Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

Abstract

BackgroundIndigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS.MethodThe Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.’s “Behaviour Change Wheel” guide.ResultsTargets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients’ capability, opportunity and motivation.ConclusionsThe ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.

Understanding decisions to use e‐cigarettes or behavioural support to quit tobacco: a qualitative study of current and ex‐smokers and stop smoking service staff

“…The Stages of Change model, for instance, proved influential internationally in smoking cessation work, but systematic research has cast considerable doubt on its effectiveness, leading to it being largely discredited . The ‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’ (COM‐B) model, part of the wider Behaviour Change Wheel framework , is now favoured within the smoking cessation sector in the United Kingdom and beyond , and also underpins Public Health England's SSS commissioning guidance for councils . COM‐B posits that ‘behaviour’ is a product of ‘motivation’ (reflective and automatic brain processes), ‘opportunity’ (factors external to an individual) and ‘capability’ (psychological and physical capacities).…”

A collaborative approach to developing sustainable behaviour change interventions for childhood obesity prevention: Development of the Choosing Healthy Eating for Infant Health (CHErIsH) intervention and implementation strategy

“…Use of the BCW also enabled us to make the programme theory underlying both aspects of our intervention explicit, by facilitating our development of a logic model linking specific intervention components to study outcomes, via the intended mechanisms of change. While several other implementation frameworks or models could have used to develop the HCP‐level implementation strategy (Nilsen, ), the BCW was specifically developed to improve the design and implementation of evidence‐based practice (Michie et al , ) and has previously been used to develop implementation strategies to support the delivery of patient‐level interventions (Gould et al , ; Mc Sharry, Murphy, & Byrne, ; Sinnott et al , ). However, examples of studies that have used the Behaviour Change Wheel approach with this amount of evidence sources from such varied perspectives are rare; our study showcases the transparent and systematic development of a thorough and extremely comprehensive evidence‐based intervention and associated implementation strategy.…”

Barriers and opportunities for management of shared sanitation facilities in low-income settlements in Kenya

“…The BCW has been applied to understand behavioural determinants and design interventions aimed at instilling good hygiene habits in schools in Uganda [14], development of caregiver hygiene behaviour measures [15] and other health related interventions [16][17][18][19][20][21][22]. The approach involves three stages: (1) Understanding the behaviour and identifying what needs to change (2) Identifying Intervention Functions (3) Identifying content and relevant 'Delivery mode' for the intervention.…”