◽  
Helen Eborall ◽  
Mark Goodall ◽  
John Wilding
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Sedentary Behaviour ◽  
Behaviour Change ◽  
Feasibility Study ◽  
Theoretical Domains Framework ◽  
Comparative Approach ◽  
Service Research ◽  
Behaviour Change Techniques ◽  
Behaviour Change Intervention

IntroductionIncreased physical activity and reduced sedentary behaviour can encourage favourable outcomes after bariatric surgery. However, there is a lack of evidence as to how to support patients with behaviour change. The aim of this study is to assess the feasibility of a physiotherapist led, online group-based behaviour change intervention to increase physical activity and reduce sedentary behaviour following bariatric surgery.Methods and analysisSingle arm feasibility study of a theory and evidence-based group behaviour change intervention based on the Behaviour Change Wheel and Theoretical Domains Framework using behaviour change techniques from the Behaviour Change Technique Taxonomy v1. The intervention has eight objectives and specifies behaviour change techniques that will be used to address each of these. Groups of up to eight participants who have had surgery within the previous 5 years will meet weekly over 6 weeks for up to 1½ hours. Groups will be held online led by a physiotherapist and supported by an intervention handbook. Feasibility study outcomes include: rate of recruitment, retention, intervention fidelity, participant engagement and acceptability. Secondary outcomes include: physical activity, sedentary behaviour, body composition, self-reported health status and will be analysed descriptively. Change in these outcomes will be used to calculate the sample size for a future evaluation study. Qualitative interviews will explore participants’ views of the intervention including its acceptability. Data will be analysed according to the constant comparative approach of grounded theory.Ethics and disseminationThis study has National Health Service Research Ethics Committee approval; Haydock 20/NW/0472. All participants will provide informed consent and can withdraw at any point. Findings will be disseminated through peer-reviewed journals, conference and clinical service presentations.Trial registration numberISRCTN31524689.

scholarly journals Feasibility of Audio-Recording Consultations with Pregnant Australian Indigenous Women to Assess Use of Smoking Cessation Behaviour Change Techniques

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yael Bar-Zeev ◽  
Eliza Skeleton ◽  
Michelle Bovill ◽  
Maree Gruppetta ◽  
Billie Bonevski ◽  
...  
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Behaviour Change ◽  
Future Research ◽  
Behaviour Change Techniques ◽  
Health Providers ◽  
Post Intervention ◽  
Audio Recording ◽  
Smoking Cessation Counselling ◽  
Audio Recordings

Introduction. Behavioural counselling is an effective method to improve smoking cessation during pregnancy. Audio recordings of consultations have been used previously to assess fidelity in specialized smoking cessation services, but not in primary care. Aims. The study is aimed at assessing the feasibility of audio-recording smoking cessation counselling as part of an intervention in primary care settings and exploring the number and type of behaviour change techniques (BCTs) delivered. Methods. This study was a nested feasibility study within a larger trial. Health providers (HPs) and pregnant women were asked to agree or decline audio recording their smoking-related consultations. Data collected included percentage providing consent, number of recordings performed, HP type, and date (pre/post intervention). Interviews were conducted to assess the trial procedures’ acceptability. Results. Two services provided seven recordings, all pre-intervention. Of the 22 recruited women, 14 consented to being audio recorded (64%) and five provided recordings; of the 23 recruited HPs, 16 agreed (69%), and two provided recordings. Qualitative data suggest that HPs found audio recording difficult to remember. HPs spent on average two minutes discussing smoking and used few BCTs. Conclusions. Audio recordings of smoking-related counselling were not feasible as planned. Future research will need to explore acceptable methods to assess BCT use in primary care.

scholarly journals Characterising the ‘Txt2Stop’ Smoking Cessation Text Messaging Intervention in Terms of Behaviour Change Techniques

2012 ◽  
Vol 7 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Susan Michie ◽  
Caroline Free ◽  
Robert West
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Text Messaging ◽  
Self Regulation ◽  
Text Message ◽  
Behaviour Change Techniques ◽  
Rater Reliability ◽  
Communication Techniques ◽  
Regulatory Capacity ◽  
Text Messaging Intervention

The ‘Txt2Stop’ SMS messaging programme has been found to double smokers’ chances of stopping. It is important to characterise the content of this information in terms of specific behaviour change techniques (BCTs) for the purpose of future development. This study aimed to (i) extend a proven system for coding BCTs to text messaging and (ii) characterise Txt2Stop using this system. A taxonomy previously used to specify BCTs in face-to-face behavioural support for smoking cessation was adapted for the Txt2Stop messages and inter-rater reliability for the adapted system assessed. The system was then applied to all the messages in the Txt2Stop programme to determine its profile in terms of BCTs used. The text message taxonomy comprised 34 BCTs. Inter-rater reliability was moderate, reaching a ceiling of 61% for the core program messages with all discrepancies readily resolved. Of 899 texts delivering BCTs, 218 aimed to maintain motivation to remain abstinent, 870 to enhance self-regulatory capacity or skills, 39 to promote use of adjuvant behaviours such as using stop-smoking medication, 552 to maintain engagement with the intervention and 24 were general communication techniques. The content of Txt2Stop focuses on helping smokers with self-regulation and maintaining engagement with the intervention. The intervention focuses to a lesser extent on boosting motivation to remain abstinent; little attention is given to promoting effective use of adjuvant behaviours such as use of nicotine replacement therapy. As new interventions of this kind are developed it will be possible to compare their effectiveness and relate this to standardised descriptions of their content using this system.

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