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The behaviour alter wheel: A new method for characterising and designing behaviour change interventions
Implementation Science volume six, Article number:42 (2011) Cite this article
Abstract
Groundwork
Improving the design and implementation of show-based practice depends on successful behaviour modify interventions. This requires an appropriate method for characterising interventions and linking them to an assay of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but information technology is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.
Methods
A systematic search of electronic databases and consultation with behaviour alter experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to come across these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco command and obesity.
Results
Nineteen frameworks were identified roofing nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and merely a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour arrangement' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B organization'). This forms the hub of a 'behaviour change cycle' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in ane or more of these weather; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English language Department of Wellness'due south 2010 tobacco control strategy and the National Institute of Wellness and Clinical Excellence's guidance on reducing obesity.
Conclusions
Interventions and policies to change behaviour tin be usefully characterised past ways of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then past policy categories. Research is needed to found how far the BCW can lead to more efficient design of effective interventions.
Peer Review reports
Groundwork
Improving the implementation of evidence-based exercise and public health depends on behaviour alter. Thus, behaviour modify interventions are central to the constructive do of clinical medicine and public wellness, every bit indeed they are to many pressing issues facing social club. 'Behaviour change interventions' can be defined every bit coordinated sets of activities designed to change specified behaviour patterns. In general, these behaviour patterns are measured in terms of the prevalence or incidence of particular behaviours in specified populations (e.yard., commitment of smoking cessation advice by general practitioners). Interventions are used to promote uptake and optimal use of effective clinical services, and to promote healthy lifestyles. Prove of intervention effectiveness serves to guide health providers to implement what is considered to be best practise (for example, Cochrane reviews, Prissy guidance). While there are many examples of successful interventions, in that location are as well endless examples of ones that it was hoped would be constructive but were not [[one], e.g. [2, 3]]. To improve this situation, and to better the translation of research into practise, we need to develop the science and engineering of behaviour change and brand this useful to those designing interventions and planning policy.
The process of designing behaviour change interventions usually involves first of all determining the wide approach that volition be adopted so working on the specifics of the intervention design. For example, when attempting to reduce excessive antibiotic prescribing one may decide that an educational intervention is the appropriate arroyo. Alternatively, one may seek to incentivise advisable prescribing or in some way penalise inappropriate prescribing. Once one has washed this, ane would decide on the specific intervention components. This paper examines this first part of this procedure. We and others are also working on how one identifies specific component 'behaviour change techniques' [4, 5].
In club to identify the type or types of intervention that are likely to exist constructive, it is important to canvass the full range of options available and use a rational system for selecting from amidst them. This requires a organisation for characterising interventions that covers all possible intervention types together with a system for matching these features to the behavioural target, the target population, and the context in which the intervention will be delivered. This should exist underpinned by a model of behaviour and the factors that influence it.
Interventions are commonly designed without evidence of having gone through this kind of process, with no formal analysis of either the target behaviour or the theoretically predicted mechanisms of activity. They are based on implicit commonsense models of behaviour [6]. Even when one or more models or theories are chosen to guide the intervention, they do not cover the full range of possible influences so exclude potentially important variables. For example, the often used Theory of Planned Behaviour and Health Belief Model do not address the important roles of impulsivity, habit, cocky-command, associative learning, and emotional processing [7].
In improver, oft no assay is undertaken to guide the choice of theories [8]. Useful guidance from the UK Medical Research Council for developing and evaluating complex interventions advocates drawing on theory in intervention design but does not specify how to select and utilise theory [9]. It should also be noted that even when interventions are said to be guided by theory, in do they are often not or are but minimally [10].
Thus, in order to amend intervention blueprint, we demand a systematic method that incorporates an agreement of the nature of the behaviour to be changed, and an appropriate system for characterising interventions and their components that can make apply of this understanding. These constitute a starting point for assessing in what circumstances different types of intervention are likely to exist effective which can and so class the footing for intervention design.
