From Theory to Intervention: Mapping Theoretically Derived Behavioural Determinants to Behaviour Change Techniques

Authors


  • Authors 1 and 2 are members of the MRC Health Services Research Collaboration. Author 3 is a member of the Aberdeen Health Psychology Group, funded by the Institute of Applied Health Sciences, and of the Health Services Research Unit, funded by the Chief Scientist Office of the Scottish Government Health Directive. Author 4 is funded by NHS NIHR Academic Unit Funding. The views expressed are not necessarily those of the funding bodies. We thank Jess Berentson-Shaw and Moira Cruickshank for help in data preparation and Charles Abraham for valuable discussions on related work (Abraham & Michie, in press).

* Address for correspondence: Susan Michie, Department of Psychology, University College London, London WC1E 7HB, UK. Email s.michie@ucl.ac.uk

Abstract

Theory provides a helpful basis for designing interventions to change behaviour but offers little guidance on how to do this. This paper aims to illustrate methods for developing an extensive list of behaviour change techniques (with definitions) and for linking techniques to theoretical constructs. A list of techniques and definitions was generated from techniques published in two systematic reviews, supplemented by “brainstorming” and a systematic search of nine textbooks used in training applied psychologists. Inter-rater reliability of extracting the techniques and definitions from the textbooks was assessed. Four experts judged which techniques would be effective in changing 11 theoretical constructs associated with behaviour change. Thirty-five techniques identified in the reviews were extended to 53 by brainstorming and to 137 by consulting textbooks. Agreement for the 53 definitions was 74.7 per cent (15.4% cells completed and 59.3% cells empty for both raters). Agreement about the link between the 35 techniques and theoretical constructs was 71.7 per cent of 385 judgments (12.2% agreement that effective and 59.5% agreement that not effective). This preliminary work demonstrates the possibility of developing a comprehensive, reliable taxonomy of techniques linked to theory. Further refinement is needed to eliminate redundancies, resolve uncertainties, and complete technique definitions.

Abstract

La théorie fournit une base utile pour concevoir des interventions destinées à modifier le comportement, mais offre peu d’informations sur la façon de s’y prendre. Cet article expose des méthodes permettant de dresser une vaste liste de techniques de changements comportementaux (avec définitions) et de relier ces techniques à des notions théoriques. Un ensemble de techniques et de définitions est issu de techniques répertoriées dans deux revues de questions systématiques, enrichi par un brainstorming et une exploitation rigoureuse de neuf manuels utilisés pour la formation des psychologues praticiens. On a évalué la fidélité inter-juges d’extraction des techniques et des définitions à partir des manuels. Quatre experts se sont demandé quelles techniques seraient efficaces pour modifier onze notions théoriques en rapport avec le changement comportemental. Les 35 techniques identifiées dans les revues de questions passèrent à 53 après le brainstorming, puis à 137 à l’issue de l’examen des manuels. Le pourcentage d’accord sur les 53 définitions a été de 74,7% (15,4% de réponses positives et 59,3% de réponses négatives). L’accord en ce qui concerne le rapport entre les 35 techniques et les notions théoriques a porté sur 71% des 385 jugements (12,2% d’accords sur l’efficacité et 59,5% sur l’inefficacité). Ce travail exploratoire montre qu’il est possible de concevoir une taxonomie fidèle et détaillée de techniques reliées à la théorie. Une réflexion complémentaire est indispensable pour éliminer les redondances, supprimer des approximations et préciser les définitions des techniques.

INTRODUCTION

There is increasing recognition that interventions to change behaviour should draw on theories of behaviour and behaviour change in their development. For example, in the UK, the Medical Research Council has published a strategy for developing and evaluating complex interventions, which starts with a “theory” phase before progressing to “modelling” and then experimental phases (exploratory trial and randomised controlled trial (RCT)) (Medical Research Council, 2000; Campbell, Murray, Darbyshire, Emery, Farmer, Griffiths, Guthrie, Lester, Wilson, & Kinmonth, 2007). In the theory phase, evidence is accumulated and a theoretical basis for intervention is developed which is modelled in the next phase. Modelling involves hypothesising and testing both what to target (behavioural determinants) and how to do this (techniques to change these determinants). The process of designing and implementing an intervention was seen as challenging: “Problems often arise in the evaluation of complex interventions because researchers have not fully defined and developed the intervention” (Campbell, Fitzpatrick, Haines, Kinmonth, Sandercock, Spiegelhalter, & Tyrer, 2000, p. 694).

