scholarly journals Translating Qualitative Data into Intervention Content Using the Theoretical Domains Framework and Stakeholder Co-Design: A Worked Example from a Study of Cervical Screening Attendance in Older Women

2021 ◽  
Author(s):  
Alison Bravington ◽  
Hong Chen ◽  
Judith Dyson ◽  
Lesley Jones ◽  
Christopher Dalgleish ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Service User ◽  
Qualitative Data ◽  
Peer Group ◽  
Cervical Screening ◽  
Theoretical Domains Framework ◽  
Data Set ◽  
Practitioner Training ◽  
Intervention Content ◽  
Screening Attendance

Abstract Background: Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from qualitative exploration of cervical screening in women over fifty in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service user leaflet and a short video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over fifty, and to increase sensitivity to age-related problems in cervical screening among primary care practitioners.Methods: We translated qualitative data into barriers and facilitators by recoding a primary data set, and subsequently applied the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs) based on the data set. Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide intervention content and mode of delivery.Results: Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas – clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners).Conclusion: The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.

scholarly journals Designing interventions to change eating behaviours

2015 ◽  
Vol 74 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Lou Atkins ◽  
Susan Michie
Keyword(s):  
Behaviour Change ◽  
Design Process ◽  
Theoretical Domains Framework ◽  
Research Literature ◽  
Intervention Design ◽  
Eating Behaviours ◽  
Behavioural Science ◽  
Behaviour Change Technique ◽  
Behaviour Change Wheel ◽  
Intervention Content

Understanding and changing eating behaviours are central to the work of Nutrition Society members working in both research and applied settings. The present paper describes a recently published resource to guide the design of interventions to change behaviour, The Behaviour Change Wheel: A Guide to Designing Interventions (BCW Guide). This is a practical guide to intervention design that brings together recently-developed theory-based tools in behavioural science into a coherent step-by-step design process. It is based on the BCW, a synthesis of nineteen frameworks of behaviour change found in the research literature. The BCW has at its core a model of behaviour known as ‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’. The model recognises that behaviour is part of an interacting system involving all these components. The BCW identifies different intervention options that can be applied to changing each of the components and policies that can be adopted to deliver those intervention options. The book shows how the BCW links to theory-based frameworks to understand behaviour such as the Theoretical Domains Framework and the recently developed Behaviour Change Technique Taxonomy v1 for specifying intervention content. In essence, it shows how to link what is understood about a given behaviour to types of intervention likely to be effective and then translate this into a locally relevant intervention. In addition, the present paper sets out some principles of intervention design.

scholarly journals Making Every Contact Count and Healthy Conversation Skills as very brief or brief behaviour change interventions: a scoping review

2021 ◽  
Author(s):  
Amelia Parchment ◽  
Wendy Lawrence ◽  
Rachel Perry ◽  
Em Rahman ◽  
Nick Townsend ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Scoping Review ◽  
Service User ◽  
Statistical Significance ◽  
Theoretical Domains Framework ◽  
Skills Training ◽  
Dietary Quality ◽  
Service Users ◽  
Conversation Skills ◽  
Positive Effects

Abstract Aim To identify and map the available evidence regarding the implementation of Making Every Contact Count and/or Healthy Conversation Skills for both staff delivering and service users receiving the brief or very brief intervention/s. Methods A scoping review approach was used to rapidly map and provide an overview of the relevant literature, identify gaps in knowledge, and inform further, related research. Articles investigating experiences, perceptions and impact of Making Every Contact Count and/or Healthy Conversation Skills were included. Quantitative, qualitative, and mixed methods studies were eligible for inclusion, as were reviews and reports. Results Twenty-two articles were included in total. Healthy Conversation Skills training was found to be acceptable, and had a positive impact on staff confidence and competence in supporting behaviour change, across studies. Some positive effects of intervention exposure on the sedentary behaviour and dietary quality of service users were evidenced. Changes in confidence following Making Every Contact Count training were varied, as was perceived acceptability of the intervention for staff. Two studies highlighted positive impacts of the intervention on service user health; however, statistical significance was not reported. The perceived barriers and facilitators of implementation for both interventions mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework. Conclusion Healthy Conversation Skills is an acceptable and effective behaviour change intervention that could provide a consistent approach to Making Every Contact Count training and evaluation. Further research is warranted to evaluate this approach for more staff and service user groups.

scholarly journals Breaking through the barriers to recruit research participants in community settings: a qualitative exploration using the Theoretical Domains Framework and Behaviour Change Wheel

2020 ◽  
Author(s):  
Jennie Rose ◽  
Jane Akister ◽  
Fiona Maxton ◽  
Sarah Anne Redsell
Keyword(s):  
Behaviour Change ◽  
Service User ◽  
Theoretical Domains Framework ◽  
Professional Role ◽  
Service Users ◽  
Barriers And Enablers ◽  
Behaviour Change Wheel ◽  
Health Visitors ◽  
Community Midwives ◽  
Specific Barriers