There exists a plethora of frameworks for classifying behaviour modify interventions but an informal analysis suggests that none are comprehensive and conceptually coherent. For example, 'MINDSPACE' an influential report from the Uk's Institute of Government, is intended as a checklist for policymakers of the most of import influences on behaviour [11]. These influences provide initial letters for the acronym MINDSPACE: messenger, incentives, norms, defaults, salience, priming, affect, commitment, and ego. The framework does non appear to cover all the important intervention types. Moreover, the listing is a mixture of modes of delivery (e.yard., messenger), stimulus attributes (e.g., salience), characteristics of the recipient (east.m., ego), policy strategies (e.one thousand., defaults), mechanisms of action (e.grand., priming), and related psychological constructs (e.g., affect). In that sense it lacks coherence. The report recognises two systems past which man behaviour tin can be influenced -- the cogitating and the automatic -- only information technology focuses on the latter and does non try to link influences on behaviour with these ii systems.
A 2d instance comes from the Cochrane Effective Practice and Organisation of Intendance Review Group (EPOC)'s 2010 taxonomy [12]. This categorises interventions to change health professional behaviour into professional, fiscal, organisational, or regulatory, roofing many of the primal intervention types. Nonetheless, the categories are very broad and inside each is a mixture of different types of interventions at different conceptual levels. For example, 'professional' includes individual behaviour (distributing educational materials) and organisational interventions (local consensus processes); 'fiscal' includes individual and organisational incentives and environmental restructuring (changing the available products); 'organisational' includes input (irresolute skill mix), processes (advice) and furnishings (satisfaction of providers); and 'regulatory' includes legal (changes in patient liability) and social influence (peer review). Professional, financial, and organisational interventions are found across all categories.
Bated from specific frameworks, there are some wide distinctions that have been widely adopted. Ane such stardom is between population-level and private-level interventions [thirteen]. While superficially highly-seasoned, in that location are many interventions that this distinction cannot readily classify and it has not been possible to arrive at a satisfactory definition of the distinction that does not incorporate inconsistencies. For example, if wide accomplish is a feature of population level interventions, routine general practitioner (GP) smoking assessment and communication (given to all patients) should fall into that category; however it is delivered specifically to individuals and can be tailored to those individuals. Indeed, the NHS Cease Smoking Services might be considered a typical case of individual-level interventions, but they reach more than 600,000 smokers each year [14]. We do non consider these broad distinctions further in this paper.
It appears that most intervention designers exercise not use existing frameworks as a ground for developing new interventions or for analysing why some interventions accept failed while others have succeeded. I reason for this may be that these frameworks practise non come across their needs. In order to choose the interventions probable to be virtually effective, it makes sense to outset with a model of behaviour. This model should capture the range of mechanisms that may exist involved in change, including those that are internal (psychological and physical) and those that involve changes to the external environment. In full general, insufficient attention appears to be given to analysing the nature of behaviour as the starting signal of behaviour modify interventions [xv], a notable exception being intervention mapping [16]. 'Nature of the behaviour' was identified as one of 12 theoretical domains of influence on implementation-relevant behaviours [9]. Whilst this framework of 12 theoretical domains has proved useful in assessing and intervening with implementation problems [nine], the domain of behaviour has remained nether-theorised and therefore underused in its application.
There are a number of possible objections to attempting to construct the kind of behavioural model described and link this to intervention types. The about obvious criticism is that the area is too complex and that the constructs too ill-defined to exist able to institute a useful, scientifically-based framework. Another is that no framework can address the level of detail required to determine what will or will not exist an effective intervention. The response to this is twofold: these are empirical questions and in that location is already evidence that characterising interventions by behaviour change techniques (BCTs) can be helpful in understanding which interventions are more or less effective [6, 17]; and non to embark on this enterprise is to give up on achieving a science of behaviour modify earlier the outset hurdle and condemn this field to stance and fashion.
To achieve its goal, a framework for characterising interventions should be comprehensive: information technology should use to every intervention that has been or could be developed. Failure to do this limits the scope of the system to offer options for intervention designers that may be effective.
Second, the framework needs to be coherent in that its categories are all exemplars of the same type of entity and take a broadly similar level of specificity. Thus, categories should exist from a super-ordinate entity (e.k., part of the intervention), and the framework should non include some categories that are very wide and others very specific. A beautiful case of an incoherent classification system is the Ancient Chinese Classification of Animals: 'those that belong to the Emperor, embalmed ones, those that are trained, suckling pigs, mermaids, fabulous ones, stray dogs, those that are included in this classification, those that tremble as if they were mad, innumerable ones, those drawn with a very fine camel's hair brush, others, those that take simply broken a blossom vase, and those that resemble flies from a distance' (Luis Borges 'Other Inquisitions: 1937-1952').
