Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions

Abstract

Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.

Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy

“…There are a few examples in the literature, but this approach is yet to be rigorously tested 722 Deconstruction into individual elements such as BCTs and using a common language (taxonomy) has the potential to simplify the comparison of studies, improve replication and link BCTs to outcomes 722 This process may be especially relevant in the community pharmacy setting, due to the heterogeneity of research involving implementation of clinical guidelines 12…”

“…The aim of creating the taxonomy was to improve intervention design and execution and allow for comparison across studies 6. It was used in this way by the Resources Enhancing Alzheimer's Caregiver Health consortium to examine multiple intervention studies 7. These characteristics make ITAX an appropriate tool for process evaluation in post hoc analysis, rather than simply a checklist for use at the intervention design stage.…”

Evaluating factors influencing the delivery and outcomes of an incentive-based behaviour change strategy targeting child obesity: protocol for a qualitative process and impact evaluation

“…The purpose of this is threefold: (1) to optimise the robustness and replication potential of the research by using a common language to recognise and specify the components of the intervention that are changing behaviour (use of the taxonomy supports the CONSORT guidelines for the reporting of behaviour change interventions,42 (2) to facilitate translation of the interventions for the greatest effect on child obesity outcomes by separating the active ingredients within the intervention components and the conditions under which they are effective, from components that may be less necessary and (3) to understand more about any intervention components that may be useful but were not sufficient in dose to produce an impact on outcomes 34. It will also be useful to refer to the full list of 93 items in the BCTT41 in the analysis of how and why specific components worked or did not work.…”

“…Therefore, completion of a detailed qualitative process evaluation will facilitate the translation of knowledge from clinical research with children, and help guide how effective incentive strategies could be optimally implemented into routine practice for addressing childhood obesity. Furthermore, using a framework for deconstructing and specifying various intervention components within a process evaluation will enable the active components of the intervention that change behaviour to be isolated, along with underlying mediators of action, effective modes of delivery and the most receptive populations 34. This will facilitate replication of the interventions into community health settings, inform resource allocation and advance intervention science.…”

Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations

“…46–50 Equally important is the need to track intervention adherence, dose (delivered and received), and fidelity. 46,51–53 For intervention trials that are being conducted by multiple investigative teams (such as in a multicenter trial), the ability to identify common process measures allows intervention implementation to be examined both within and across trials, thereby increasing the richness of the data. 25,54 …”