There are three main reasons for advocating the use of theory in designing interventions. First, interventions are likely to be more effective if they target causal determinants of behaviour and behaviour change; this requires understanding these causal determinants, i.e. theoretical mechanisms of change. Second, theory can be tested and developed by evaluations of interventions only if those interventions and evaluations are theoretically informed. Third, theory-based interventions facilitate an understanding of what works and thus are a basis for developing better theory across different contexts, populations, and behaviours.

Theory represents an integrated summary of the hypothesised causal processes involved in behaviour change. Unlike “theory-inspired” interventions, theory-based interventions use an explicit causal pathway (Michie & Abraham, 2004) and enable the intervention developer to avoid implicit causal assumptions which may lack evidence or even have been invalidated (Johnston, 1995). Causal processes that underlie a behavioural intervention can be tested within randomised controlled trials examining the effectiveness of the intervention (the Improved Clinical Effectiveness through Behaviour Research Group (ICEBeRG), 2006; Francis, Grimshaw, Zwarenstein, Eccles, Shiller, Godin, Johnston, O’Rourke, Presseau, & Tetro, 2007), thereby strengthening the evidence base for intervention design. Without a theoretical basis, even a large literature on behaviour change interventions may offer no guidance on how to design an intervention for a new situation (Foy, Eccles, Jamtvedt, Young, Grimshaw, & Baker, 2005). In trials of interventions to enhance the implementation of evidence-based practice by health professionals, evidence from over 235 RCTs showed modest success; however, the authors of the systematic review concluded that they had no basis on which to design a new intervention as very few of the trials had used any theoretical foundation and it was therefore impossible to find an integrating framework that could signal the basis of effective interventions (Grimshaw, Thomas, MacLennan, Fraser, Ramsay, Vale, Whitty, Eccles, Matowe, Shirran, Wensing, Dijstra, & Donaldson, 2007).

Nevertheless, even with a theoretical framework, there is little information about how to develop theory-based interventions. A notable exception is Social Cognitive Theory (Bandura, 1997) which specifies how to change the main causal determinant of behaviour, namely self-efficacy, using four techniques: mastery experiences, modelling or vicarious experience, persuasion, and giving physiologically compatible experiences. By contrast, a systematic review of the use of the Theory of Planned Behaviour (Ajzen, 1991) in interventions concluded that the theory was rarely used to design the intervention and was more frequently used as a background to understand the behaviour and to develop measures (Hardeman, Johnston, Johnston, Bonetti, Wareham, & Kinmonth, 2002). Even when people use theory, they tend to use it to explain behaviour but not to change behaviour. For example, Ajzen proposes that the first stage in developing behaviour change interventions is to identify what predicts the behaviour and then to change the predictors, but leaves open the question as to how to change these targets. This is evident in his advice, “Once it has been decided which beliefs the intervention will attempt to change, an effective intervention method must be developed. This is where the investigator's experience and creativity comes into play” (Ajzen, 2006, p. 2). Hardeman, Sutton, Griffin, Johnston, White, Wareham, and Kinmonth (2005) attempt to make the process explicit, but comment that there was no simple link between theory and the choice of intervention techniques.

Thus there is little guidance on how to progress through the early phases of the MRC framework for complex interventions. In considering the key tasks in optimising an intervention, Campbell et al. (2007) do not even refer to the theory-base identified in conceptualising the target problem. Hardeman et al. (2005) have proposed a causal modelling approach (see Box 1). Each arrow represents a causal process and interventions are targeted at changing these causal processes. Within this framework, behaviour change is achieved by targeting the determinants of behaviour.

Figure BOX 1.  .

Proposed framework for causal modelling approaches (Hardeman et al., 2005): Adding behaviour change techniques to the causal modelling schema.