In addition, the categories should be able to be linked to specific behaviour change mechanisms that in turn can be linked to the model of behaviour. These requirements constitute three criteria of usefulness that can be used to evaluate the framework: comprehensiveness, coherence, and links to an overarching model of behaviour. We limited the criteria to those we considered to class a basis for judging adequacy. In that location are others, eastward.g., parsimony, that are desirable features only do not lend themselves to thresholds. Other criteria can be used to evaluate its applicability, due east.m., reliability, ease of use, ease of advice, ability to explain outcomes, usefulness for generating new interventions, and power to predict effectiveness of interventions
In light of the above, this newspaper aims to:
- 1.
Review existing frameworks of behavioural interventions to establish how far each meets the criteria of usefulness, and to identify a comprehensive list of intervention descriptors at a level of generality that is usable by intervention designers and policy makers.
- 2.
Use this list to construct a framework of behaviour change interventions that meets the usefulness criteria listed higher up.
- 3.
Establish the reliability with which the new framework can be used to characterise interventions in ii public health domains.
Methods
Prior to reviewing the literature on intervention frameworks, we needed to establish a set up of criteria for evaluating their usefulness. Following this, our method involved iii steps: a systematic literature review and evaluation of existing behaviour modify intervention frameworks, development of a new framework, and a test of the reliability of the new framework.
Establishing criteria of usefulness
From the assay set out in the Introduction, we established 3 criteria of usefulness:
- i.
Comprehensive coverage -- the framework should apply to every intervention that has been or could be developed: failure to do this limits the scope of the system to offer options for intervention designers that may be effective.
- ii.
Coherence, i.east., categories are all exemplars of the same type and specificity of entity.
- 3.
Links to an overarching model of behaviour.
We use the term 'model' hither in the sense divers in the Oxford English language Dictionary: 'a hypothetical description of a circuitous entity or process.' For the overarching model of behaviour, we started with motivation, divers as: brain processes that energize and straight behaviour) [18]. This is a much broader conceptualisation than appears in many discourses, roofing as it does bones drives and 'automatic' processes besides as choice and intention.
Our next step was to consider the minimum number of additional factors needed to business relationship for whether modify in the behavioural target would occur, given sufficient motivation. We drew on 2 sources representing very unlike traditions: a The states consensus meeting of behavioural theorists in 1991 [19], and a principle of Us criminal police force dating back many centuries. The one-time identified iii factors that were necessary and sufficient prerequisites for the performance of a specified volitional behaviour: the skills necessary to perform the behaviour, a potent intention to perform the behaviour, and no environmental constraints that make it impossible to perform the behaviour. Under US criminal law, in order to prove that someone is guilty of a crime one has to evidence three things: means or capability, opportunity, and motive. This suggested a potentially elegant way of representing the necessary conditions for a volitional behaviour to occur. The common determination from these two dissever strands of thought lends confidence to this model of behaviour. We take built on this to add not-volitional mechanisms involved in motivation (e.m., habits) and to conceptualise causal associations between the components in an interacting system.
In this 'behaviour system,' capability, opportunity, and motivation interact to generate behaviour that in turn influences these components as shown in Figure 1 (the 'COM-B' system). Capability is defined as the private's psychological and physical capacity to appoint in the activity concerned. It includes having the necessary cognition and skills. Motivation is defined every bit all those brain processes that energize and direct behaviour, non just goals and witting decision-making. Information technology includes habitual processes, emotional responding, as well equally analytical decision-making. Opportunity is defined every bit all the factors that lie outside the private that make the behaviour possible or prompt it. The single-headed and double-headed arrows in Figure i represent potential influence between components in the system. For example, opportunity can influence motivation as tin can capability; enacting a behaviour tin alter capability, motivation, and opportunity.
The COM-B system - a framework for agreement behaviour.
A given intervention might change one or more than components in the behaviour arrangement. The causal links inside the system can work to reduce or dilate the upshot of detail interventions by leading to changes elsewhere. While this is a model of behaviour, information technology also provides a basis for designing interventions aimed at behaviour change. Applying this to intervention blueprint, the task would exist to consider what the behavioural target would be, and what components of the behaviour system would demand to be changed to accomplish that.
