Friday, April 05, 2013

Journal Club on Taxonomy of Behaviour Change Techniques

On Monday the 8th of April we review the recent paper by Prof. Susan Michie and colleagues:

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W... Wood CE. (2013). The Behaviour Change Technique Taxonomy (v1) of 93 hierarchically-clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, doi: 10.1007/s12160-013-9486-6.


In recent years there has been a growing emphasis on the need to identify the 'active ingredients' and methods of administration that define behaviour change interventions. This process aims to help ensure that interventions are implemented accurately and can be replicated. It also aims to assist in allowing effective techniques to be promoted and evidence of causal mechanisms of behaviour change to accumulate.

Abraham and Michie (2008) produced an initial taxonomy of 26 behaviour change techniques (BCT). It has since been cited over 400 times and represents an important method that has been used to inform intervention design, description, and evidence synthesis. Such BCTs are defined by Michie et al. (2013) as:

"..observable, replicable, and irreducible component of an intervention designed to alter or redirect causal processes that regulate behavior; that is, a technique is proposed to be an “active ingredient” (e.g., feedback, self-monitoring, and reinforcement)."

The initial taxonomy was limited in that it held few characteristics of a traditional taxonomy such as a hierarchical structure reflecting the aggregate of subcomponents. Rather the taxonomy allowed researchers to  systematically distinguish between the low-level components that characterise interventions targeting behaviour. 

The paper

Michie and colleagues (2013) have sought to produce an updated taxonomy characterized by a reliable hierarchical classification of distinct BCTs. To do this they use Delphi methods to develop an expert consensus (through progressive rounds where panel members are given feedback regarding the responses of others (in this case the options eliminated) and the variation in responses is gradually funnelled down towards a convergent solution (in this case with the assistance of an expert panel)). This process, described comprehensively in the paper, resulted in selection of 93 BCTs which clustered into 16 overarching groups:

1) Scheduled consequences
2) Reward & threat
3) Repetition & substitution
4) Antecedents
5) Associations
6) Covert learning
7) Natural consequences
8) Feedback & monitoring
9) Goals & planning
10) Social support
11) Comparison of behaviour
12) Self-belief
13) Comparison of outcomes
14) Identity 
15) Shaping knowledge
16) Regulation

With this study the authors aim to produce an agreed taxonomy of BCTs that can be used as a base for further modifications and extensions. In the mean time the taxonomy is placed to act as a 'gold standard' for identifying the active components of interventions and systematic descriptions of intervention content that will assist in replication.

Questions for the journal club:

i) Is a systematic taxonomy of behaviour change techniques necessary? Why?
ii) What are the underlying assumptions regarding the generalizability of intervention techniques across domains and are these assumptions valid?
iii) The v1 taxonomy is based on the perspectives of a relatively small group of experts, is this the most adequate method? What are the alternatives? What techniques are used to ensure high quality responses?

Note. The authors make several attempts to ensure their study is informed by leading figures in the field. They offer meaningful compensation (£140), recruit experts with a broad set of skills/backgrounds from both the UK (8 of 14 experts) and abroad (6 of 14 experts), and achieve a high response rate (14 of 19 experts contacted agreed to take part).

iv) What does the identification of higher-order BCT clusters add to the taxonomy?

v) How does v1 compare to other less systematic approaches to compiling the core efffective methods to change behaviour? The case of MINDSPACE (Dolan et al., 2012):

Messenger we are heavily influenced by who communicates information
Incentives our responses to incentives are shaped by predictable mental 
shortcuts such as strongly avoiding losses 
Norms we are strongly influenced by what others do
Defaults we "go with the flow" of pre-set options
Salience our attention is drawn to what is novel and seems relevant to us
Priming our acts are often influenced by sub-conscious cues
Affect our emotional associations can powerfully shape our actions
Commitments we seek to be consistent with our public promises, and 
reciprocate acts
Ego we act in ways that make us feel better about ourselves

vi) Are there important modifiable processes involved in the regulation of behaviour that are missed by the taxonomy?

vii) How is the BCT taxonomy research agenda likely to progress and contribute to enhancing the science of behaviour change?

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