Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data)

Study 5a: quality, reliability of BCT identification and validity did not differ for descriptions written by untrained writers with and without BCTTv1 (all p > 0.05).

“Study 5a: quality, reliability of BCT identification (between trained coders) and validity (trained coder agreement with expert consensus) did not differ for descriptions written by untrained writers with and without BCTTv1 (all p > 0.05).”

Training improved trainee confidence in identifying BCTs assessed in workshops.

“Trainee confidence in identifying BCTs assessed improved in workshops (p < 0.001).”

• AssumptionRests on an assumption: The process of coding interventions into BCTs is a highly skilled task requiring familiarity with labels and definitions and ability to make a series of complex interpretative judgements.
• AssumptionRests on an assumption: This requires an effective programme of coder training to ensure sufficient level of skills to demonstrate reliability and validity of identifying BCTs.

Training did not improve intercoder agreement for either workshop or distance group tutorial method.

“Intercoder agreement did not improve for either method (workshops p = 0.08 and tutorials p = 0.57).”

• AssumptionRests on an assumption: The process of coding interventions into BCTs is a highly skilled task requiring familiarity with labels and definitions and ability to make a series of complex interpretative judgements.
• AssumptionRests on an assumption: This requires an effective programme of coder training to ensure sufficient level of skills to demonstrate reliability and validity of identifying BCTs.

Training doubled the proportion achieving competence (agreement with expert consensus PABAK > 0.60) for both workshop and distance group tutorial trainees.

“with the proportion achieving competence (i.e.agreement with expert consensus PABAK > 0.60) doubling (both p < 0.05)”

• AssumptionRests on an assumption: The process of coding interventions into BCTs is a highly skilled task requiring familiarity with labels and definitions and ability to make a series of complex interpretative judgements.
• AssumptionRests on an assumption: This requires an effective programme of coder training to ensure sufficient level of skills to demonstrate reliability and validity of identifying BCTs.

Only providing the taxonomy made no difference (study 5a).

“while only providing the taxonomy made no difference (study 5a).”

Training improved trainee agreement with expert consensus for both workshop and distance group tutorial trainees.

“Trainee agreement with expert consensus improved across workshop and distance group tutorial trainees (both p < 0.05)”

• AssumptionRests on an assumption: The process of coding interventions into BCTs is a highly skilled task requiring familiarity with labels and definitions and ability to make a series of complex interpretative judgements.
• AssumptionRests on an assumption: This requires an effective programme of coder training to ensure sufficient level of skills to demonstrate reliability and validity of identifying BCTs.

This produced a list of 94 BCTs.

“This produced a list of 94 BCTs.”

Only six combinations achieved satisfactory evidence of similarity.

“However, only six combinations achieved satisfactory evidence of similarity.”

Thirty-six of the 208 'bottom-up' × 'top-down' pairings showed greater overlap than expected by chance.

“Thirty-six of the 208 'bottom-up' × 'top-down' pairings (i.e.16 × 13) showed greater overlap than expected by chance.”

There was good test-retest reliability.

“and there was good test-retest reliability.”

Study 5b: quality of descriptions written by untrained raters without BCTTv1 was rated as greater than descriptions written by trained writers, with BCTTv1 (all p < 0.05).

“Study 5b: quality of descriptions written by untrained raters without BCTTv1 was rated as greater than descriptions written by trained writers, with BCTTv1 (all p < 0.05).”

Providing BCTTv1 plus training resulted in descriptions of poorer quality when comparing trained with untrained writers (study 5b).

“providing BCTTv1 plus training resulted in descriptions of poorer quality when comparing trained with untrained writers (study 5b)”

Reliability of BCT identification was greater for descriptions written by trained than untrained writers, with BCTTv1 (study 5b).

“However, reliability of BCT identification was greater for descriptions written by trained than untrained writers, with BCTTv1 (study 5b) but not in the within-person study (study 5c).”

BCTs relating to 'Reward and Punishment' and 'Cues and Cue Responses' were perceived as markedly different from other BCTs.

“BCTs relating to 'Reward and Punishment' and 'Cues and Cue Responses' were perceived as markedly different from other BCTs.”

Providing BCTTv1 both with and without training did not improve validity of BCT identification.