Behavioural determinants (step 1) can be identified from theories of behaviour. So for example, the Theory of Planned Behaviour (Ajzen, 1991), Social Cognitive Theory (Bandura, 1997), and Operant Learning Theory (Skinner, 1963) all propose, and have evidence from cross-sectional and longitudinal studies to support a range of constructs which affect behaviour (Walker, Grimshaw, Johnston, Pitts, Steen, & Eccles, 2003) including: intention, perceived behavioural control, self-efficacy, outcome expectancy, response-reinforcement contingencies, and discriminative stimuli. Evidence-based behaviour change techniques can be directed at these identified behavioural determinants, and evidence for their role in behaviour change investigated (Michie, Hardeman, Fanshawe, Prevost, Taylor, & Kinmonth, 2007). However, effective mapping of theoretical constructs to behaviour change techniques also requires work to: (1) address the problem of the wide range of theoretical frameworks available; (2) specify the range of techniques available to change the determinants of behaviour; (3) develop a basis for selecting relevant techniques to map on to differing determinants of behaviour.

Ideally, researchers designing interventions would choose a small number of the theoretical frameworks based on empirical evidence of their predictive and intervention value, i.e. there should be evidence that the theory can predict the behaviour and that interventions which change these determinants achieve change in behaviour. However, where that is lacking, it would be valuable to find a systematic way to simplify these potential determinants. Two independent attempts at simplification, based on expert consensus, have been published (Fishbein, Triandis, Kanfer, Becker, Middlestadt, & Eichler, 2001; Michie, Johnston, Abraham, Lawton, Parker, & Walker, 2005a) and show good agreement about the key behavioural determinants (see Table 1).

Table 1. 
Key Determinants of Behaviour Change from Fishbein et al., 2001; Michie et al., 2004 (see Original Publications for Definitions)
Fishbein, Triandis, Kanfer et al., 2001Michie, Johnston, Abraham et al., 2004
Self-standardsSocial/professional role and identity
Knowledge
SkillsSkills
Self-efficacyBeliefs about capabilities
Anticipated outcomes/AttitudeBeliefs about consequences
IntentionMotivation and goals
Memory, attention, and decision processes
Environmental constraintsEnvironmental context and resources
NormsSocial influences
Emotion
Action planning

However, there is still the need to identify techniques to change these behavioural determinants, as illustrated in Box 1. The work reported in this paper relates to the development of methods to clarify the list of behaviour change techniques (step 2) and to identify links between the behaviour change techniques and behavioural determinants (step 3).

There is a wide range of techniques available to change behavioural determinants. These techniques are described in texts largely used by applied psychologists and mental health practitioners. However, they tend to be integrated with other techniques designed to change mental states rather than behaviour and are presented as practical tools without reference to their evidence base or clear indication of which theoretical constructs they might target. There is currently no comprehensive and accessible list of techniques; it would be extremely difficult for someone new to the field of behaviour change to extract these techniques from the literature and to find the detail that would be necessary to use them in a complex intervention. In addition, their appropriate application depends on mapping these techniques on to the proposed behavioural determinants.

Thus this paper reports the development of a procedure for selecting relevant techniques to map on to each of the behavioural determinants. It seems obvious that different techniques will address different behavioural determinants. For example, it might be appropriate to rehearse practical skills where the determinant is lack of skill, but not where there is lack of motivation to perform the skill. This mapping process is essential if we are to optimise the benefits of theory-based interventions. Other approaches to intervention development have not done this work, e.g. MRC framework, Intervention Mapping (Kok, Schaalma, Ruiter, Van Empelen, & Brug, 2004).

This paper describes two pieces of preliminary work addressing steps 2 and 3 (Box 1). The first was to develop an extensive list of behaviour change techniques and definitions; the second identified links between these techniques and the theory-based behavioural determinants identified through step 1 and specified in Table 1. This paper describes a first iteration of this process and provides a basis for the further elaboration of this work (dealing with issues such as the further identification of techniques, completing technique definitions, and the elimination of overlap between techniques). Our aim is to contribute to a process of constructing an evolving taxonomy of behaviour change techniques to be used for developing theory-based behaviour change interventions.

METHOD

Stage 1: Generating a List of Techniques and Definitions

The list of techniques and definitions was developed incrementally by brainstorming and consulting textbooks. The reliability of definition extraction was then tested.

