Intervention functions and BCTs from the Cochrane review

In this video, we revisit the results of the Cochrane Review in order to show how the COM-B model can be linked to intervention functions, and to introduce you to behaviour change techniques or PCTs. Interventions in the Cochrane Review included elements that we classify with five of the nine intervention functions in the behaviour change wheel. These were 1, education. 2, persuasion. 3, enablement. 4, environmental restructuring. And 5, restrictions. In this course, we began by showing how to identify what behaviour you’re trying to change by defining the problem in behavioural terms, selecting the target behaviour, and specifying the target behaviour.

We then showed how the COM-B model and theoretical domain’s framework can be used to analyse facilitators and barriers to behaviour change in order to identify what it will take to bring about the desired change. The next steps in systematic intervention design are to identify what types of broad intervention approaches might be relevant, and which specific behaviour change techniques should be included in the intervention. The COM-B model has been mapped to intervention functions based on expert consensus. For each COM-B component that has been identified as relevant in bringing about the desired change in the target behaviour, this matrix shows which of the intervention functions are likely to be effective in bringing about that change.

Most interventions in the Cochrane Review had more than one intervention function. This can be demonstrated by one of the interventions, Dulac 2008, which we used earlier in this course to show how to apply TACTA. This intervention had four distinct components. 1, audit and feedback. 2, educational meetings with dissemination of educational materials. 3, educational outreach by academic detailing. And 4, reminders, which were physical in the forms of posters, internet and faxes to physicians. We classified these components with four intervention functions. Education, enablement, environmental restructuring and persuasion. Also note that audit and feedback and reminders each have two intervention functions. Hulgan 2004 is an example of a circumstantial reminder, which we always classified as both enabling and using environmental restructuring.

We classified circumstantial reminders as enabling, because they were targeted at doctors who were managing specific patients and were triggered by actions or events related to the target behaviour. In this case, ordering either levofloxacin or ciprofloxacin. We classified this reminder as persuasive, because it also included information about the recommendations of the antibiotic committee. Peto 2008 is an example of an intervention that has both restrictive and enabling components. The restrictive component was requiring expert approval for prescriptions, but this was reinforced by rounds by the anti-microbial stewardship team to review patients who were receiving the restricted antibiotics, and to recommend change if necessary.

In the Cochrane Review, we use five of the intervention functions to classify interventions in the 29 randomised controlled trials and 91 interrupted time series studies that were included in the matter of aggression. We can use the matrix of COM-B components and intervention functions to consider how these interventions may have changed behaviour. Education and persuasion influence capability and motivation, but not opportunity. Restriction and enablement both influence opportunity. All of the examples of environmental restructuring in the Cochrane Review were reminders. We classified all circumstantial reminders as enabling, and all physical reminders as persuasive. As we saw in slide 7, circumstantial reminders were linked to specific patients, Whereas physical reminders, such as posters or pocket antibiotic policies were not linked to specific patients.

Consequently, in the matter of aggression, compared interventions that were likely to influence opportunity, capability and motivation through enablement and or restriction, as well as educational persuasion. And those that were only likely to influence capability or motivation through education or persuasion without enablement or restriction. Once you’ve identified which of the nine intervention functions might change your target behaviour, the next step is to consider the behaviour change techniques that could be considered for each of these intervention functions. A behaviour change technique or BCT, is defined as an active component of an intervention designed to change behaviour.

The defining characteristics of BCT are that it is observable, replicable and irreducible component of an intervention designed to change behaviour and a postulated active ingredient within that intervention. The BCT taxonomy is a standardised language for describing the active ingredient in interventions. It includes 93 distinct BCTs, which are clustered into 16 groups. In the next video, we’ll use one of the studies from the Cochrane Review to show how BCTs can be identified within antimicrobial stewardship programmes.