Optimizing Making Every Contact Count (MECC) Interventions:A Strategic Behavioral Analysis

Objective: This Strategic Behavioural Analysis aimed to: identify barriers and facilitators to healthcare professionals’ implementation of MECC; code behavioural components of nationally delivered interventions to improve MECC implementation; assess the extent to which these components are theoretically congruent with identified theoretical domains representing barriers and facilitators. Comparing national interventions that aim to support implementation of behaviour change related activity to the barriers and facilitators for the target behaviour enables identification of opportunities being missed in practice thereby facilitating intervention optimisation.Methods: A mixed-methods study involving: a systematic review to identify barriers and facilitators to implementing MECC classified using the COM-B model and Theoretical Domains Framework (TDF); a content analysis of national interventions to improve MECC implementation in England using the Behaviour Change Wheel (BCW) and Behaviour Change Techniques Taxonomy (BCTTv1); linking intervention content to barriers identified in the systematic review.Results: Across 27 studies, the most frequently-reported barriers related to eight TDF domains: Environmental Context and Resources, Beliefs About Capabilities, Knowledge, Beliefs About Consequences, Intentions, Skills, Social Professional Role and Identity, Emotions. National interventions aimed at supporting MECC implementation included on average 5.1 BCW intervention functions (Education, Modelling, Persuasion, Training were used in all interventions) and 8.7 BCTs. Only 21 of BCTs potentially relevant to key domains were used across interventions. The majority of BCTs linked to seven of the eight most important domains were not used in any existing interventions.Conclusions: Intervention developers should seize missed opportunities by incorporating more theoretically relevant BCTs to target barriers to implementing MECC