Abstract Background Recruitment of pregnant or postnatal women and young families into health research is a challenge. Community midwives and health visitors are well placed to invite service users to participate, but evidence suggests that they do not always invite all potentially eligible service users. Our aim was to use the Theoretical Domains Framework to explore health visitors’ and community midwives’ perceived barriers and enablers to approaching service users about participation in research and to use the Behaviour Change Wheel to suggest theory-based strategies to improve future recruitment. Methods Health visitors and community midwives working in four NHS Trusts and one community partnership in England were invited to complete an anonymous, online survey. The sample comprised health visitors (n=39) and community midwives (n=22). Qualitative data from open-ended questions about recruitment behaviour informed by the Theoretical Domains Framework were analysed using directed content analysis and inductive coding to identify salient Theoretical Domains Framework domains and specific barriers and enablers. Strategies to address these barriers and enablers were identified using the Behaviour Change Wheel. Results Six key Theoretical Domains Framework domains were identified as salient to service user approach: (a) environmental context and resources; (b) social/professional role and identity; (c) social influences; (d) goals; (e) beliefs about capabilities; (f) knowledge. Intervention strategies were identified to address specific barriers (insufficient time and staff capacity, inadequate study materials, rejection of the study’s relevance to practitioners’ role, negative influence of researchers and managers, and competing priorities) and to leverage specific enablers (additional staff resource, the relevance of service user approach to professional role, positive influence of team members, managers and researchers, and a belief in the link between service user approach and improvements in healthcare). Conclusions This study provides new insights into why community midwives and health visitors do, and do not, invite service users to participate in research. Using the Theoretical Domains Framework and the Behaviour Change Wheel we identified that resourcing and social support for staff together with education and communication about the health benefits of approaching service users about research participation are key to improving research recruitment involving these health professionals.

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

scholarly journals Children’s Experiences of Their Journey to School: Integrating Behaviour Change Frameworks to Inform the Role of the Built Environment in Active School Travel Promotion

2021 ◽  
Vol 18 (9) ◽  
pp. 4992
Author(s):  
Nafsika Michail ◽  
Ayse Ozbil ◽  
Rosie Parnell ◽  
Stephanie Wilkie
Keyword(s):  
Behaviour Change ◽  
Primary Schools ◽  
Theoretical Domains Framework ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
School Travel ◽  
Cross Sectional ◽  
Active School Travel ◽  
Affective Experiences

Childhood obesity is a public health problem with multiple effects on children’s life. Promoting Active School Travel (AST) could provide an inclusive opportunity for physical activity and shape healthy behaviours. Data for this cross-sectional study were drawn from questionnaires carried out in five primary schools located in Newcastle upon Tyne, UK, in neighbourhoods chosen for their variability in IMD (index of multiple deprivation) and spatial structure of street networks (measured through space syntax measure of integration). A randomly selected and heterogenic sample of 145 pupils (aged 9–10) completed an open-ended questionnaire to state what they like and dislike about their journey to school. Thematic analysis identified four typologies (environmental context, emotions, social influences and trip factors) based on the Theoretical Domains Framework (TDF) and specific themes and sub-themes underlying children’s affective experiences of their journeys to school. This study is the first known to authors to attempt to adapt the Capability, Opportunity and Motivation Behaviour (COM-B) model into AST and children’s experiences and associated behavioural domains with design aspects. Such an insight into children’s attitudes could inform urban planners and designers about how to apply more effective behaviour change interventions, targeting an AST increase among children.

scholarly journals Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i20-i22
Author(s):  
H Talkhan ◽  
D Stewart ◽  
T McIntosh ◽  
H Ziglam ◽  
P V Abdulrouf ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Free Text ◽  
Behaviour Change Interventions ◽  
Antimicrobial Prescribing ◽  
Behavioural Determinants ◽  
Inferential Analysis ◽  
Determinants Of Implementation

