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. 2019 Jul 17;53(8):708-720.
doi: 10.1093/abm/kay082.

Links Between Behavior Change Techniques and Mechanisms of Action: An Expert Consensus Study

Lauren E Connell  1   2 , Rachel N Carey  1 , Marijn de Bruin  3 , Alexander J Rothman  4 , Marie Johnston  3 , Michael P Kelly  5 , Susan Michie  1
Affiliations

Links Between Behavior Change Techniques and Mechanisms of Action: An Expert Consensus Study

Lauren E Connell et al. Ann Behav Med. .

Abstract

Background: Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior.

Purpose: To elicit expert consensus on links between BCTs and MoAs.

Methods: In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links.

Results: Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1-4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as "definite" links, 464 (29.2 per cent) as "definitely not" links, and 1,032 (65.1 per cent) as "possible" or "unsure" links. No "definite" links were identified for 10 BCTs (e.g., "Action Planning" and "Behavioural Substitution") and for six MoAs (e.g., "Needs" and "Optimism").

Conclusions: The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies.

Keywords: Behavior change; Behavior change technique; Expert consensus; Mechanism of action; Methodology; Theory.

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Figures

Fig. 1.
Fig. 1.
Descriptive characteristics of experts included in the consensus exercise. (A) Self-reported work sector; (B) geographical location; (C) professional background. Axis labels are in descending order, and label the pie chart in a clockwise direction.
Fig. 2.
Fig. 2.
The frequency with which behavior change techniques (BCTs) were definitely linked to mechanisms of action (MoAs) by ≥80% of experts is depicted in the dark grey bars, and the frequency with which MoAs were linked to BCTs by ≥80% of experts is depicted in the light grey bars.
Fig. 3.
Fig. 3.
A heat map indicating the proportion of experts rating a behavior change technique (BCT) was “definitely” linked to a mechanism of action (MoA). Values range from 0 to 1, with values closer to 1 shaded in the darkest grey. A 1 indicates 100% of experts agreed a BCT that was definitely linked to a MoA. M.A.D.P. = Memory, Attention, and Decision Processes; P.S.V. = Perceived Susceptibility and Vulnerability; S.P.R.I = Social/Professional Role and Identity; B. Con. = Beliefs about Consequences; G.A.B. = General Attitudes and Beliefs; A.T.B = Attitude towards the Behavior; B.R. = Behavioral Regulation; B.Cap. = Beliefs about Capabilities.
Fig. 4.
Fig. 4.
A heat map indicating the proportion of experts rating a behavior change technique (BCT) was “definitely” not linked to a mechanism of action (MoA). Values range from 0 to 1, with values closer to 1 shaded in the darkest grey. A 1 indicates 100% of experts agreed a BCT was definitely not linked to a MoA. M.A.D.P. = Memory, Attention, and Decision Processes; P.S.V. = Perceived Susceptibility and Vulnerability; S.P.R.I = Social/Professional Role and Identity; B. Con. = Beliefs about Consequences; G.A.B. = General Attitudes and Beliefs; A.T.B = Attitude towards the Behavior; B.R. = Behavioral Regulation; B.Cap. = Beliefs about Capabilities.
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