TTBCI Top 10 of 2015

Applying the Behaviour Change Technique (BCT) Taxonomy v1: a Study of Coder Training

Authors: Caroline E Wood, Michelle Richardson, Marie Johnston, Charles Abraham, Jill Francis, Wendy Hardeman, Susan Michie

Abstract: Behaviour Change Technique Taxonomy v1 (BCTTv1) has been used to detect active ingredients of interventions. The purpose of this study was to evaluate effectiveness of user training in improving reliable, valid and confident application of BCTTv1 to code BCTs in intervention descriptions. One hundred sixty-one trainees (109 in workshops and 52 in group tutorials) were trained to code frequent BCTs. The following measures were taken before and after training: (i) inter-coder agreement, (ii) trainee agreement with expert consensus, (iii) confidence ratings and (iv) coding competence. Coding was assessed for 12 BCTs (workshops) and for 17 BCTs (tutorials). Trainees completed a course evaluation. Methods improved agreement with expert consensus (p < .05) but not inter-coder agreement (p = .08, p = .57, respectively) and increased confidence for BCTs assessed (both p < .05). Methods were as effective as one another at improving coding competence (p  = .55). Training was evaluated positively. The training improved agreement with expert consensus, confidence for BCTs assessed, coding competence but not inter-coder agreement. This varied according to BCT.


Assessing Connections Between Behavior Change Theories Using Network Analysis

Authors: Heather L. Gainforth, Robert West, Susan Michie

Abstract: A cross-disciplinary scoping review identified 83 of behavior change theories, with many similarities and overlapping constructs. Investigating the derivation of these theories may provide further understanding of their contribution and intended application. To develop and apply a method to describe the explicit derivation of theories of behavior change. A network analysis of the explicit “contributing to” relations between the 83 theories was conducted. Identification of relations involved textual analysis of primary theory sources. One hundred and twenty-two connections between the theories were identified amounting to 1.8 % of the number possible. On average, theories contributed to one or two theories (mean = 1.47 ± 3.69 contributions) and were informed by one or two theories (mean = 1.47 ± 1.61 contributing theories). Most behavior change theories appear to be explicitly informed by few prior theories. If confirmed, this suggests a considerable dislocation between generations of theories which would be expected to undermine scientific progress.


Building New Computational Models to support Health Behavior Change and Maintenance: New Opportunities in Behavioral Research

Authors: Donna Spruijt-Metz , Eric Hekler, Niilo Saranummi, Stephen Intille, Ilkka Korhonen, Wendy Nilsen, Daniel E. Rivera, Bonnie Spring, Susan Michie, David A. Asch, Alberto Sanna, Vicente Traver Salcedo, Rita Kukakfa, Misha Pavel

Abstract: Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static “snapshots” of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloud-enabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing “gold standard” measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a “knowledge commons,” which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.


Expectations are More Predictive of Behavior than Behavioral Intentions: Evidence from Two Prospective Studies

Authors: Christopher J. Armitage, Paul Norman, Soud Alganem, Mark Conner

Abstract: Understanding the gap between people’s behavioral intentions and their subsequent behavior is a key problem for behavioral scientists, but little attention has been paid to how behavioral intentions are operationalized. Test the distinction between asking people what they intend to do, as opposed to what they expectthey will do. Two studies were conducted in the domains of alcohol consumption (N = 152) and weight loss (N = 141). Participants completed questionnaires assessing their behavioral intentions, expectations, and self-efficacy at baseline; alcohol consumption/weight were assessed at both baseline and follow-up. In study 1, expectations were more predictive of alcohol consumption than behavioral intentions, controlling for baseline alcohol consumption and self-efficacy. In study 2, changes in expectations were more predictive of weight loss than changes in behavioral intentions, controlling for baseline weight and self-efficacy.The findings support a potentially important distinction between behavioral intentions and expectations.


Perceived Control and Intrinsic vs. Extrinsic Motivation for Oral Self-Care: a Full Factorial Experimental Test of Theory-Based Persuasive Messages

Authors: Liam Staunton, Paul Gellert, Keegan Knittle, Falko F. Sniehotta

Abstract: Correlational evidence suggests that perceived control (PC) and intrinsic motivation (IM), key constructs in social cognitive and self-determination theories, may interact to reinforce behavior change. This proof-of-principle study examines the independent and synergistic effects of interventions to increase PC and IM upon dental flossing frequency. University students (n = 185) were randomized in a 2 × 2 full factorial design to receive two computer-based interventions: one to either increase or decrease PC and another to increase either IM or extrinsic motivation. These constructs were measured immediately post-intervention; flossing behavior was measured 1 week later. The interventions to increase PC and PC/IM had main and interaction effects on flossing, respectively. The PC/IM interaction effect was mediated by increases in PC and IM. Combining interventions to increase PC and IM seems to be a promising avenue of research, which has implications for both theory and intervention development.


Predicting Changes Across 12 Months in Three Types of Parental Support Behaviors and Mothers’ Perceptions of Child Physical Activity

Authors: Ryan E. Rhodes, John C. Spence, Tanya Berry, Sameer Deshpande, Guy Faulkner, Amy E. Latimer-Cheung, Norman O’Reilly, Mark S. Tremblay

Abstract: Parental support has been established as the critical family-level variable linked to child physical activity with encouragement, logistical support, and parent-child co-activity as key support behaviors. This study aims to model these parental support behaviors as well as family demographics as mediators of mothers’ perceptions of child physical activity using theory of planned behavior (TPB) across two 6-month waves of longitudinal data. A representative sample of Canadian mothers (N = 1253) with children aged 5 to 13 years of age completed measures of TPB, support behaviors, and child physical activity. Autoregressive structural equation models showed that intention and perceived behavioral control explained support behaviors, yet child age (inverse relationship) and family income were independent predictors. The three support behaviors explained 19–42 % of the variance in child physical activity between participants, but analyses of change showed much smaller effects. Mothers’ support behaviors are related to perceived child physical activity, but support is dependent on perception of control, child age, and family income.


