Article summary with From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques - Michie, Johnston, Francis, Hardeman & Eccles - 2009

Designing interventions to change behaviour often rely on theories that provide little guidance on how behaviour is changed. In the current article, the researchers try to explain methods for the development of behaviour changing techniques and for linking existing techniques to the underlying theoretical constructs.

What are the objectives of this study?

Interventions to change behaviour should be based on behavioural theories. Problems with interventions often arise in the evaluation part. This is because the intervention is not fully defined. When designing an intervention there are some steps that need to be taken.

1. Accumulation of evidence

2. Creating a theoretical basis

3. Modelling of the theoretical basis. This includes hypothesis testing of what to target and how to target.

4. Designing and implementing including evaluation.

The use of theory in interventions is important because interventions are often more effective when they target the behaviours that are responsible for behavioural change. Also, the only way to test a theory properly is when it relies on theoretically informed evaluations. Lastly interventions based on theory facilitate the understanding of the intervention across different populations, contexts and behaviours. A theory-based intervention is an intervention where implicit causal assumptions are avoided and that can be tested using a randomised controlled trial. Without a theoretical basis intervention prove to be less effective, but even with a theoretical framework the information about how to develop theory-based interventions is limited. Therefore, researchers that design intervention should have a small number of theoretical frameworks that are based on empirical evidence of the predictive value. Then, techniques should be identified to change these behavioural determinants. There is currently no accessible and comprehensive list of techniques. There should be a procedure for the selection of techniques to target behavioural determinants. The aim of this study is to contribute to the process of constructing a taxonomy about techniques used for behavioural change and the development of theory-based interventions.

What methods were used in this study?

They generated a list of techniques published in two systematic reviews. In stage 1 a list of techniques and definitions was created by consultation of textbooks and brainstorming. Also, the reliability of the extracted definitions was measured. Then thirty-five techniques were used for brainstorming by clinical psychologists. In addition, two of the authors expanded the created list by systematically extracting techniques from textbooks. These textbooks were identified by clinical course leaders. Then the reliability of extracting definitions was tested. A third, independent researcher assessed this reliability. During stage two techniques were mapped onto behavioural determinants. The applicability of each technique was rated and categorized upon agreement. The categories were the following:

1. Agreed use: researchers agreed upon the use of the technique

2. Agreed non-use: agreement that technique would not be used

3. Disagreement

What were the results of the study?

The researchers found eleven constructs associated with behaviour change. Thirty-five techniques were identified and expanded to fifty-three by brainstorming techniques and enlarged to one hundred thirty-seven by using textbooks. The fifty-three definitions that were agreed upon by the four experts were assessed together with the additional eighty-three definitions derived from textbooks. Then the definitions were mapped onto behavioural determinants. The agreement for fifty-three of the definitions came to 74.7%. Furthermore, agreements about the link between the thirty-five techniques and theoretical constructs was calculated to be 71%.

What can be concluded by the research?

The work illustrates that developing a comprehensive and reliable taxonomies related to theory can be developed. A reasonable agreement can be accomplished about the identification of separate techniques, definitions and mapping them onto behavioural determinants. It is clear that this is a cumulative process and the created list will get more and more additions to it. A technique should have a clear definition and should not duplicate techniques that are already in the list. The generation of the list used for theory-based interventions has a wider applicability. It can also be used to describe interventions without a theoretical basis, but only when the behavioural determinants fit the 11 described domains. Furthermore, it could be used to describe interventions that have already been published in meta-analysis. However, further refinement is needed to diminish redundancies, complete definitions and to resolve uncertainties.

What were the strengths and limitations of the current study?

Despite the subjective difficulty of the task, the results of the mapping techniques showed a reasonable level of agreement. A lack of familiarity with the techniques would result in disagreement or uncertainty. This finding alone can be applied in avoid wasting human resources on interventions likely to be unsuccessful. There is also a substantial agreement about changes to some of the determinants and techniques on changing each of the eleven theoretical domains.

However, the classification across causal determinants was not evenly distributed. This indicates that fewer options for the selection of change techniques that we are not aware of. Some techniques appear to be relevant to changing more constructs than others. The selection of techniques should be guided, and it may be more feasible to operationalize certain techniques instead of others. In future research, more techniques for a single determinant might be identified.

Another possibility is that with a larger body of experts it is likely that more techniques could be found using a larger body of experts. This will increase the number of techniques substantially.