This system places no priority on an individual, group, or ecology perspective -- intra-psychic and external factors all accept equal status in controlling behaviour. However, for a given behaviour in a given context it provides a way of identifying how far changing particular components or combinations of components could effect the required transformation. For example, with one behavioural target the only barrier might exist capability, while for another information technology may be enough to provide or restrict opportunities, while for notwithstanding another changes to adequacy, motivation, and opportunity may be required.
Inside the 3 components that generate behaviour, information technology is possible to develop further subdivisions that capture important distinctions noted in the research literature. Thus, with regard to capability, nosotros distinguished between physical and psychological capability (psychological capability beingness the capacity to engage in the necessary thought processes - comprehension, reasoning et al.). With opportunity, we distinguished between concrete opportunity afforded by the environment and social opportunity afforded by the cultural milieu that dictates the way that we think about things (e.g., the words and concepts that brand up our language). With regard to motivation, we distinguished between cogitating processes (involving evaluations and plans) and automated processes (involving emotions and impulses that arise from associative learning and/or innate dispositions) [7, 18, 20]. Thus, nosotros identified 6 components inside the behavioural system (Figure 1). All, autonomously from reflective motivation, are necessary for a given behaviour but it is possible to generate a profile of which should be targeted to achieve the behavioural target.
Systematic literature review of current frameworks
We used the following search terms to place scholarly manufactures containing frameworks of behaviour change interventions: Topic = (taxonomy or framework or nomenclature) AND Topic = ('behaviour change' or 'behavior change') AND Topic = (prevention OR intervention OR promotion OR treatment OR program OR programme OR policy OR law OR politics OR regulation OR authorities OR found OR legislation).
Searches of Spider web of Science (Science and Social Science databases), Pubmed. and PsycInfo were supplemented by consulting with 8 international experts in behaviour change, fatigued from the disciplines of psychology, health promotion, epidemiology, public health, and anthropology. Given that at that place may be frameworks described in books and non peer-reviewed articles, we acknowledged that it was unlikely that we would arrive at a complete ready, but we sought to sail plenty to be able to undertake an analysis of how well as a whole they matched the criteria described earlier and to achieve sufficient coverage of the key concepts and labels.
Documents were included if: they described a framework of behaviour change interventions (not specific behaviour change techniques); the framework was specified in enough item to allow their fundamental features to exist discerned; and they were written in English language. They were originally selected on the basis of titles and abstracts. A subset was and so selected using the inclusion criteria for full review. The nature of the topic meant that this review could non be undertaken using the PRISMA guidelines [21].
Once the frameworks were identified, their categories and category definitions were extracted and tabulated. This was done independently by MS and a researcher who was not part of the study team or familiar with this work. The frameworks were coded according to the criteria for usefulness by RW and SM.
Develop a new framework
The new framework was developed by tabulating the full set up of intervention categories that had been identified and establishing links between intervention characteristics and components of the COM-B system that may need to be changed. The definitions and conceptualisation of the intervention categories were refined through word and by consulting the American Psychological Association'southward Dictionary of Psychology and the Oxford English language Dictionary. The resulting framework was then compared with the existing ones in terms of the criteria of usefulness (i.due east., met or not met).
Finally, a structure for the framework, in terms of organisation of components and links between them was arrived at through an iterative process of word and testing against specific examples and counter-examples. Linking interventions to components of the behaviour system was achieved with the aid of a broad theory of motivation that encapsulated both cogitating and automated aspects, and focused on the moment to moment control of behaviour by the internal and external surround which in plow is influenced by that behaviour and the processes leading upwards to it [vii]. Thus, for example, interventions that involved coercion could influence reflective motivation by changing conscious evaluations of the options or past establishing automated associations betwixt anticipation of the behaviour and negative feelings in the presence of particular cues. In that location is not the space to go into details of this assay hither. These can be establish in [7].
Test the reliability of the framework
The framework was used independently by RW and SM to classify the 24 components of the 2010 English government tobacco control strategy [22] and the 21 components of the 2006 Dainty obesity guidance [23]. The level of inter-rater agreement was computed and any differences resolved through discussion. The areas of tobacco control and obesity reduction were called because these are among the virtually important in public health and ones where health professional behaviour has consistently been institute to fall brusk of that recommended by show-based guidelines [24–26]. In add-on, these documents cover a broad spectrum of behaviour alter approaches. Following reliability testing and discussion of any disagreements, a 'gold standard' was established.