Systematic Review of Health Branding: Growth of a Promising Practice

Authors: W Douglas Evans , Jonathan Blitstein, Donna Vallone, Samantha Post, Wendy Nielsen

Abstracts: Brands are marketing tools that create mental representations in the minds of consumers about products, services, and organizations. Brands create schema that help consumers decide whether to initiate or continue use of a product or service. Health branding determines behavioral choice by building consumer relationships and identification with health behaviors and their benefits. Health branding can be measured by the associations individuals form with health behaviors. In 2008, Evans and colleagues systematically reviewed the literature on health brands, reported on branded health messages and campaigns worldwide, and examined specific branding strategies in multiple subject areas. This paper extends that review. We replicated the comprehensive online literature search strategy from 2008. We screened a total of 311 articles and included 130 for full-text review. This included both articles from the 2008 review and new articles. After excluding those new articles that did not meet full-text inclusion criteria, we reviewed 69 in total. Of these, 32 were new articles since the 2008 review. Branded health campaigns cover most major domains of public health and appear worldwide. Since 2008, we observed improvement in evaluation, application of theory, and description of campaign strategies in published work. We recommend enhanced education of public health practitioners and researchers on the use and evaluation of branding.


Theory-Based Approach for Maintaining Resistance Training in Older Adults with Prediabetes: Adherence, Barriers, Self-Regulation Strategies, Treatment Fidelity, Costs

Authors: Richard A. Winett , Brenda M. Davy, Jyoti Savla, Elaina L. Marinik, Sarah A. Kelleher, Sheila G. Winett, Tanya M. Halliday, David M. Williams

Abstract: Effectively preventing and treating chronic diseases through health behavior changes often require intensive theory- and evidence-based intervention including long-term maintenance components. We assessed the efficacy of theory-based maintenance approaches varying by dose for persistently performing resistance training (RT) with the hypothesis that a higher-dose social cognitive theory (SCT) approach would produce greater RT adherence than lower-dose Standard. The Resist-Diabetes study first established 2×/week resistance training (RT) in a 3-month supervised intervention in older (50–69 years, N = 170), overweight to obese (BMI 25–39.9 kg/m2) previously inactive adults who fit prediabetes criteria (fasting glucose concentration = 95–125 mg/dl; oral glucose tolerance test 2-h glucose concentration = 140–199 mg/dl or both). After the supervised phase, participants (N = 159) were then randomly assigned to one of two conditions for transition (3 weeks) and then RT alone in community settings for extended contact, maintenance (6 months), and then no contact (6 months). SCT featured continued tailored, interactive personal, and web-based check-ups focused on RT, self-regulation, and a barrier/strategies approach. Standard involved low-dose, generic personal, and web-based check-ups within the same theoretical approach. SCT and Standard both resulted in similar RT, 2×/week adherence during maintenance (74.4 %) and no-contact phases (53.1 %). Cost analysis indicated the Standard intervention for transition and maintenance was inexpensive ($160). Standard can be translated into practice with the potential for continuous contact and persistence in RT beyond the typical program maintenance phase.


Using an Extended Theory of Planned Behavior to Predict a Change in the Type of Blood Product Donated

Authors: Kathleen L. Bagot, Barbara M. Masser, Katherine M. White

Abstract: Demand for essential plasma-derived products is increasing. This prospective study aims to identify predictors of voluntary non-remunerated whole blood (WB) donors becoming plasmapheresis donors. Surveys were sent to WB donors who had recently (recent n = 1,957) and not recently donated (distant n  = 1,012). Theory of Planned Behavior (TPB) constructs (attitude, subjective norm, self-efficacy) were extended with moral norm, anticipatory regret, and donor identity. Intentions and objective plasmapheresis donation for 527 recent and 166 distant participants were assessed. Multi-group analysis revealed that the model was a good fit. Moral norm and self-efficacy were positively associated while role identity (suppressed by moral norm) was negatively associated with plasmapheresis intentions. The extended TPB was useful in identifying factors that facilitate conversion from WB to plasmapheresis donation. A superordinate donor identity may be synonymous with WB donation and, for donors with a strong moral norm for plasmapheresis, may inhibit conversion.


Which Behavior Change Techniques are Associated with Changes in Physical Activity, Diet and Body Mass Index in People with Recently Diagnosed Diabetes?

Authors: Nelli Hankonen, Stephen Sutton, A. Toby Prevost, Rebecca K. Simmons, Simon J. Griffin, Ann Louise Kinmonth, Wendy Hardeman

Abstract: Meta-analyses have identified promising behavior change techniques (BCTs) in changing obesity-related behaviors from intervention descriptions. However, it is unclear whether these BCTs are used by intervention participants and are related to outcomes. The purpose of this study is to investigate BCT use by participants of an intervention targeting physical activity and diet and whether BCT use was related to behavior change and weight loss. Intervention participants (N = 239; 40–69 years) with recently diagnosed type 2 diabetes in theADDITION-Plus trial received a theory-based intervention which taught them a range of BCTs. BCT usage was reported at 1 year. Thirty-six percent of the participants reported using all 16 intervention BCTs. Use of a higher number of BCTs and specific BCTs (e.g., goal setting) were associated with a reduction in body mass index (BMI). BCT use was associated with weight loss. Future research should identify strategies to promote BCT use in daily life.