Optimising the value of the evidence generated in Implementation Science : the use of ontologies to address the challenges

Our thanks to Marta Marques, Emma Norris, Ildiko Tombor, Holly Walton, Olga Perski and Hilary Groarke for comments on an earlier draft of this editorial. The project is funded by a Wellcome Trust collaborative award [The Human Behaviour-Change Project: Building the science of behaviour change for complex intervention development’, 201,524/Z/16/Z].Peer reviewedPublisher PD

Characterising the ‘Txt2Stop’ Smoking Cessation Text Messaging Intervention in Terms of Behaviour Change Techniques

The ‘Txt2Stop’ SMS messaging programme has been found to double smokers’ chances of stopping. It is important to characterise the content of this information in terms of specific behaviour change techniques (BCTs) for the purpose of future development. This study aimed to (i) extend a proven system for coding BCTs to text messaging and (ii) characterise Txt2Stop using this system. A taxonomy previously used to specify BCTs in face-to-face behavioural support for smoking cessation was adapted for the Txt2Stop messages and inter-rater reliability for the adapted system assessed. The system was then applied to all the messages in the Txt2Stop programme to determine its profile in terms of BCTs used. The text message taxonomy comprised 34 BCTs. Inter-rater reliability was moderate, reaching a ceiling of 61% for the core program messages with all discrepancies readily resolved. Of 899 texts delivering BCTs, 218 aimed to maintain motivation to remain abstinent, 870 to enhance self-regulatory capacity or skills, 39 to promote use of adjuvant behaviours such as using stop-smoking medication, 552 to maintain engagement with the intervention and 24 were general communication techniques. The content of Txt2Stop focuses on helping smokers with self-regulation and maintaining engagement with the intervention. The intervention focuses to a lesser extent on boosting motivation to remain abstinent; little attention is given to promoting effective use of adjuvant behaviours such as use of nicotine replacement therapy. As new interventions of this kind are developed it will be possible to compare their effectiveness and relate this to standardised descriptions of their content using this system.</jats:p

How many papers are published each week reporting on trials of interventions involving behavioural aspects of health?

Behavioural science as applied to human health and wellbeing is crucial for meeting the challenges facing humanity in the 21st century. Although only a small fraction of health-related research focuses on behaviour, it still represents a substantial body of evidence that is accumulating rapidly. The sheer number of publications presents a huge challenge for manual extraction of information from study reports for purposes of evidence synthesis. We assessed the extent of this challenge, focusing on estimating the number of published reports of effectiveness trials relating to behaviour, either as outcomes or as key determinants of health outcomes. We adopted a conservative search strategy using words and phrases relating to effectiveness or efficacy trials of interventions involving commonly researched health-related behaviours. We reviewed a sample of the papers identified using the search strategy to estimate the proportion that were in scope. Using the search strategy we found an estimated 6,793 papers published per year over the years 2018-2022 inclusive. Of these, 81% were estimated by manual inspection to be in scope, resulting in an estimated 5,502 per year or 106 papers per week. The true figure is likely to be higher because of behaviours that were not canvassed in the search and trials represent only a small fraction of papers seeking to describe and understand behavioural issues relating to health and wellbeing

Scientific discipline

Formal ontological definition: A human activity that involves systematically gathering and using data to develop, evaluate and revise explanatory and predictive models in order to increase knowledge and understanding of a topic of study. Comment: A given scientific discipline (e.g., physics, communications science, meteorology, psychology and anthropology) is typically characterised both by the topic of study and the methods used to investigate it. Scientific disciplines can be subclasses of other scientific disciplines (e.g., particle physics is a subclass of physics) and they can overlap in their methods or topic of study (e.g., social psychology and sociology)

Why are there different versions of the COM-B model diagram?

The Capability, Opportunity, Motivation-Behaviour (COM-B) model is used to understand and predict human behaviour, and develop interventions aimed at influencing behaviour. It has been presented in several different diagrams, varying in the specification of the causal links between capability, opportunity, motivation and behaviour. The differences arise from the different levels of elaboration of the model. For many purposes the simplest version as set out in the original paper describing the model is sufficient. This version represents causal influences from capability and opportunity to motivation and bidirectional influences between these and behaviour. However, in principle there can also be causal influences from motivation to capability and opportunity, and for greater precision the diagram can show capability and opportunity influencing the relationship between motivation and behaviour rather than behaviour directly. There may be occasions when it is useful to include one or more of these additional causal specifications in the COM-B model diagram

Theory and ontology in behavioural science

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Creating ontological definitions for use in science

Ontologies aim to represent the world in terms of uniquely defined classes and their properties which are expressed as relationships with other classes. They are becoming widely used in science to improve clarity, searching, inference and the ability to link data from different sources. Ontological definitions are descriptions that represent the essential properties of classes of entities (which include objects, object attributes and processes) that distinguish them from other classes. Classes have unique IRIs (Internationalised Resource Identifiers) that can be used for searching; they also have labels which are words of phrases that people can use to identify the class in passages of text or tables. This article provides a brief guide to help with writing good ontological definitions. The standard format of such a definition of a class, A, is: ‘a B that C’ or its semantic equivalent, where A is the class being defined, B is a parent class and C describes a set of properties of A that distinguish it from other members of B

A cluster randomised controlled trial of the efficacy of a brief walking intervention delivered in primary care : study protocol

Background: The aim of the present research is to conduct a fully powered explanatory trial to evaluate the efficacy of a brief self-regulation intervention to increase walking. The intervention will be delivered in primary care by practice nurses (PNs) and Healthcare Assistants (HCAs) to patients for whom increasing physical activity is a particular priority. The intervention has previously demonstrated efficacy with a volunteer population, and subsequently went through an iterative process of refinement in primary care, to maximise acceptability to both providers and recipients. Methods/ Design: This two arm cluster randomised controlled trial set in UK general practices will compare two strategies for increasing walking, assessed by pedometer, over six months. Patients attending practices randomised to the self-regulation intervention arm will receive an intervention consisting of behaviour change techniques designed to increase walking self-efficacy (confidence in ability to perform the behaviour), and to help people translate their “good” intentions into behaviour change by making plans. Patients attending practices randomised to the information provision arm will receive written materials promoting walking, and a short unstructured discussion about increasing their walking. The trial will recruit 20 PN/HCAs (10 per arm), who will be trained by the research team to deliver the selfregulation intervention or information provision control intervention, to 400 patients registered at their practices (20 patients per PN/HCA). This will provide 85% power to detect a mean difference of five minutes/day walking between the self-regulation intervention group and the information provision control group. Secondary outcomes include health services costs, and intervention effects in sub-groups defined by age, ethnicity, gender, socioeconomic status, and clinical condition. A mediation analysis will investigate the extent to which changes in constructs specified by the Theory of Planned Behaviour lead to changes in objectively assessed walking behaviour. Discussion: This trial addresses the current lack of evidence for interventions that are effective at increasing walking and that can be offered to patients in primary care. The intervention being evaluated has demonstrated efficacy, and has been through an extensive process of adaptation to ensure acceptability to both provider and recipient, thus optimising fidelity of intervention delivery and treatment receipt. It therefore provides a strong test of the hypothesis that a self-regulation intervention can help primary care patients increase their walking