Changing behaviour ‘more or less’: do interventions include different BCTs for increasing and decreasing behaviours?

Abstract

BACKGROUND: Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, decreasing ineffective clinician behaviours, versus adopting new procedures, may require different approaches. It is not clear if interventions targeting de-implementation (decreasing) versus implementation (increasing) already use different approaches. We used the Behaviour Change Technique (BCT) Taxonomy (version1) to investigate whether these interventions contain different BCTs. METHODS: Intervention descriptions in 181 articles from three systematic reviews in the Cochrane library were coded for increasing versus decreasing behaviour and BCTs using the BCT Taxonomy (v1). BCTs frequencies were calculated and compared using Pearson’s Chi-squared (χ2). FINDINGS: In Audit and Feedback interventions Feedback on behaviour (χ2=9.800, p<0.01) and Instruction on how to perform the behaviour (χ2=10.667, p<0.005) were reported more frequently for de-implementation. Goal setting (behaviour) (χ2=8.067, p<0.01) was reported more frequently for implementation. In Antibiotic Prescribing interventions, Instruction on how to perform the behaviour (χ2=35.280, p<0.001), Behaviour substitution (χ2=9.800, p<0.01) and Restructuring physical environment (χ2 = 10.889, p< 0.01) were more frequently reported for de-implementation whilst Feedback on behaviour (χ2 = 5.400, p< 0.05) was more frequently reported for implementation. There were no differences in BCT frequency for implementation or de-implementation in the Imaging interventions. No intervention descriptions contained BCTs within the clusters: Regulation, Identity, Scheduled consequences, Self-belief and Covert learning. DISCUSSION: Whilst different BCTs were reported in interventions for implementation versus de-implementation, these differences were not evident across all three reviews. Additional investigation is required to determine if different processes are involved in decreasing, versus increasing, behaviour.