An ontology of mechanisms of action in behaviour change interventions

Behaviour change and rehabilitation adherence in adults with tendinopathy: a scoping review

PURPOSE

This scoping review aimed to identify behaviour change strategies influencing rehabilitation adherence in adults with tendinopathy, a common musculoskeletal condition requiring prolonged rehabilitation with poor adherence and variable outcomes.

METHODS

Following the Joanna Briggs Institute (JBI) methodology, seven databases were searched until April 2023. Records included reviews, intervention, and qualitative studies published in English. Behaviour change strategies were deductively coded and mapped to the capability, opportunity, and motivation model of behaviour (COM-B).

RESULTS

Eighty-six articles were retained. The primary behaviour change strategies in tendinopathy rehabilitation reports addressed Psychological Capability; from knowledge through education, instruction, and self-monitoring using exercise diaries. Also, Social Opportunity involves demonstration and monitoring of rehabilitation behaviour, and Physical Opportunity focuses on time-efficient programs with access to equipment and health professionals. Few reports addressed Automatic Motivation (positive reinforcement and habit formation). Barriers identified in the reports were Reflective Motivation (negative beliefs and fears), Physical Opportunity (time-constraints), and Physical Capability (pain and comorbidities).

CONCLUSIONS

Further research should explore the impact of education on beliefs, fears, and pain-management, as well as the effectiveness of teaching habit formation for improved time-management. Implementing these behaviour change strategies may enhance tendinopathy rehabilitation adherence, improving clinical trial efficacy, guiding clinical practice, and impacting patient outcomes.

An analysis of physical activity coping plans: mapping barriers and coping strategies based on user ratings

Introduction

Personalising recommendations for physical activity coping plans can help bridging the physical activity intention-behaviour gap. Data-driven 'black-box' approaches result in recommendations that prove difficult to explain, and may have undesired consequences. This study aimed to explicitly link barriers and coping strategies using end-user input.

Method

152 participants (85 female) took part in an online task. Participants were asked to judge the relevance of coping strategies for barriers to physical activity, and under which circumstances coping strategies were relevant for a given barrier. Data was aggregated and heat maps were produced. Necessary conditions for the relevance of each combination were coded and their frequencies were reported.

Results

Relevance of 1570 combinations of barriers and coping strategies were assessed, with 2 combinations rated 'always relevant' by all participants, and 37 combinations rated as 'always relevant' by no participants. Barriers differ strongly in how many coping strategies are relevant for them, and coping strategies differ strongly in how many barriers they are relevant for. Resulting aggregates concerning the average rating as 'never relevant', 'always relevant' and 'relevant under certain conditions' are shared for each barrier coping strategy combination, as are the conditions associated with different barriers and coping strategies.

Discussion

This study introduces a novel method to create rules for recommendations using input from stakeholders. The datasets created throughout this research are available for re-use in future research, as well as for clinical practice and (digital) intervention development. This data can be used as a base for explainable personalised recommendations for physical activity coping plans.

A research agenda to advance the study of implementation mechanisms

BACKGROUND

Implementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms-the processes responsible for change-is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution.

METHOD

Building on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: "What actions need to be taken to move this research forward?" The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team.

RESULTS

From this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms.

CONCLUSIONS

This research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.

Improving retrospective intervention descriptions: Lessons learned from research on type 2 diabetes programmes in the United Kingdom and the Republic of Ireland

In recent years, multiple countries worldwide have implemented behavioural interventions within national healthcare systems. Describing the content of these interventions is critical to improve their implementation, replication, and effectiveness, as well as to advance behavioural science. Tools, such as the Behaviour Change Technique Taxonomy, can enhance the quality of intervention description and reporting. As interventions are frequently developed without the use of such tools, retrospective coding of existing interventions to accurately characterise their content is becoming more common. However, the use of these tools for retrospective coding poses various challenges, the discussion of which has been neglected to date. This commentary discusses the challenges encountered when retrospectively describing the content of five nationally implemented programmes for type 2 diabetes in the United Kingdom and the Republic of Ireland and suggests recommendations to tackle these challenges. We present important methodological, practical, and ethical considerations for researchers to reflect on, relevant to the retrospective description of existing interventions. Specifically, we discuss (i) the importance of positive relationships and collaboration with intervention stakeholders, (ii) the practical and ethical considerations when analysing the content of implemented interventions, (iii) the independence of research teams and the potential for misclassification of intervention content, and (iv) the challenges associated with the analysis of intervention content using behavioural science tools. There is a growing demand for more robust approaches to address the methodological, practical, and ethical challenges associated with such studies. The present commentary describes key issues to be considered by research teams, as well as concrete recommendations to improve the retrospective characterisation of intervention content.

Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: An embedded randomized controlled trial

Background

The use of a second informant (co-respondent) is a common method of identifying potential bias in outcome data (e.g., parent-report child outcomes). There is, however, limited evidence regarding methods of increasing response rates from co-respondents. The use of financial incentives is associated with higher levels of engagement and follow-up data collection in online surveys. This study investigated whether financial incentives paid to index participants in an online trial of a parenting-focused intervention, would lead to higher levels of co-respondent data collection.

Methods

A study within a trial (SWAT) using a parallel group RCT design. Participants in the host study (an RCT of an online intervention) were randomised into one of two SWAT arms: received/did not receive a £15 voucher when referred co-respondent completed baseline measures. Primary outcome was completion (No/Yes) of Spence Children's Anxiety Scale (SCAS or SCAS-Pre) at baseline. Additional analysis explored impact of incentives on data quality.