Abstract Introduction A recent systematic review by Talkhan et al demonstrated the need for theoretically based behaviour change interventions in this area. [1] For development of such complex interventions, emphasis should be placed on using theory to systematically identify behavioural determinants of antimicrobial prescribing. Aim To identify and quantify clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. Methods This cross-sectional survey is part of a multi-phase explanatory, sequential mixed methods PhD project in Qatar. Questionnaires were distributed (online and paper based) to all doctors (~4,000) and pharmacists (~400) within Hamad Medical Corporation (HMC, the main healthcare provider). The questionnaire was developed with reference to the Determinants of Implementation Behaviour Questionnaire (a generic questionnaire derived from the 14 theoretical domains of the Theoretical Domains Framework, TDF). [2] Each item was presented as a 5-point Likert scale (scored 5=Strongly agree to 1=Strongly disagree). Personal and practice demographics were also collected for data contextualisation. The draft questionnaire was reviewed for face/content validity by an expert panel of six researchers in Qatar and the UK with experience in the use of the TDF, followed by ‘Think aloud’ testing and piloting. Analysis investigated the behavioural determinants and influential factors through descriptive, principal component analysis (PCA) and inferential analysis. Ethics approval was granted from a UK university and HMC. Results In total, 535 responses were received, 339 (63.4%) from doctors and 196 (36.6%) from pharmacists. Respondents were predominantly male, 346 (64.7%). Just over half (n=285, 53.3%) had ≤ 5 years’ experience as health professionals. PCA showed a three component (C) solution with components incorporating a number of questionnaire items labelled: ‘Guidelines compliance’ (C1 with 8 items), ‘Influences on prescribing’ (C2 with 7 items) and ‘Self-efficacy’ (C3 with 5 items) in prescribing/recommendation activity. A scale score for each respondent was calculated through summation of Likert scores for the relevant questionnaire items within each component. These scales had high internal reliability (Cronbach’s alpha all >0.7) showing consistency in response between component items indicating statistical appropriateness for developing scales. The median score (possible scale range, midpoint) for each scale was C1, 32 (8 to 40, 24), C2, 26 (7 to 35, 21) and C3, 20, (5 to 25, 15). By way of example Table 1 shows levels of agreement for items in C2. This shows lower levels of agreement than C1 scale with the median scale score (26) closer to the midpoint (21) indicating that respondents had less positive views. Inferential analysis using these scale scores and free text analysis is in progress. Conclusion A theoretical basis was used throughout providing insights to behavioural determinants for the development of a theory-based behaviour change intervention. Preliminary results suggest that social influences, staff development and quality monitoring may be useful targets for behaviour change interventions to improve antimicrobial prescribing practice. Limitations include potential social desirability bias and focus on one healthcare organisation/country in the Middle East which may limit generalisability of findings. More in-depth exploration is required to select and test appropriate linked theory-based behaviour change techniques. References 1. Talkhan H, Stewart D, McIntosh T, Ziglam H Palli Valapila, A; Moza Sulaiman H, Diab M, Cunningham S. The use of theory in the development and evalu​ation of behaviour change interventions to improve antimicrobial prescribing: a systematic review. J Antimicrob Chemother. 2020;75(9):2394–2410, Available from https://doi.org/10.1093/jac/dkaa154 [Accessed 12 Oct 2020]. 2. Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJ, Crone MR. Measuring determinants of implementation behaviour: psychometric properties of a questionnaire based on the Theoretical Domains Framework. Implement. Sci. 2014;9(1):33.

scholarly journals Influences on single-use and reusable cup use: a multidisciplinary mixed-methods approach to designing interventions reducing plastic waste

2021 ◽  
Author(s):  
Ayse Lisa Allison ◽  
Fabiana Lorencatto ◽  
Susan Michie ◽  
Mark Miodownik
Keyword(s):  
Behaviour Change ◽  
Online Survey ◽  
Intervention Development ◽  
Theoretical Domains Framework ◽  
Intervention Strategies ◽  
Theoretical Understanding ◽  
Study Materials ◽  
Detailed Method ◽  
Single Use ◽  
The Uk

Background: An estimated 2.5-5 billion single-use coffee cups are disposed of annually in the UK, most of which consist of paper with a plastic lining. Due to the difficulty of recycling poly-coated material, most of these cups end up incinerated or put in landfills. As drinking (take-away) hot beverages is a behaviour, behaviour change interventions are necessary to reduce the environmental impacts of single-use coffee cup waste. Basing the design of interventions on a theoretical understanding of behaviour increases the transparency of the development process, the likelihood that the desired changes in behaviour will occur and the potential to synthesise findings across studies. Aim: The present paper presents a methodology for identifying influences on using single-use use and reusable cups as a basis for designing intervention strategies. Method and application: Two behaviour change frameworks: The Theoretical Domains Framework and the Capability-Opportunity-Motivation-Behaviour model of behaviour, were used to develop an online survey and follow-up interviews. Research findings can inform the selection of intervention strategies using a third framework, the Behaviour Change Wheel. The application of the methodology is illustrated in relation to understanding barriers and enablers to single-use and reusable cup use across the setting of a London university campus. Conclusions: We have developed a detailed method for identifying behavioural influences relevant to pro-environmental behaviours, together with practical guidance for each step and a worked example. Benefits of this work include it providing guidance on developing study materials and collecting and analysing data. We offer this methodology to the intervention development and implementation community to assist in the application of behaviour change theory to interventions.

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

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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