Next, reliability of use by practitioners was assessed past request two policy experts (the Department of Wellness Policy Lead for implementation of the 2010 English language authorities tobacco command strategy and a tobacco researcher) to independently classify the 24 components of the strategy (see Additional file 1 for coding materials). Their coding information were compared with the 'gold standard.'
Results
Systematic literature review of existing frameworks
From the systematic literature search, 1,267 articles were identified from the electronic databases, eight of which met our inclusion criteria. The skillful consultations produced a farther 17 articles, 11 of which met the inclusion criteria resulting in a full of 19 articles describing 19 frameworks. (Run into Additional file ii for more detail of catamenia of studies through the review procedure, and Additional file 3 for reasons for exclusion). Additional file 4 shows the frameworks and gives a brief description of each [11, 12, 16, 27–42].
Several things became apparent when reviewing the frameworks. Offset of all, it was articulate it would be necessary to define terms describing categories of intervention more precisely than is washed in everyday linguistic communication in club to achieve coherence. For example, in everyday language 'teaching' can include 'training,' but for our purposes it was necessary to distinguish between 'didactics' and 'training' with the former focusing on imparting cognition and developing understanding and the latter focusing on evolution of skills. Similarly we had to differentiate 'preparation' from 'modelling.' In common parlance, modelling could exist a method used in training, but we use the term more specifically to refer to using our propensity to imitate equally a motivational device. A third example is the use of the term 'enablement.' In everyday apply, this could include most of the other intervention categories, but here refers to forms of enablement that are either more encompassing (as in, for instance, 'behavioural support' for smoking cessation) or work through other mechanisms (as in, for example, pharmacological interventions to aid smoking abeyance or surgery to enable control of calorie intake). There is non a term in the English language linguistic communication to draw that nosotros intend, and then rather than invent a new term nosotros take stayed with 'enablement.'
Second, information technology became credible that a distinction needed to be made betwixt interventions (activities aimed at changing behaviour) and policies (actions on the function of responsible government that enable or support interventions). For example, an intervention that involved incentivising primary care organisations to prioritise public health interventions could be implemented through different policies such as producing guidelines and/or legislation. A 2nd case is that raising the financial toll of a behaviour whose incidence one wishes to reduce (an example of coercion) could be enabled and supported past unlike policies, from financial measures (revenue enhancement) to legislation (fines). We therefore had to divide the categories that emerged into 'interventions' and 'policies.'
Tertiary, any given intervention could in principle perform more than than ane behaviour alter part. Thus the intervention categories identified from the 19 existing frameworks were better conceived of as non-overlapping functions: a given intervention may involve more than i of these. For example, a specific instance of brief doctor advice to reduce booze consumption may involve the 3 dissimilar functions of educational activity, persuasion, and enablement, whereas another may involve merely one or two of these. With regard to the policies, it was possible to care for them as non-overlapping categories.
With this in listen, scrutiny of the frameworks yielded a prepare of 9 intervention functions and vii policy categories that were included in at least i framework. Tabular array 1 lists these and their definitions (their sources are detailed in Additional file 5). Additional file vi shows whether or not the intervention functions and policy categories were covered by each of the reviewed frameworks. The inter-rater reliability for coding the frameworks by intervention functions and policy categories was 88%.
Additional file 7 shows how existing frameworks met the criteria of usefulness. Information technology is apparent that no framework covered all the functions and categories and thus did not see the criterion of comprehensiveness. Only three frameworks met the criterion of coherence. Seven were explicitly linked to an overarching model of behaviour.
Development of a new framework
Given that policies can just influence behaviour through the interventions that they enable or support, it seemed advisable to place interventions between these and behaviour. The most parsimonious way of doing this seemed to be to represent the whole classification arrangement in terms of a 'behaviour change wheel' (BCW) with three layers as shown in Figure ii. This is not a linear model in that components within the behaviour system interact with each other equally do the functions within the intervention layer and the categories within the policy layer.
The Behaviour Change Bicycle.
Having established the structure of the new framework, the side by side step was to link the components of the behaviour system to the intervention functions and to link these to policy categories using the arroyo described in the Methods section. This led to a framework that met the third benchmark of linkage with an overarching model of behaviour change (Tables 2 and 3).