Brainstorming.  35 techniques identified from two published systematic reviews (Hardeman, Griffin, Johnston, Kinmonth, & Wareham, 2000; Abraham & Michie, in press) were expanded by “brainstorming” by four health and clinical psychologists (SM, MJ, JF, WH) with expertise in developing and implementing behaviour change interventions. Definitions were also agreed at this stage (see Appendix A).

Textbooks.  Two researchers (authors JF, WH) expanded this list by systematically extracting techniques from textbooks in current use in training applied psychologists in behaviour change techniques. The textbooks were identified by correspondence with clinical psychology course leaders. The nine textbooks (asterisked in the References) (3,182 pages) were consulted according to year of publication, starting with the most recently published books. They covered a range of therapies and approaches (e.g. operant conditioning, behaviour therapy, self-management interventions). Systematic extraction consisted of reading the Contents, Glossaries (where present) and full text to identify: (1) specific reference to each of the 53 techniques; (2) technique definitions, if present; (3) additional techniques and their definitions.

Testing the Reliability of Extracting Definitions.  While extracting the data, JF and WH independently created a matrix of techniques by textbooks. If a technique was reported, the researchers recorded verbatim the description of the technique and the page number. The cell was left blank if the technique was not reported. Reliability between the two researchers in extraction of techniques and definitions was assessed by a third, independent researcher who assessed the proportion of occasions that: there was agreement that no definition was offered; extracted definitions were identical or almost identical; there was disagreement in definitions; there was a definition from only one researcher.

Stage 2: Mapping Techniques onto Behavioural Determinants

Stage 2 was conducted concurrently with Stage 1 and so the experts used the initial set of 35 behaviour change techniques, without definitions. Four researchers (SM, MJ, JF, WH) answered the question, “Which techniques would you use as part of an intervention to change [each determinant]?” (where Blank = no; 1 = possibly, 2 = probably, 3 = definitely). The researchers thus independently rated the applicability of each technique to changing each of the 11 behavioural determinants in Table 1, Column 2. Data relating to 35 techniques × 11 behavioural determinants (giving 385 ratings per rater) were categorised to examine agreement. Categories were: (1) Agreed use: agreement that they would use the technique (at least three raters reported 2 or 3); (2) Agreed non-use: agreement that they would not use the technique (all blank or only one rating of 2 or only 2 ratings of 1); (3) Disagreement (as for (2) but containing a 3); and (4) Uncertain (all the remaining cells in the matrix).

RESULTS

Generating a List of Techniques and Definitions

The 53 definitions agreed by the four experts during the brainstorming exercise are shown in Appendix A. Extraction of definitions, and assessment of their reliability, will be established for the additional 83 techniques identified in textbooks in a future study.

Testing the Reliability of Extracting Definitions

In identifying definitions for the 53 techniques in nine textbooks, the two researchers agreed on 74.7 per cent (363) of the 486 cells (including agreement that the book presented no definition in 288 cells and identification of almost identical definitions in 75 cells). Of the remaining 123 cells, 19 recorded different definitions; 101 recorded a definition by only one rater, indicating possible omissions; and three cells contained both agreement and disagreement (i.e. more than one definition recorded, with only partial inter-rater agreement).

Mapping Techniques onto Behavioural Determinants

The matrix of results is shown in Appendix B. Overall there was 71 per cent agreement, with agreement that a technique was useful in 47 of 385 (12.2%) cells, that a technique was not useful in 229 (59.5%) cells, and disagreement in 32 (8.3%) cells. Of the 385 cells, 77 (20%) were classified as “uncertain”. The number of techniques agreed to be useful for each behavioural determinant is shown in Figure 1. Raters agreed on one technique that would change Social/professional role and identity; Knowledge; and Environmental context/resources. They agreed on two techniques that would change Social influences and Emotion; three techniques that would change Memory, attention, decision processes; four techniques that would change Beliefs about consequences; five techniques that would change Action planning; nine techniques that would change Beliefs about capabilities and Motivation and goals; and 10 techniques that would change Skills. Conversely, raters agreed on one technique (Self-monitoring) that would likely be effective in changing four constructs and on five techniques (Goal/target specified; Graded task; Increasing skills; Social processes; Information regarding behaviour and outcome) that would likely be effective in changing three constructs. The mapped techniques and constructs can be identified in Appendix B.

Figure 1.

