An assessment of physiotherapist’s delivery of behaviour change techniques within the SOLAS feasibility trial

Abstract

Delivering the SOLAS intervention BCTs with high fidelity was not feasible. The assessment of partial delivery of BCTs provided greater insight into the techniques that should be removed from the protocol or that may require further training. Complex interventions should consider a list of 'core' or mandatory BCTs alongside 'optional' BCTs, depending on the target behaviour, and the needs of individual participants. Statement of contribution What is already known on this subject? BCTs are the smallest active components of behavioural interventions, yet typically their effectiveness is determined through meta-analyses. Attempted delivery of BCTs is often unaccounted for yet may provide valuable insight into difficulty with delivery. There is a need to investigate BCT implementation beyond simple presence/absence to identify protocol refinements or required BCT training. What does this study add? BCT delivery was assessed in greater depth than previous research, including partial delivery. Highlights the need for appropriate training in BCTs that are difficult to deliver, particularly those associated with 'goals and planning' Highlights the need for intervention-specific criteria as to what constitutes 'high', 'moderate', and 'low' fidelity.

Feasibility cluster randomised controlled trial evaluating a theory-driven group-based complex intervention versus usual physiotherapy to support self-management of osteoarthritis and low back pain (SOLAS)

“…These ndings are consistent with previous literature and suggest sustained increases in autonomous motivation may be required for behaviour change [51][52]. Although PTs underwent training and were deemed competent to deliver SOLAS within the feasibility trial, they struggled to effectively utilise speci c strategies related to goal setting [25][26]. This is noteworthy as a collaborative goal-setting process between a health care professional and patient is likely to be important in increasing and sustaining a patient's autonomous motivation and competence for the particular behaviour [53][54][55].…”

“…A comprehensive assessment of the delity of intervention delivery, another key component of feasibility has been reported separately [25][26][27].…”

“…The small increases found in subjectively measured PA and in the SM behaviours related to PA within SOLAS up to 2 months provide preliminary evidence of its effect on these behaviours. PTs overall moderate delity to the intervention BCTs and their inability to deliver all 26 BCTs targeting PA within the trial may have contributed to these small effects [26]. If a de nitive trial is to take place, rst, the core intervention BCTs must be identi ed and second, training enhancements are required to target PTs' use of particular BCTs.…”

Development of a complex community pharmacy intervention package using theory-based behaviour change techniques to improve older adults’ medication adherence

“…Tailoring of adherence interventions in the literature is, however, currently uncommon-this has been illustrated in a recent meta-analysis of 771 adherence interventions delivered to adult patients (18 years+) which found only nine studies that reported individual-level tailoring [6]. Keogh et al [25] have also recently advocated for the inclusion of 'core' and 'optional' BCTs in complex interventions, following their recent feasibility study that found that a physiotherapistled self-management group intervention containing a large number of BCTS (n = 31) was delivered with low to moderate fidelity. This type of tailoring could be particularly useful in contexts where there are high levels of heterogeneity amongst patients and in busy healthcare environments where time restrictions limit the duration of sessions/appointments.…”

Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes

“…These can be conceptualized as compositional/structural features forming items of the index and functional/process features forming the anchors to quantify each item. While studies have previously developed methods to characterize the content of BS using the behaviour change techniques (BCTs) taxonomies and BCT associations with outcomes , these limit ratings to the delivery process and their predictive value for outcomes. The extent to which fidelity of delivery of a BS intervention influences smoking cessation outcomes remains unclear.…”