Testing the reliability of the new framework
The initial coding of the intervention functions and policy categories of the 2010 English language Tobacco Command Strategy was achieved with an inter-rater understanding of 88%. The inter-rater agreement for the Squeamish Obesity Guidance was 79%. Differences were readily resolved through discussion (come across Boosted file viii for details of the analysis). The percentage agreement between the identified components and the 'gold standard' was 85% for the implementation atomic number 82 for the 2010 English language authorities tobacco command strategy in the Department of Health and 75% for the tobacco researcher.
Discussion
Within 19 frameworks for classifying behaviour change interventions, nine intervention functions and seven policy categories could be discerned. None of the frameworks covered all of these. Merely a minority of the frameworks could exist regarded as coherent or linked to an overarching model of behaviour. However, it was possible to construct a new BCW framework that did run across these criteria from the existing ones. This framework could exist reliably applied to allocate interventions within two important areas of public health.
We believe that this is the showtime attempt to undertake a systematic analysis of behaviour intervention frameworks and apply usefulness criteria to them. This is besides the starting time time that a new framework has been synthetic from existing frameworks explicitly to overcome their limitations. Moreover, we are not aware of other attempts to assess the reliability with which a framework can be applied in exercise.
It must exist recognised that at that place are a virtually infinite number of ways of classifying interventions and intervention functions. The one arrived at here will no doubt be superseded. Simply for the present, information technology has the benefits of having been derived from classifications already bachelor and therefore covering concepts that accept previously been considered to be important, and using an overarching model of behaviour to link interventions to potential behavioural targets. The well-nigh of import test of this framework volition be whether it provides a more than efficient method of choosing the kinds of intervention that are likely to be appropriate for a given behavioural target in a given context and a given population.
Just by identifying all the potential intervention functions and policy categories this framework could prevent policy makers and intervention designers from neglecting important options. For case, it has been used in UK parliamentary circles to demonstrate to Members of Parliament that the current Great britain Government is ignoring important prove-based interventions to change behaviour in relation to public health [43, 44]. By focusing on environmental restructuring, some incentivisation and forms of subtle persuasion to influence behaviour, as advocated by the popular book 'Nudge' [45], the UK Government eschews the utilise of compulsion, persuasion, or the other BCW intervention functions that 1 might use.
Although awareness of the full range of interventions and policies is important for intervention design, the BCW goes across providing this. Information technology forms the basis for a systematic analysis of how to make the selection of interventions and policies (every bit in Tables two and 3). Having selected the intervention office or functions nearly likely to exist effective in changing a particular target behaviour, these tin can then exist linked to more fine-grained specific behaviour alter techniques (BCTs). Any one intervention office is likely to contain many individual BCTs, and the aforementioned BCT may serve unlike intervention functions. An exam of BCTs used in self-direction approaches to increasing concrete action and healthy eating [46], and in behavioural support for smoking abeyance [47, 48], shows that these BCTs serve 5 of the intervention functions: education, persuasion, incentivisation, grooming, and enablement. The other iv intervention functions (coercion, brake, ecology restructuring, and modelling) place more emphasis on external influences and less on personal bureau. Reliable taxonomies for BCTs within these intervention functions have still to be developed.
I of the strengths of this framework is that it incorporates context very naturally. There is a full general recognition that context is key to the effective blueprint and implementation of interventions, but it remains under-theorised and under-investigated. The 'opportunity' component of the behavioural model is the context, so that behaviour can simply exist understood in relation to context. Behaviour in context is thus the starting bespeak of intervention design. The behaviour organization as well has automatic processing at its eye, broadening the understanding of behaviour across the more reflective, systematic cognitive processes that accept been the focus of much behavioural enquiry in implementation scientific discipline and wellness psychology (for case, social noesis models such equally the Theory of Planned Behaviour).