Results

Intention to treat analysis of 899 parents (183 co-respondents) in the no-incentive arm, and 911 parents (199 co-respondents) in incentive arm. Nomination of co-respondents was similar between incentive arms. The RR for the incentive arm compared to the no incentive arm was 1.13 (95% CI: 0.91 to 1.41, p = 0.264) indicating that incentives did not impact completion of outcomes by consented co-respondents. There were no indications of different data quality between arms.

Discussion

The finding that payment of financial incentives to index participant does not lead to greater levels of co-respondent outcome completion suggests that careful consideration should be made before allocating resources in this way in future trials.

Trial registration

The host study was registered at Study Record | ClinicalTrials.gov and the SWAT study was registered in the SWAT Store | The Northern Ireland Network for Trials Methodology Research (qub.ac.uk): SWAT number 143: Filetoupload,1099612,en.pdf (qub.ac.uk).

A data extraction template for the behaviour change intervention ontology

Background

The Behaviour Change Intervention Ontology (BCIO) aims to improve the clarity, completeness and consistency of reporting within intervention descriptions and evidence synthesis. However, a recommended method for transparently annotating intervention evaluation reports using the BCIO does not currently exist. This study aimed to develop a data extraction template for annotating using the BCIO.

Methods

The BCIO data extraction template was developed in four stages: i) scoping review of papers citing component ontologies within the BCIO, ii) development of a draft template, iii) piloting and revising the template, and iv) dissemination and maintenance of the template.

Results

A prototype data extraction template using Microsoft Excel was developed based on BCIO annotations from 14 papers. The 'BCIO data extraction template v1' was produced following piloting and revision, incorporating a facility for user feedback.

Discussion

This data extraction template provides a single, accessible resource to extract all necessary characteristics of behaviour change intervention scenarios. It can be used to annotate the presence of BCIO entities for evidence synthesis, including systematic reviews. In the future, we will update this template based on feedback from the community, additions of newly published ontologies within the BCIO, and revisions to existing ontologies.

A meta-analysis of the effect of visiting zoos and aquariums on visitors' conservation knowledge, beliefs, and behavior

Zoos and aquariums are well placed to connect visitors with the issues facing biodiversity globally and many deliver interventions that seek to influence visitors' beliefs and behaviors with respect to conservation. However, despite primary studies evaluating the effect of such interventions, the overall effect of engaging with zoos and the factors that influence this effect remain unclear. We conducted a systematic review to investigate the effect of zoo-led interventions on knowledge, beliefs (attitudes, intentions, self-efficacy, and social norms), and behavior among zoo visitors. These outcomes were identified using the Theory of Planned Behavior as a theoretical lens. We identified and described the nature of zoo-led interventions in 56 studies and used the behavior change technique (BCT) taxonomy to identify 6 specific BCTs used in interventions to date. Multilevel meta-analyses revealed a small to medium positive effect of engaging with zoo-led interventions on outcomes (d+  = 0.40, 95% confidence interval = 0.28-0.51). Specifically, visitors were more knowledgeable about conservation issues, held more favorable attitudes toward conservation, and reported being more likely to act for the benefit of biodiversity. No evidence of publication bias was present. Effect sizes were, however, heterogeneous and subgroup analyses revealed that the nature of the intervention or type of outcome did not explain this variance. Larger effects were, however, found in studies conducted at a single institution relative to research at multiple institutions and studies that used within-participant designs relative to between-participant designs. Taken together, these findings demonstrate how behavior change frameworks can be used to describe zoo-led interventions and supports the assertion that zoos and aquariums can promote changes in beliefs and behaviors that may help protect biodiversity.

Specifying how intervention content is communicated: Development of a Style of Delivery Ontology

Background: Investigating and enhancing the effectiveness of behaviour change interventions requires detailed and consistent specification of all aspects of interventions. We need to understand not only their content, that is the specific techniques, but also the source, mode, schedule, and style in which this content is delivered. Delivery style refers to the manner by which content is communicated to intervention participants. This paper reports the development of an ontology for specifying the style of delivery of interventions that depend on communication. This forms part of the Behaviour Change Intervention Ontology, which aims to cover all aspects of behaviour change intervention scenarios. Methods: The Style of Delivery Ontology was developed following methods for ontology development used in the Human Behaviour-Change Project, with seven key steps: 1) defining the scope of the ontology, 2) identifying key entities and developing their preliminary definitions by reviewing 100 behaviour change intervention evaluation reports and existing classification systems, 3) refining the ontology by piloting the ontology through annotations of 100 reports, 4) stakeholder review by eight behavioural science and public health experts, 5) inter-rater reliability testing through annotating 100 reports using the ontology, 6) specifying ontological relationships between entities, and 7) disseminating and maintaining the ontology. Results: The resulting ontology is a five-level hierarchical structure comprising 145 unique entities relevant to style of delivery. Key areas include communication processes, communication styles, and attributes of objects used in communication processes. Inter-rater reliability for annotating intervention evaluation reports was α=0.77 (good) for those familiar with the ontology and α=0.62 (acceptable) for those unfamiliar with it. Conclusions: The Style of Delivery Ontology can be used for both annotating and describing behaviour change interventions in a consistent and coherent manner, thereby improving evidence comparison, synthesis, replication, and implementation of effective interventions.