Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle
Open accessAbstract
BACKGROUND: Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the 'Sepsis Six' evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27-47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to identify mechanisms of change. The aim of this study was to illustrate this process by using the Behaviour Change Wheel; Behaviour Change Technique (BCT) Taxonomy; Capability, Opportunity, Motivation model of behaviour; and Theoretical Domains Framework to characterise the content and theoretical mechanisms of action of an existing intervention to implement Sepsis Six. METHODS: Data came from documentary, interview and observational analyses of intervention delivery in several wards of a UK hospital. A broad description of the intervention was created using the Template for Intervention Description and Replication framework. Content was specified in terms of (i) component BCTs using the BCT Taxonomy and (ii) intervention functions using the Behaviour Change Wheel. Mechanisms of action were specified using the Capability, Opportunity, Motivation model and the Theoretical Domains Framework. RESULTS: The intervention consisted of 19 BCTs, with eight identified using all three data sources. The BCTs were delivered via seven functions of the Behaviour Change Wheel, with four ('education', 'enablement', 'training' and 'environmental restructuring') supported by the three data sources. The most frequent mechanisms of action were reflective motivation (especially 'beliefs about consequences' and 'beliefs about capabilities') and psychological capability (especially 'knowledge'). CONCLUSIONS: The intervention consisted of a wide range of BCTs targeting a wide range of mechanisms of action. This study demonstrates the utility of the Behaviour Change Wheel, the BCT Taxonomy and the Theoretical Domains Framework, tools recognised for providing guidance for intervention design, for characterising an existing intervention to implement evidence-based care.
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Distinctions between strategies used to support implementation and strategies used to integrate screening EBIs into practice are important when selecting and reporting strategies because the evidence base and underlying theory differ for these two types.
“We contend that these distinctions are important when selecting and reporting strategies for use in research and practice because the evidence base and, to a large extent, the underlying theory, differ for strategies used to support implementation (e.g., [6, 7]) as compared to strategies used to integrate screening EBIs into practice (e.g., [8, 9]).”
From Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (2017) · cites this paper as [9]
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- Authors
- Steinmo, S., Fuller, C., Stone, S. P., & Michie, S.
- Affiliations
- University College London (GB)
- Corresponding author
- Steinmo, Siri
- Venue
- Implementation Science
- Published
- 2015-08-08
- Volume
- 10
- Issue
- 1
- Pages
- 111-111
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC4529730
- OpenAlex
- W1935719333
- Cited by
- 119
- References
- 36
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 11 · 2022: 14 · 2021: 21 · 2020: 22 · 2019: 9 · 2018: 8 · 2017: 12 · 2016: 7 · 2015: 1
- FWCI
- 17.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- Sepsis Six, sepsis, implementation strategies, behaviour change techniques, Behaviour Change Wheel, BCT taxonomy, Theoretical Domains Framework, mechanisms of change, evidence-based care, hospital wards, sepsis mortality
- MeSH terms
- Humans, Motivation, Organizational Innovation, Personnel, Hospital, Psychological Theory, Program Development, Sepsis, Patient Care Bundles
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