Selecting BCTs for intervention in acute coronary syndrome delay: combining systematic review and Delphi Methods

Abstract

Background: Evidence from behaviour change technique (BCT) based systematic reviews is often limited in size, homogeneity or quality. We present an example of supplementing the best available published evidence with Delphi methods to select the most promising BCTs for an intervention to reduce delay in Acute Coronary Syndrome. Methods: Systematic review of interventions targeting pre-hospital delay in acute conditions to identify effective BCTs. Delphi consensus methods asking 11 BCT experts to rate essential techniques from BCTTv1 for intervention inclusion and to identify the theoretical mode of action. Findings: Thirty-three identified studies were too heterogeneous to quantitatively link the 23 identified BCTs to effectiveness. Most frequently identified BCTs were ‘information provision’ (n=28), ‘instruction provision’ (n=24) and ‘action planning’ (n=17). BCT experts rated ‘action planning’, ‘salience of consequences’ and ‘problem solving’ as essential. Mapping of BCTs to theoretical constructs further informed BCT selection and theoretical coherence. Discussion: The specified methods overcome limitations of inconclusive review findings by combining best available evidence from the literature with theory and expert consensus evidence to ensure a systematic and transparent intervention development process.