Table 4 BCTs - definitions, examples, frequency and association with intervention outcomes
BCT | Definitiona | Example | No. used in very promising intervention | No. used in quite promising interventions | No. used in not promising interventions | Total no. of times used across all interventions | Promise ratio |
|---|---|---|---|---|---|---|---|
Feedback on behaviour | Monitor and provide informative or evaluative feedback on performance of the behaviour (e.g. form, frequency, duration, intensity) | “presented local pre-test prescribing in comparison with overall pre-test data and qualitative data on factors influencing antibiotic prescribing behaviour.” [59] | 5 | 3 | 1 | 9 | 8 |
Discrepancy between behaviour and goal | Draw attention to discrepancies between a person’s current behaviour (in terms of the form, frequency, duration, or intensity of that behaviour) and the person’s previously set outcome goals, behavioural goals or action plans (goes beyond self-monitoring of behaviour) | “individualized direct feedback regarding specific instances when inappropriate urine cultures were sent and when ASB was treated” [71] | 4 | 0 | 0 | 4 | – |
Instruction on how to perform the behaviour | Advise or agree on how to perform the behaviour (includes ‘Skills training’) | ““a 60-min presentation summarizing treatment recommendations” [69] | 7 | 7 | 4 | 18 | 3.5 |
Information about health consequences | Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour | “education was provided regarding the potential adverse effects of unnecessary antibiotic use, including promotion of antibiotic resistance,” [71] | 2 | 2 | 1 | 5 | 4 |
Prompts/cues | Introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour. The prompt or cue would normally occur at the time or place of performance | “Posters and other promotional material such as bookmarks were also distributed” [65] | 2 | 5 | 0 | 7 | – |
Monitoring of behaviour by others without feedback | Observe or record behaviour with the person’s knowledge as part of a behaviour change strategy | “pharmacists did not interfere with antibiotic prescribing, but collected data on antibiotics prescribed, duration of therapy, laboratory tests, signs and symptoms of infection, and culture and sensitivity results” [67] | 0 | 2 | 0 | 2 | – |
Demonstration of the behaviour | Provide an observable sample of the performance of the behaviour, directly in person or indirectly e.g. via film, pictures, for the person to aspire to or imitate (includes ‘Modelling’). | “stimulated interactions between the participants” [60] | 1 | 3 | 0 | 4 | – |
Adding objects to the environment | Add objects to the environment in order to facilitate performance of the behaviour | “the introduction of the RAMP antimicrobial stewardship tool” [65] | 4 | 6 | 3 | 13 | 3.33 |
Problem solving | Analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators | “prompted to … identify barriers to implementation, to develop strategies for addressing those barriers, and to discuss and clarify their role in implementation” [56] | 0 | 2 | 2 | 4 | 1 |
Material incentive (Behaviour) | Inform that money, vouchers or other valued objects will be delivered if and only if there has been effort and/or progress in performing the behaviour (includes ‘Positive reinforcement’) | “the intervention facilities were paid an additional $1000 each year during the 2 intervention years to incentivize guideline compliance” [53] | 0 | 1 | 0 | 1 | – |
Social support (practical) | Advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour | “the providers were given a telephone number for both the infectious diseases physician on call and the antibiotic stewardship pharmacist. They were informed that this number could be called 24 h a day 7 days a week for any infectious disease related questions” [69] | 3 | 3 | 0 | 6 | – |
Restructuring the social environment | Change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) | “The homes identified a study liaison nurse who was the facility’s change agent for the study” [53] | 2 | 5 | 1 | 8 | 7 |
Self-monitoring behaviour | Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy | “We asked the nurses to complete a one page log of presenting symptoms and signs for every resident in whom urinary tract infection was suspected, as a reminder to use the algorithms.” [23] | 2 | 2 | 0 | 4 | – |
Self-monitoring outcomes of behaviour | Establish a method for the person to monitor and record the outcome(s) of their behavior as part of a behavior change strategy | “results of specimens/swabs or ‘not available yet’ or ‘none taken’ recorded; outcome of antibiotic treatment documented” [65] | 0 | 1 | 0 | 1 | – |
Feedback on outcome(s) of behaviour | Monitor and provide feedback on the outcome of performance of the behaviour | “use of antibiograms” [69] | 1 | 0 | 2 | 3 | 0.5 |
Credible source | Present verbal or visual communication from a credible source in favour of or against the behaviour | “The LID consultation service consisted of an infectious disease physician and nurse practitioner” [57] | 7 | 3 | 2 | 12 | 5 |
Review behaviour goals | Review behaviour goal(s) jointly with the person and consider modifying goal(s) or behaviour change strategy in light of achievement. This may lead to re-setting the same goal, a small change in that goal or setting a new goal instead of (or in addition to) the first, or no change | “the identification of opportunities for improved practice (i.e. planning action)” [59] | 0 | 0 | 1 | 1 | – |
Restructuring the physical environment | Change, or advise to change the physical environment in order to facilitate performance of) the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments | “Change to default stop dates for some antibiotics - simplified access to guidelines on computers” [62] | 0 | 2 | 0 | 2 | – |
Shaping Knowledge | This is the cluster heading for BCTs that serve an educational purpose in the taxonomy | “Residents, their family members, and other NH staff received an informational brochure related to antibiotic prescribing and the QI program, and many attended family night gatherings or a resident council meeting or health fair where this information was presented” [64] | 1 | 1 | 0 | 2 | – |