Contributions to the literature
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Using systematic guidelines to develop behaviour change interventions requires judgements, which can be opaque.
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We propose a three-phase process, namely, evidence synthesis, stakeholder involvement and decision-making to move from the evidence base to the intervention involving and incorporating stakeholder perspectives into the design process.
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We believe this approach represents a transparent and systematic framework for developing behaviour change interventions in any setting.
Introduction
Aims
Phase 1: Evidence synthesis
Introduction
Methods
Ideal | Possible compromises | Worked example | |
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Evidence collection | Mixed-methods meta-synthesis based on published papers | • Rapid primary data collection • Rapid reviews | • 5 primary qualitative studies • 1 rapid review • 1 literature mapping exercise |
Personnel | Widest possible grouping of fully trained stakeholders design and conduct the mixed-methods meta-synthesis | • Multidisciplinary research team • Behavioural scientists plus practitioners | • Face-to-face meeting of multidisciplinary research team (N = 16) including behavioural scientists, academics, psychologists, mental health practitioners and the patient and public involvement lead |
Input | Recommendations based on mixed-methods meta-synthesis | Accessible summaries of the key findings and recommendations for intervention development from individual studies | Two weeks prior to face-to-face meeting, the full programme team (N = 27) received: • Two slides for a 5-min presentation • Single-page summaries of the key findings and recommendations for each of the 7 studies and comments invited. |
Identify key domains to be included in intervention | Already present in mixed-method synthesis conclusions | Use COM-B to structure people’s identification of key domains, which can be completed by: • Individuals • Small group • Facilitated large group discussions | Face-to-face meeting attendees used post-it notes to categorise intervention domains into the six COM-B areas: • Individually • In small groups mixed by experience/expertise • In facilitated large group discussion |
Cross-validation | Experts cross-check evidence synthesis phase with knowledge and experience | Experts cross-check evidence synthesis phase with knowledge and experience | Identification of potential barriers/enablers to behaviour change identified via a scoping search of previously published literature conducted by PB and KL |
Results
Phase 2: Stakeholder involvement
Introduction
Methods
Standard RAND/UCLA | Adapted RAND/UCLA | Worked example | |
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Inputs | Series of systematic reviews/meta-analyses | Intervention domains from phase 1 | 93 domains identified in phase 1 |
Stakeholders | Experts | As broad as possible, being mindful of traditionally excluded groups | • Patients (n = 9) • Practitioners (n = 19) • Key informants (n = 15) |
Number of rounds | 3: • Individual ratings of appropriateness • Moderated group ratings of appropriateness • Individual ratings of necessity | 3 per group of stakeholders: • Individual ratings of importance • Moderated group ratings of items rated ‘not important’ • Individual ratings of ‘how essential?’ | Separate meetings of patients, practitioners and key informants completing: • Individual ratings of importance • Moderated group ratings of items rated 'not important' • Individual ratings of ‘how essential?’ |
Critical cut-offs | Median of = > 7 on 1–9 point Likert-type scales | Median of = > 7 on 1–9 point Likert-type scales | Median of = > 7 on 1–9 point Likert-type scales |
Results
Phase 3: Decision-making
Introduction
Methods
Ideal | Possible compromises | Worked example | |
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Personnel | Widest possible grouping of fully trained stakeholders | • Multidisciplinary research team • Behavioural scientists plus practitioners | Face-to-face meeting of an intervention development subgroup comprised of a behavioural scientist, principal investigators, programme manager, researcher, patient and public involvement lead |
Input | Recommendations based on RAND/UCLA analyses of multiple stakeholder groups conducted separately | Recommendations based on RAND/UCLA analyses of single expert group | Three days prior to face-to-face meeting, intervention development subgroup (n=6) received output of phase 2 |
Identify intervention content | All stakeholder groups agree fully on intervention domains. Translate intervention domains into behaviour change techniques and modes of delivery using APEASE criteria | Decide on decision rules to aid choice of intervention domains. Translate intervention domains into behaviour change techniques and modes of delivery using APEASE criteria | Agree criterion of two or more stakeholder groups from phase two rating domains as ‘essential’ (i.e. Median ≥ 7 on round 3). Translate intervention domains into behaviour change techniques and modes of delivery using APEASE criteria |
Final approvals | Full multidisciplinary research team and all stakeholders provided with intervention materials for feedback. Details of the behaviour change intervention described using the Template for Intervention Description and Replication (TIDieR) | Subgroup of multidisciplinary research team and stakeholders provided with intervention materials for feedback. Details of the behaviour change intervention described using the Template for Intervention Description and Replication (TIDieR) | Full multidisciplinary research team provided with intervention materials for feedback. Details of the behaviour change intervention described using the Template for Intervention Description and Replication (TIDieR) |
Results
Target levels | ||||
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COM-B DOMAINS | Services | Practitioners | Patients | |
CAPABILITY | Physical capability | |||
Psychological capability | • Provide knowledge on procedures and guidelines to deliver psychological interventions remotely • Boost practitioners’ telephone skills | • Provide knowledge about the origins, drivers, and processes of telephone treatment • Develop telephone skills to enable a good therapeutic relationship, improve patient engagement, deliver patient-centred care, and effectively deliver treatment without visual aids and non-verbal cues | • Improve knowledge on psychological treatments (e.g. counselling, cognitive behavioural therapy, guided-self-help) and its different modes of delivery (e.g. face-to-face, telephone, group, online) | |
OPPORTUNITY | Physical opportunity | • Ensure practitioners are working in a comfortable and confidential environment • Ensure resources needed for telephone delivery are available | ||
Social opportunity | • Provide regular assessment and monitoring of telephone performance in service • Promote learning and collaborative work across practitioners | • Provide assessment and monitoring of telephone performance during training and clinical practice | ||
MOTIVATION | Automatic motivation | Identify feelings related to working by telephone, and discuss feelings of being undervalued | ||
Reflective motivation | • Promote reflective practice (e.g. telephone performance, beliefs and emotions related to working remotely, professional role expectations/challenges) | • Challenge negative beliefs associated to telephone treatment (e.g. telephone is a lower version of treatment) |