Number of techniques which raters agreed to be useful in changing each behavioural determinant (from Appendix B).

DISCUSSION

The procedures and results reported are early stages in a programme of work aimed at developing a comprehensive taxonomy of behaviour change techniques, linked to theoretically derived behavioural determinants. In the context of a complex series of tasks, we have demonstrated that we can reach reasonable agreement (75%) about the identification of separate techniques and their definitions, and in mapping the techniques onto behavioural determinants informed by psychological theory (71%). However, it is also clear that this is a cumulative process and that the list generated will continue to have additions. For the list to be cumulative, the definitions need to be clear and agreed. We need to establish not only that a technique has a clear definition, but also that it does not duplicate existing techniques. Readers can evaluate for themselves the extent of our success to date by examining Appendix A.

This list was generated in the context of developing theory-based interventions, but it clearly has wider applicability. It can be used to develop and describe interventions without an explicit theoretical basis as long as there is evidence of behavioural determinants that fit with the 11 domains described by Michie et al. (2005a).

The list of behaviour change techniques can also be used to describe published interventions in systematic reviews and meta-analyses. Complex interventions usually involve a combination of the techniques described in this preliminary list. The current status of reporting complex behaviour change interventions does not achieve scientific standards of replicability, even when extended protocols are reported. For example, experienced researchers in psychology, primary care, public health, epidemiology, and health services research rated their confidence in replicating even a very high standard protocol (US Diabetes Prevention Program, 2001) to be 1.7 (on a scale of 1 to 5) (Michie et al., 2005a; Michie, Johnston, Francis, & Hardeman, 2005b). The definitions generated in Appendix A are likely to prove useful in the reporting of complex interventions.

The results of mapping the techniques to the behavioural determinants also showed a reasonable level of agreement, despite the subjective difficulty of the task, and the fact that the task was completed without definitions. Any lack of familiarity with the techniques would be reflected in disagreement or uncertainty. Nevertheless, the pattern of results shows that a substantial amount of the consensus is in agreeing that a technique is not appropriate for changing specific determinants. This finding alone could be used to avoid wasting research resources on interventions that are extremely unlikely to be successful. Furthermore, there is substantial agreement about how to change some of the determinants. There is clear agreement about techniques for changing each of the 11 theoretical domains. However, the distribution of techniques across the causal determinants was not even. This means that, for example, to change skills, researchers could select from the 10 possible techniques identified for this determinant. In contrast, these results indicate that, for other determinants, there will be fewer options for selecting change techniques or that we are unaware of relevant literature. Conversely, some techniques appear to be relevant to changing more constructs than do others; so, for example, self-monitoring is judged to be appropriate for changing four constructs whilst self-talk is judged to be appropriate for only one. The selection of techniques is likely to be guided by the particular application: it may be more feasible to operationalise some of these techniques than others, given situational constraints. Future work is likely to identify more techniques for each causal determinant.

The agreement observed in Appendix B represents opinion, not evidence of actual effectiveness of the techniques. Opinions are likely to be influenced by people's experiences and knowledge. It is possible that the experts making the judgments in Appendix B (see Figure 1) had greater expertise, for example, in changing skills and capabilities than in changing emotional and environmental influences on behaviour. In addition, this work is only an illustration of what could be achieved using a larger sample of experts. Nevertheless, we see this consensus work of identifying likely candidate techniques for changing each behavioural determinant as necessary for building an evidence base of technique effectiveness.

The 385 cells of Appendix B will be increased substantially by identifying more techniques; it would be virtually impossible to undertake effectiveness work without reducing this number. By selecting candidate techniques for changing each behavioural determinant, we are laying the basis for undertaking systematic reviews and conducting experimental studies, including intervention modelling experiments (Eccles, Grimshaw, Walker, Johnston, & Pitts, 2005; Bonetti, Eccles, Johnston, Steen, Grimshaw, Baker, Walker, & Pitts, 2005) to identify the most effective techniques.

