Methods for strengthening evaluation and implementation: specifying components of behaviour change interventions

Improving health depends largely on changing behaviour, whether this is ?lifestyle? behaviours, e.g. smoking and physical activity, ?illness? behaviours, e.g. taking prescribed medication, or ?health care? behaviours, e.g. hospital staff washing their hands. Money is being invested in research aimed at developing interventions to change such behaviours. These interventions are usually complex but often described in very general terms that do not give information about the content, e.g. ?behavioural counselling? or ?stress management?. If the content of interventions cannot be clearly agreed and understood, then, even if an intervention works very well, it would be very difficult to ensure that we can implement the successful intervention in the NHS. In medicine, we require interventions to be defined precisely, e.g. the chemicals in drugs, their dose and frequency. We need to be just as precise for interventions to change behaviour if we want to improve patient and public health. This research will enable behavioural scientists to accumulate more evidence about what works (as well as what does not work and is a waste of money) and how interventions work. It will enable health practitioners to deliver more effective interventions, and avoid harmful interventions being delivered by the NHS. This research aims to develop a scientific method for describing interventions to change behaviour by defining the specific techniques used (e.g. goal setting or use of rewards). We are already aware of over 100 techniques, but it is not clear which of these are the same, different or overlapping techniques. The research will involve groups of experts from a variety of backgrounds producing clear and reliable definitions for each technique for use by practitioners and researchers. This includes reporting interventions in research reports, synthesising research findings in systematic reviews, and delivering interventions, for example, to help people stop smoking or health professionals to provide high quality health care. The research will deliver a web-based resource comprising a handbook of clearly defined and agreed techniques and a training tool. We predict that this will be an invaluable tool for all those wanting to develop interventions to change behaviours to improve health, and for health practitioners working in the NHS.

The importance of behaviour change to improving health is demonstrated by increasing investment by funding bodies in developing and evaluating complex interventions to change population, patient and practitioner behaviours. The development of effective interventions is hampered by the absence of a nomenclature to specify and report their content. This limits the possibility of replicating effective interventions, synthesising evidence, and understanding the causal mechanisms underlying behaviour change. In contrast, biomedical interventions are precisely specified, e.g. the pharmacological ?ingredients? of prescribed drugs, their dose and frequency of administration. For most complex interventions, the precise ?ingredients? are unknown; descriptions e.g. ?behavioural counselling? can mean different things to different researchers or implementers. The lack of a method for specifying complex interventions undermines the precision of syntheses of evidence of effectiveness, posing a problem for secondary, as well as primary, research. We will develop a reliable method of specifying intervention components (?techniques?) aimed at changing behaviour. This will strengthen the scientific basis for developing, evaluating and reporting complex interventions. The research builds on extensive pilot work by the applicants, an identified multidisciplinary need for such a method and a large team of collaborators keen to participate in its development. The research will be conducted in three phases. The first will develop the nomenclature. We will refine our preliminary list of techniques and definitions. Experts will then define the key attributes of each technique and how it relates to, and differs from, others, using a consensus development method, the Delphi method. They will evaluate the techniques and their definitions until they achieve an agreed list of clearly defined, non-redundant techniques. The second phase will test the nomenclature. Trained experts (primary researchers and systematic reviewers), equipped with a coding manual and guidance, will use the nomenclature to code published descriptions of complex interventions. Reliability between experts, over time, and across types of user will be assessed. We will assess whether using the nomenclature to write intervention descriptions enhances the clarity and replicability of interventions. The third phase will develop a web-based users? resource of clearly specified and non-redundant techniques, which will aid the scientific understanding of, and development of, effective complex interventions. Dissemination throughout the project will be by stakeholder meetings, targeted multidisciplinary workshops, conference presentation, journal publication and an interactive web-based platform (a Wiki).