Application of the Behaviour Change Wheel Framework to the development of interventions within the City4Age project

The probability of an intervention being effective is likely increased if it is designed following a behavioural analysis and with the aid of evidence-based intervention frameworks. For example, the Behaviour Change Wheel (BCW) framework and its associated COM-B model of behaviour have been used successfully as a starting point for designing behaviour change interventions. However, the BCW framework can also be applied at a later stage in the design process, such as when an intervention has been designed but before it is deployed. Here we describe the application of the BCW framework and COM-B model to evaluate and refine already designed interventions. We use a multidisciplinary multi-site project (‘City4Age’) as a case study. The project aims to promote independent living of older adults through the deployment of interventions using wearable and environment-based technology. We conducted face-to-face interviews with site representatives to identify the target behaviours, perceived barriers and facilitators, intervention functions, and modes of delivery for each planned intervention. Additionally, literature reviews were conducted to identify evidence-based facilitators and barriers for each targeted behaviour. Subsequently, we 1) compared the intervention functions proposed by the project-sites with those most likely to be effective according to the BCW; and 2) assessed the congruency of the barriers and facilitators identified by the pilot-sites with those identified in the literature. For five planned interventions across two project-sites (Birmingham and Singapore), two had intervention functions unlikely to be effective according to the BCW. The two planned interventions to promote social engagement did not address barriers or facilitators evident in the literature, indicating they required refinement. Applying the BCW framework allowed to identify which interventions needed refining. It also helped in providing specific guidance in our recommendations for improvements prior to deployment

The perceptions of food service staff in a nursing home on an upcoming transition towards a healthy and sustainable food environment:a qualitative study

Background: Healthy and sustainable food environments are urgently needed, also in nursing and residential care homes. Malnutrition in care homes is becoming an increasing problem as populations worldwide are ageing and many older people do not consume sufficient protein, fibre, fruit, and vegetables. Nursing homes also often experience a lot of food waste. A transition in the food environment like a nursing home, involves the participation of facility management and food service staff members. This study aims to map out their perceived barriers and facilitators for this transition. Methods: A qualitative study using semi-structured interviews was conducted with food service staff members (n = 16), comprising of kitchen staff (n = 4), wait staff (n = 10), and facility management (n = 2) of two nursing homes in the Netherlands. Thematic analysis was used to derive content and meaning from transcribed interviews. Results: Four main themes were identified. Theme 1: ‘Communication, transparency and accountability in the chain’, highlighting the lack of effective communication flows and a fragmented overview of the food service chain as a whole. Theme 2: ‘Understanding, knowledge and ability of the concepts healthy and sustainable’, revealing the gap in staff’s understanding of these abstract concepts, despite perceiving themselves as having sufficient knowledge and ability. Theme 3: ‘The pampering service mind-set’, highlighting the contradiction in the staff’s shared goal of proving the highest quality of life for residents while also pampering them in ways that may not align with promoting healthy and sustainable food choices. Theme 4: ‘Transition is important but hard to realize’, describing the barriers such as existing routines and a lack of resources as challenges to implementing changes in the food service. Conclusions: Facilitators to transitioning nursing homes towards a healthy and sustainable food environment as perceived by staff members included transparent communication, accountability in the food supply chain, staff’s perceived ability and shared goal, while barriers included lack of understanding of the concepts healthy and sustainable, the current pampering mindset, and top-down decision-making. These findings provide valuable insights for nursing homes seeking to transition towards a healthier and more sustainable food environment.</p

Decarbonising existing homes in Wales: a participatory behavioural systems mapping approach

To reduce carbon emissions, urgent change is needed to high-carbon human behaviours including home energy use. Previous policy failures point to insufficient integration of systemic and behavioural approaches which are too often seen as alternative and incompatible approaches to bring about change. A novel behavioural systems mapping approach was used to inform national policy recommendations for energy-saving retrofit of homes in Wales. Three participatory workshops were held with the independent Welsh residential decarbonisation advisory group ('the Advisory Group') to: (1) map relationships between actors, behaviours and influences on behaviour within the home retrofit system; (2) provide training in the Behaviour Change Wheel (BCW) framework and (3) use these to develop policy recommendations for interventions. Recommendations were analysed using the capability, opportunity and motivation (COM-B) model of behaviour to assess whether they addressed these factors. Two behavioural systems maps (BSMs) were produced, representing privately rented and owner-occupied housing tenures. The main causal pathways and feedback loops in each map are described. Necessary interventions to achieve national-scale retrofit included: government-led investment, campaigns and awareness-building, financial-sector funding mechanisms, enforcement of regulations and creating more streamlined and trusted supply chain services. Of 27 final policy recommendations, six addressed capability, 24 opportunity and 12 motivation. Participatory behavioural systems mapping can be used in conjunction with behaviour change frameworks to develop policy recommendations that address the behavioural determinants of complex environmental problems in a systemic way. Research is underway to refine and extend the approach through application to other sustainability challenges and methods of constructing systems maps

Development of a theory- and evidence-informed behaviour change intervention to promote appropriate antibiotic use in acute hospitals

Background: Antimicrobial resistance poses a serious threat to global public health. Behaviours such as inappropriate antibiotic use in hospitals have contributed to this problem, and evidence-based interventions are urgently needed to improve prescribing practices in acute settings. Previous behaviour change interventions aimed at reducing inappropriate antibiotic use in hospitals have been sub-optimal and lacked details on their development. Methods: Guided by the recommendations of the 2008 MRC Framework for Complex Interventions, intervention development followed a phased approach, including a systematic review and meta-ethnography, two qualitative studies with a total of 35 participants, and the development and operationalisation of the intervention content. A meta-ethnography, the first theoretical stage, synthesised 15 qualitative papers and provided an understanding of the contextual determinants influencing antibiotic prescribing in acute hospitals. The resulting conceptual model reflected how these challenges operate on both micro- and macro-level, highlighting key areas for improvement. Central to the design of an effective intervention was the generation of a robust theoretical basis using the Behaviour Change Wheel. The selection of an intervention content was guided by the APEASE criteria and coded according to an established Behaviour Change Technique Taxonomy. Healthcare professionals and patient representatives were involved at all stages of intervention design and interpretation. Focus groups carried out with key stakeholders filled in gaps in the literature and enabled modelling of the initial draft of the intervention. The optimisation phase, including assessing the intervention acceptability and suitability for clinical practice, was conducted using semi-structured interviews. Results and Conclusions: A digital antibiotic review tracking toolkit (DARTT), a complex, multifaceted behaviour change intervention to improve antibiotic use in acute hospitals, was developed using systematic methods. This work addresses a gap in the literature regarding how to develop behaviour change interventions that are grounded in theory and acceptable for the target group. Findings from this work are potentially transferable to a variety of behaviour change interventions and clinical settings