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      Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature

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          Abstract

          Background

          Despite advances in behavioral science, there is no widely shared understanding of the “mechanisms of action” (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change.

          Purpose

          This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature.

          Methods

          Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link.

          Results

          Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT–MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were “Beliefs about Capabilities” and “Intention.” Binomial test results identified up to five MoAs linked to each of the BCTs ( M = 1.71, range: 1–5) and up to eight BCTs for each of the MoAs ( M = 3.63, range: 1–8).

          Conclusions

          The BCT–MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.

          Abstract

          This study produced a large dataset of hypothesised links between behaviour change techniques and the processes through which they change behaviour, as described in a set of published research reports. These findings can be used in the design of behaviour change interventions, and in furthering our understanding of how interventions have their effects.

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          Most cited references9

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          Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories

          ABSTRACT Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Methods: Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. Findings: One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. Discussion: There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance.
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            Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health.

            We present a vision of clinical science, based on a conceptual framework of intervention development endorsed by the Delaware Project. This framework is grounded in an updated stage model that incorporates basic science questions of mechanisms into every stage of clinical science research. The vision presented is intended to unify various aspects of clinical science toward the common goal of developing maximally potent and implementable interventions, while unveiling new avenues of science in which basic and applied goals are of equally high importance. Training in this integrated, translational model may help students learn how to conduct research in every domain of clinical science and at each stage of intervention development. This vision aims to propel the field to fulfill the public health goal of producing implementable and effective treatment and prevention interventions.
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              What theory, for whom and in which context? Reflections on the application of theory in the development and evaluation of complex population health interventions

              Recent years have seen a growing emphasis on the value of building and testing middle range theory throughout the development and evaluation of complex population health interventions. We agree that a coherent theoretical basis for intervention development, and use of evaluation to test key causal assumptions and build theory, are crucial. However, in this editorial, we argue that such recommendations have often been operationalised in somewhat simplistic terms with potentially perverse consequences, and that an uncritical assumption that an intervention explicitly based on theory is inherently superior carries significant risks. We first argue that the drive for theory-based approaches may have exacerbated a propensity to select ‘off-the-shelf’ theories, leading to the selection of inappropriate theories which distract attention from the mechanisms through which a problem is actually sustained. Second, we discuss a tendency toward over-reliance on individual-level theorising. Finally, we discuss the relatively slow progress of population health intervention research in attending to issues of context, and the ecological fit of interventions with the systems whose functioning they attempt to change. We argue that while researchers should consider a broad range of potential theoretical perspectives on a given population health problem, citing a popular off-the-shelf theory as having informed an intervention and its evaluation does not inherently make for better science. Before identifying or developing a theory of change, researchers should develop a clear understanding of how the problem under consideration is created and sustained in context. A broader conceptualisation of theory that reaches across disciplines is vital if theory is to enhance, rather than constrain, the contribution of intervention research. Finally, intervention researchers need to move away from viewing interventions as discrete packages of components which can be described in isolation from their contexts, and better understand the systems into which change is being introduced.
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                Author and article information

                Journal
                Ann Behav Med
                Ann Behav Med
                abm
                Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine
                Oxford University Press (US )
                0883-6612
                1532-4796
                August 2019
                10 October 2018
                10 October 2018
                : 53
                : 8
                : 693-707
                Affiliations
                [1 ]Centre for Behaviour Change, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
                [2 ]Department of Kinesiology, University of Rhode Island, 25 W Independence Way, Kingston, RI 02881, USA
                [3 ]Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
                [4 ]Department of Psychology, University of Minnesota, Minneapolis, MN, USA
                [5 ]Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
                Author notes
                Author information
                http://orcid.org/0000-0003-0063-6378
                Article
                kay078
                10.1093/abm/kay078
                6636886
                30304386
                96be6e1f-08eb-4c43-adda-65af1cf0b7e5
                © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 15
                Funding
                Funded by: UK Medical Research Council
                Award ID: MR/L011115/1
                Categories
                Regular Articles

                Neurology
                behavior change,theory,methodology,behavior change technique,mechanism of action,evidence synthesis

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