In conclusion, we have shown that we can reach reasonable agreement about the identification of techniques and their definitions, and in mapping the techniques onto theoretical constructs. Further work on the taxonomy will involve generation of additional techniques, expert review of the definitions of the already identified 137 techniques, consensus work on selecting candidate techniques, and the collection of evidence of effectiveness through experimental studies and systematic reviews. As indicated in the introduction, we see the process of achieving truly theory-based rather than theory-inspired behaviour change interventions as difficult, but desirable, if we are to achieve a sound scientific basis for the development and reporting of such interventions. The work we have described in this paper, while a substantial body of work, is a first iteration of the process and is being further developed. However, we wish to place it in the public domain and invite comment and feedback.

Footnotes

  • 1

     This Appendix presents work in progress. Further work is needed to agree the final definitions for the techniques.

APPENDIX A

Behaviour Change Techniques and Labels Identified in Three Stages: (a) Reviews; (b) Brainstorming; (c) Textbook Consultation.1

StageTechnique numberTechnique label and definition
(a) Review identified techniques1.Goal: set behavioural goal
2.Standard: decide target standard of behaviour (specified and observable)
3.Monitoring: record specified behaviour (person has access to recorded data of behavioural performance e.g. from diary)
4.Record antecedents and consequences of behaviour (social and environmental situations and events, emotions, cognitions)
5.Feedback: of monitored (inc. self-monitored) behaviour
6.Comparison: provide comparative data (cf. standard, person's own past behaviour, others’ behaviour)
7.Social comparison: provide opportunities for social comparison e.g. contests and group learning
8.Discrepancy assessment: highlight nature of discrepancy (direction, amount) between standard, own or others’ behaviour (goes beyond simple self-monitoring)
9.Contract: of agreed performance of target behaviour with at least one other, written and signed
10.Planning: identify component parts of behaviour and make plan to execute each one or consider when and/or where a behaviour will be performed, i.e. schedule behaviours (not including coping planning—see 11)
11.Coping planning: identify and plan ways of overcoming barriers (note, this must include identification of specific barriers e.g. “problem-solving how to fit into weekly schedule” would not count)
12.Goal review: assess extent to which the goal/target behaviour is achieved, identify the factors influencing this and amend goal if appropriate
13.Discriminative (learned) cue: environmental stimulus that has been repeatedly associated with contingent reward for specified behaviour
14.Prompt: stimulus that elicits behaviour (inc. telephone calls or postal reminders designed to prompt the behaviour)
15.Reward: contingent valued consequence, i.e. if and only if behaviour is performed (inc. social approval, exc. general non-contingent encouragement or approval)
16.Punishment: contingent aversive consequence, i.e. if and only if behaviour is not performed
17.Omission: contingent removal of valued consequence, i.e. if and only if behaviour is not performed
18.Negative reinforcement: contingent removal of aversive consequence, i.e. if and only if behaviour is performed
19.Threat: offer future punishment or removal of reward contingent on performance
20.Fear arousal: induce aversive emotional state associated with the behaviour
21.Anticipated regret: induce expectations of future regret about non-performance of behaviour
22.Graded tasks: set easy tasks to perform, making them increasingly difficult until target behaviour performed
23.Instruction: teach new behaviour required for performance of target behaviour (not as part of graded hierarchy or as part of modelling) e.g. give clear instructions
24.Shaping: build up behaviour by initially reinforcing behaviour closest to required behaviour and systematically altering behaviour required to achieve contingent reinforcement
25.Chaining: build up behaviour by starting with final component; gradually add components earlier in sequence
26.Behavioural rehearsal: perform behaviour (repeatedly)
27.Mental rehearsal: imagine performing the behaviour repeatedly
28.Habit formation: perform same behaviour in same context
29.Role play: perform behaviour in simulated situation
30.Behavioural experiments: testing hypotheses about the behaviour, its causes and consequences, by collecting and interpreting data
31.Modelling: observe the behaviour of others
32.Vicarious reinforcement: observe the consequences of others’ behaviour
33.Self talk: planned self-statements (aloud or silent) to implement behaviour change techniques
34.Imagery: use planned images (visual, motor, sensory) to implement behaviour change techniques (inc. mental rehearsal)