“Providing BCTTv1 both with and without training did not improve validity of BCT identification.”

Providing BCTTv1 plus training resulted in improvement when investigated in a within-person study (study 5c).

“but resulted in improvement when investigated in a within-person study (study 5c)”

Good test-retest reliability was achieved within coders (between baseline and 1 month) (p < 0.001).

“Good test-retest reliability was achieved within coders (between baseline and 1 month) (p < 0.001).”

Good concurrent validity was achieved for 14 out of the 15 BCTs identified by experienced coders to be present in published descriptions.

“Good concurrent validity was achieved for 14 out of the 15 BCTs identified by experienced coders to be present in published descriptions.”

Reliability did not differ across the two time points.

“Reliability did not differ across the two time points”

Study 5b: Reliability of BCT identification was greater for descriptions written by trained writers, with BCTTv1 (mean PABAK trained = 0.87; untrained = 0.84; p < 0.05).

“Reliability of BCT identification (between trained coders) was greater for descriptions written by trained writers, with BCTTv1 (mean PABAK trained = 0.87; untrained = 0.84; p < 0.05).”

Study 5c: quality of descriptions written by trained writers, with BCTTv1, was higher than descriptions written by the same writers, before training and not using BCTTv1 (all p < 0.05 except replicability of mode of delivery).

“Study 5c: quality of descriptions written by trained writers, with BCTTv1, was higher than descriptions written by the same writers, before training and not using BCTTv1 (all p < 0.05 except replicability of mode of delivery).”

There was a significant association between the 16 'bottom-up' groupings and the 13 'top-down' groupings, chi-squared = 437.80; p < 0.001.

“There was a significant association between the 16 'bottom-up' groupings and the 13 'top-down' groupings, chi-squared = 437.80;p < 0.001.”

Good intercoder reliability was observed for 80 of the 93 BCTs.

“Good intercoder reliability was observed for 80 of the 93 BCTs.”

Development of BCTTv1 comprised a series of consensus exercises involving 35 experts in delivering and/or designing BCIs.

“Development comprised a series of consensus exercises involving 35 experts in delivering and/or designing BCIs.”

Further refinement by study team members resulted in a list of 93 clearly defined, non-redundant BCTs.

“Further refinement of labels and definitions by study team members resulted in a list of 93 clearly defined, non-redundant BCTs (see Appendix 2, Table 19).”

BCTTv1 encompasses a greater number of BCTs than previous taxonomies.

“The BCTTv1 encompasses a greater number of BCTs than previous taxonomies.”

An extensive list of 93 distinct, non-redundant BCTs was developed with labels and definitions refined to capture the smallest components compatible with retaining the proposed active ingredients with minimum overlap (BCTTv1).

“An extensive list of 93 distinct, non-redundant BCTs was developed with labels and definitions refined to capture the smallest components compatible with retaining the proposed active ingredients with the minimum of overlap: BCTTv1 (see Appendix 2, Table 19).”

Together with the 21 BCTs judged satisfactory in the first round, there were 84 BCTs at the end of the Delphi exercise.

“Together with the 21 BCTs judged to be 'satisfactory' in the first round, there were 84 BCTs at the end of the Delphi exercise.”

The 'bottom-up' open-sort task yielded systematic empirical estimates of how distinct the groupings are.

“In addition to providing 16 groupings, the 'bottom-up' open-sort task yielded systematic empirical estimates of how distinct the groupings are.”

There was a moderate overlap between the 16 BCT groupings from the 'bottom-up' approach and the 12 groupings from the 'top-down' approach, indicating some common conceptualisation of BCTs across these two approaches.

“There was a moderate overlap between the 16 BCT groupings derived from the 'bottom-up' inductive approach and the 12 groupings from the 'top-down' theoretically driven approach, indicating some common conceptualisation of BCTs across these two approaches.”

There was also an association between the 16 'bottom-up' groupings and the 13 'top-down' groupings (χ2 = 437.80; p < 0.001).

“There was also an association between the 16 'bottom-up' groupings and the 13 'top-down' groupings (χ 2 = 437.80;p < 0.001).”

This was not significantly different from the level of expertise reported by participants in the open-sort task.

