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

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.

Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review

“…Finally, electronically monitored medication systems that provide individualized feedback on behaviors have been shown to improve pharmacoadherence among children with asthma and adults with chronic illnesses including HIV, perhaps by targeting motivation as well as cognitive function. These systems are comprised of theoretical behavior change techniques not tested empirically, including habit formation, goal setting, material reward, information about health consequences, and practical social support . The impact of such systems on adherence among AYAs with cancer has not been specifically studied.…”

“…Individualized approaches targeting beliefs and attitudes may complement knowledge‐focused interventions. Such approaches could be informed by theoretical frameworks such as cognitive restructuring (the deliberate adoption of a new perspective on a behavior in order to change perceptions about performing the behavior) or cognitive dissonance (creating discomfort by drawing attention to discrepancies between behavior and self‐image) . A study defining the concepts of the “good child” and the “good patient” from the perspective of AYAs found that living up to interpreted preferences of family and health care providers promoted motivation for adherence to medications, treatment regimen, appointment attendance, and staff instruction .…”

“…These systems are comprised of theoretical behavior change techniques not tested empirically, including habit formation, goal setting, material reward, information about health consequences, and practical social support. 99 The impact of such systems on adherence among AYAs with cancer has not been specifically studied.…”

“…104 to change perceptions about performing the behavior) or cognitive dissonance (creating discomfort by drawing attention to discrepancies between behavior and self-image). 99 A study defining the concepts of the "good child" and the "good patient" from the perspective of AYAs found that living up to interpreted preferences of family and health care providers promoted motivation for adherence to medications, treatment regimen, appointment attendance, and staff instruction. 105 Clinicians willing to explore how AYAs define their role as a patient, and the potential burdens living up to this role may introduce, may help avoid misunderstandings and enable improved adherence, cooperation, decision-making, and approaches to care.…”

Content validity of measures of theoretical constructs in health psychology: Discriminant content validity is needed

“…If measures lack content validity but are otherwise psychometrically sound, then they may lead to misidentification of determinants of the target mood, behaviour, or symptom. Recent work has identified behaviour change techniques that are appropriate for targeting key theoretical constructs that act as mechanisms of action to determine change in the target behaviour (Carey et al ., ; Connell et al ., ; Johnston et al ., ). Clearly, success in making use of such evidence depends on valid labelling of the theoretical construct and this process may be derailed by misleading classification of measures.…”