An existing framework that has fabricated an important contribution to making intervention design more than systematic is 'intervention mapping' [xvi]. A fundamental divergence between this and the BCW arroyo is that intervention mapping aims to map behaviour on to its 'theoretical determinants' in order to identify potential levers for alter, whereas the BCW approach recognises that the target behaviour tin in principle arise from combinations of whatsoever of the components of the behaviour system. It may appear that some components are more important than others considering of a lack of variance in (including absence or universal presence of) the variables concerned in the population under study. This tin can be illustrated past a study of GP communication to smokers, which constitute that a unmarried variable -- degree of business organisation that it would harm the doctor-patient human relationship -- accounted for pregnant variance in the rate of communication-giving [49]. 'Intervention mapping' would propose that concern be the target for an intervention (as long every bit a sentence were made that this could exist modified using interventions that were realistically applicative). The BCW would analyse the target behaviour in context and note that, regardless of what covariation might currently exist, the target behaviour consists of an activity in which adequacy is not at issue, and the cogitating motivation is broadly positive. The problem arises because automated motivational factors are currently working against the behaviour (e.g., lack of emotional reward for giving advice or penalization for not giving information technology and lack of cues to action). Moreover, the physical opportunity is express (lack of time) and the social opportunities are besides somewhat limited. It would then consider the full range of ways in which the frequency of advice-giving could exist increased. Because the target behaviour is part of a 'system,' a unmarried intervention may have consequences for other parts of the organization - these might work confronting sustainable change or in favour of it.
Thus, the BCW approach is based on a comprehensive causal assay of behaviour and starts with the question: 'What conditions internal to individuals and in their social and physical environment need to exist in place for a specified behavioural target to be achieved?' The 'intervention mapping' approach is based on an epidemiological assay of co-variation within the behavioural domain and starts with the question: 'What factors in the present population at the present time underlie variation in the behavioural parameter?' When it comes to theoretical underpinnings, the BCW approach draws from a single unifying theory of motivation in context that predicts what aspects of the motivational system will need to be influenced in what ways to accomplish a behavioural target, whereas the 'intervention mapping' arroyo draws on a range of theoretical approaches each of which independently addresses different aspects of the behaviour in question.
The BCW is existence developed into a theory- and evidence-based tool allowing a range of users to design and select interventions and policies according to an assay of the nature of the behaviour, the mechanisms that need to be changed in lodge to bring well-nigh behaviour modify, and the interventions and policies required to change those mechanisms. An ongoing plan of research is developing an 'intervention design tool' based on the BCW. It starts with a theoretical understanding of behaviour to determine what needs to alter in order for the behavioural target to exist achieved, and what intervention functions are probable to be effective to bring almost that alter. It is being field tested by a range of staff involved in policy and intervention work applying the framework to develop prototype strategies for specific implementation targets. Information are existence collected nigh ease of apply and the potential of the BCW to generate new insights.
There are a number of limitations to the research described in this paper. First, it is possible that the systematic review missed important frameworks and/or intervention functions. 2d, judgement is inevitably involved in conceptualising intervention functions and policy categories. In that location are many dissimilar ways of doing this, and no guarantees that the 1 arrived at hither is optimal. Indeed, unlike frameworks may be more than or less useful in different circumstances. Third, even though the proposed framework appears to be comprehensive and can exist used reliably to characterise interventions, information technology is possible that information technology may bear witness difficult to employ. Yet, the systematic way in which development of the BCW has been approached should enable information technology to provide a more robust starting bespeak for development of improved frameworks than has hitherto been possible.
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Acknowledgements
Marie Johnston, University of Aberdeen and Jamie Brown, University College London, provided astute and helpful comments on an earlier draft of the paper. Likewise thanks to Marie Johnston, Queen of acronyms, for COM-B. We thank Dorien Pieters, Maastricht University, for her work in coding frameworks into categories to provide a reliability check for information extraction. Cancer Enquiry UK provided financial support for RW. Matthew West (of Vasco Graphics) created the artwork.
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SM and RW conceived the study, designed the measures, supervised the systematic review, supervised the analyses and drafted the write-up. MMvS undertook the systematic review, performed the coding and commented on the write-up. All authors read and approved the final manuscript.
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Michie, Southward., van Stralen, M.Thousand. & West, R. The behaviour modify wheel: A new method for characterising and designing behaviour change interventions. Implementation Sci 6, 42 (2011). https://doi.org/10.1186/1748-5908-half dozen-42
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DOI : https://doi.org/10.1186/1748-5908-6-42
Keywords
- Behaviour Change
- Target Behaviour
- Intervention Function
- Behaviour Change Intervention
- Behaviour Change Technique
Source: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-6-42
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