35.Cognitive restructuring: changing cognitions about causes and consequences of behaviour
(b) Brainstormed techniques36.Relapse prevention: identify situations that increase the likelihood of the behaviour not being performed and apply coping strategies to those situations
37.Behavioural information: provide information about antecedents or consequences of the behaviour, or connections between them, or behaviour change techniques
38.Personalised message: tailor techniques or messages from others to individual's resources and context (includes stages of change-based information; doesn't include personal plans and feedback)
39.Verbal persuasion/persuasive communication: credible source presents arguments in favour of the behaviour. Note, there must be evidence of presentation of arguments; general pro-behaviour communication does not count.
40.Social support (instrumental): others perform component tasks of behaviour or tasks that would compete with behaviour e.g. offering childcare
41.Social support (emotional): others listen, provide empathy and give generalised positive feedback
42.Decision-making: generate alternative courses of action, and pros and cons of each, and weigh them up
43.Coping strategies: behaviours undertaken to avoid or reduce stressors
44.Stress management: behaviours undertaken to reduce stressors or impact of stressors
45.Relaxation: systematic instruction in physical and cognitive strategies to reduce sympathetic arousal, and to increase muscle relaxation and a feeling of calm
(c) Textbook identified techniques46.Desensitisation: exposure to threatening experiences
47.Systematic desensitisation: graded exposure to increasingly threatening experiences
48.Time management: action planning applied to the perceived problem of shortage of time
49.Motivational interviewing: elicit self-motivating statements and evaluation of own behaviour to reduce resistance to change
50.Environmental change: change the environment in order to facilitate the target behaviour (other than prompts, rewards, and punishments e.g. choice of food provided)
51.Set homework tasks
52.Non-specific social support (only if additional to 40 and 41)
53.General information about the behaviour and behaviour change (other than 37)
54.General problem-solving
55.Anti-depression skills training
56.Biofeedback
57.Differential reinforcement
58.Escape
59.Extinction
60.Flooding
61.Group contingencies
62.Implosive therapy
63.Avoidance
64.Counter-conditioning
65.Distraction
66.Exposure
67.Fading; thinning
68.Flooding in imagination
69.Habit reversal
70.Negative punishment
71.Non-contingent delivery of reinforcing stimuli
72.Overcorrection
73.Peer-administered contingencies
74.Problem identification
75.Rational emotive therapy
76.Reinforcer sampling
77.Response cost
78.Response priming
79.Satiation
80.Screening
81.Social skills training
82.Stress inoculation program
83.Symbolic desensitisation
84.Thought stopping
85.Time out
86.Token economy
87.Activity scheduling
88.Adventitious reinforcement/superstitious conditioning
89.Altering antecedent chains
90.Anger control training
91.Assertion training
92.Buddy system
93.Clarification (supportive therapy)
94.Classical conditioning
95.Community reinforcement
96.Covert conditioning
97.Covert sensitisation
98.Deflection techniques
99.Discrimination training
100.Emetic therapy
101.Encounter (existential analysis)
102.Fishbowl
103.Fogging
104.Functional communication training
105.Functional family therapy
106.Identification (psychoanalysis)
107.Instigation
108.Interpretation (psychoanalysis)
109.Least-to-most prompting
110.Lottery
111.Most to least prompt sequences
112.Motivational techniques
113.Multiple exemplar training (generalisation)
114.Natural maintaining contingencies (generalisation)
115.Negotiation training
116.Paradoxical instructions
117.Paradoxical intention (behaviour therapy)
118.Positive reinforcement
119.Positive scanning
120.Premackian reinforcers
121.Rate reduction
122.Reassurance (supportive therapy)
123.Recapitulation
124.Reframing
125.Reinforcer displacement
126.Response priming
127.Restitution
128.Rule release
129.Self-exploration
130.Self-help
131.Small group exercises
132.Stimulus generalisation
133.Stimulus narrowing
134.Systematic rational conditioning
135.Thinning
136.Turtle technique
137.Vicarious punishment

APPENDIX B

Data from Consensus Process for Linking Behaviour Change Techniques with Determinants of Behaviour

Figure 3.

Figure 3.

Figure 3.

Figure 3.

a In the study to map behaviour change techniques on to behavioural determinants, four expert judges independently answered the following question by placing numbers in the cells of the matrix: “Whcih techniques would you use as part of an intervention to change each construct domain?” Response options were “blank” = No; 1 = Possibly; 2 = Probably; 3 = Definitely. Responses were collated and coded as indicated in the key to identify agreement between the four judges, or disagreement, or uncertainty (see text for further detail).

Ancillary