Many of the leading causes of illness and death in the world are caused by human behaviours, such as eating a poor diet, being physically inactive, and smoking. Interventions and policies designed to change these behaviours can improve individual and population health at a relatively low cost, and are therefore crucial for health and wellbeing, and for national economies.

Fig. 1. The COM-B Model of Behaviour Change.

Behaviour change interventions are complex as multiple factors are involved. There are many theories of behaviour and behaviour change that aim to explain and predict when, why and how behaviour change occurs. The most basic model of behaviour change is COM-B (Fig. 1) which states that for a behaviour to occur, a person must have the capability, opportunity and motivation to change (Michie et al., 2014; Michie et al., 2011).

The COM-B model and most theories, however, do not provide specific guidance about what techniques to use to change different aspects of capability (e.g. increasing knowledge and skills), opportunity (e.g. providing walking paths, free smoking cessation services) and motivation (e.g. increasing people’s confidence to change or their belief that change will have good consequences for them and/or others). We can think of these aspects of capability, opportunity and motivation as the mechanisms of action by which intervention techniques have their effect on behaviour (Fig. 2). For example, an intervention for medication adherence may involve the use of the behaviour change technique prompts or cues (e.g. setting a daily reminder alert on the phone) to influence an individual’s memory, attention and decision processes (mechanisms of action), thus reminding them to take their medication at the same time each day (i.e. behaviour change).

This project, The Theories and Techniques of Behaviour Change Project (www.ucl.ac.uk/behaviour-change-techniques), aims to develop a method for linking behaviour change techniques to their mechanisms of action. To achieve this, we conducted four studies, one to look at how researchers have reported their studies in terms of the links between behaviour change techniques and mechanisms of action, and the other three to work with experts to build a shared view about the links.

The first study investigated links between behaviour change techniques and mechanisms of action that authors have identified in their work and reported in published articles describing behaviour change interventions. The second study investigated the thinking of international experts in behaviour change about links between behaviour change techniques and mechanisms. The third study compared the results of the first two studies (i.e. published articles and international experts), and identified a set of links between intervention techniques and mechanisms of action informed by both sources. The final study investigated whether there are groups of techniques that tend to occur together in interventions, and, if so, whether these are linked to particular theories of behaviour change.

Fig. 2. Behaviour change techniques lead to behaviour change through a variety of mechanisms of action.

By understanding the processes through which behaviour change interventions have their effects, we can develop more effective interventions and develop our knowledge of how interventions work (and why they don’t). The results of this programme of work will provide behaviour change researchers and intervention designers with a more efficient way to develop sound, theory-based interventions.

Hilary N. K. Groarke, Marta M. Marques, Rachel Carey, Susan Michie
University College of London, United Kingdom

Publication

From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action.
Michie S, Carey RN, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Connell LE
Ann Behav Med. 2016 Jul 11

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