Behaviour change techniques in control groups: development of a treatment-as-usual checklist for smoking cessation trials

Abstract

Background: Systematic reviews of behaviour change intervention trials should accurately assess and control for variability in the support provided to control groups. Since the content of control group support in trials is underreported, it is imperative to develop instruments to retrieve information about treatment activities in control groups from study authors. Therefore, the present study describes a rigorous, systematic approach towards developing a treatment-as-usual (TAU) checklist for smoking cessation trials. Methods: TAU smoking cessation treatment activities were identified from major international smoking cessation treatment manuals, existing behaviour change technique (BCT) taxonomies, focus groups with smoking cessation clients, professionals, and policy makers, and research team expertise. Treatment activities were eligible for inclusion when judged to be adequate applications of BCTs. Smoking cessation experts checked the phrasing of items. Activities were classified into meaningful categories by three independent researchers. Findings: Sixty TAU items were identified based on smoking cessation treatment manuals (32 activities), taxonomies (16 activities), focus groups and research team expertise (12 activities), relating to 40 BCTs. Activities were reliably classified (95% agreement ) into 7 categories (information/motivation; action/coping planning, abstinence; medication management; treatment engagement; group support; referral) targeting 4 behaviours (quitting, abstinence, medication adherence, and programme engagement). Discussion: Findings indicate that TAU for smoking cessation includes a wide variety of treatment activities that represent BCTs, target 4 key behaviours, and can be reliably organised in 7 categories. The TAU activity checklist may be a useful instrument to assess control group support in systematic reviews of smoking cessation interventions.