“This was not significantly different from the level of expertise reported by participants in the open-sort task: behaviour change theory, mean = 3.00, SD = 0.88, t(34) = 0.64; p > 0.10; BCIs, mean = 2.42, SD = 0.96, t(34) = 0.63; p > 0.10.”

Twenty-one of the 91 'bottom-up' and 'top-down' TDF domain combinations showed greater than expected overlap with positive Pearson's residual values.

“Twenty one of the 91 'bottom-up' and 'top-down' TDF domain combinations showed a greater than expected overlap with positive Pearson's residual values (Table 4).”

Only two combinations achieved Pearson's residual values > 5: 'grouping 1' with 'reinforcement' (6.61) and 'grouping 5' with 'social influences' (5.04).

“Only two combinations achieved Pearson's residual values > 5, which were: 'grouping 1′ with 'reinforcement' (Pearson's residual value = 6.61) and 'grouping 5′ with 'social influences' (Pearson's residual value = 5.04).”

The following commonly identified BCTs were not linked to any theoretical domains: problem-solving, credible source, discrepancy between current behaviour, self-monitoring of outcome of behaviour, monitoring of outcome behaviour by others without feedback, and pharmacological support.

“The following commonly identified BCTs were not linked to any of the theoretical domains: problem-solving, credible source, discrepancy between current behaviour, self-monitoring of outcome of behaviour, monitoring of outcome behaviour by others without feedback and pharmacological support.”

Within the 16-grouping open-sort solution, there are six points at which groupings split into groupings containing similar BCTs, creating seven higher-order strategy groupings.

“Within the reported 16-grouping open-sort solution of the taxonomy, there are six points at which groupings of BCTs split into groupings containing similar BCTs (creating seven split groupings, i.e. higher order strategy groupings).”

Thirty-seven BCTs were allocated to three domains that also had high confidence ratings and ICCs: beliefs about consequences, reinforcement, and social influences.

“Thirty-seven BCTs were allocated to three domains that also had high confidence ratings and ICCs: 'beliefs about consequences', 'reinforcement' and 'social influences'.”

Of the 24 most commonly occurring BCTs, 18 (75%) were reliably linked to seven of the theory domains, with a further two (8%) obtaining borderline statistical significance.

“Of the 24 most commonly occurring BCTs (see Michie et al. 40 ), 18 (75%) were reliably linked to seven of the theory domains, with a further two (8%) obtaining borderline statistical significance.”

• cites Michie et al. 40Not checked yet

  Not checked in the free run.

Most of the commonly used BCTs were associated with a theoretical domain.

“Most of the commonly used BCTs were associated with a theoretical domain.”

Comparison of the BCT groupings derived from the higher-order 'bottom-up' sorting strategies and the 'top-down' TDF derived groupings revealed a significant association (χ2 = 236.13; p < 0.001).

“Comparison of the BCT groupings derived from the higher-order 'bottom-up' sorting strategies, shown in the dendrogram and the 'top-down' TDF derived groupings (see Table 3) revealed a significant association (χ 2 = 236.13;p < 0.001).”

Two domains, social/professional role and identity and memory, attention and decision processes, had no BCTs significantly assigned to them.

“Two domains, 'social/professional role and identity' and 'memory, attention and decision processes' had no BCTs significantly assigned to them.”

BCTs related to reward and threat, and those related to cues and cue responses, were conceptualised quite distinctly from the other BCTs.

“Examination of this hierarchical structure revealed that BCTs related to reward and threat, and those related to cues and cue responses, were conceptualised quite distinctly from the other BCTs.”

Thirty-six of the 208 combinations showed greater than expected overlap, achieving positive Pearson's residual values.

“Thirty six of the 208 combinations showed greater than expected overlap, achieving positive Pearson's residual values (see Table 4).”

Trainees rated activities that used the taxonomy to code short excerpts and longer descriptions from published reports as being useful opportunities to apply their newly learned skills.

“Trainees rated activities that used the taxonomy to code short excerpts and longer descriptions from published reports as being useful opportunities to apply their newly learned skills.”

After distance group tutorial training, four BCTs were rated with high confidence by over 90% of trainees: self-monitoring of outcome(s) of behaviour, self-monitoring of behaviour, goal-setting (outcome) and credible source.

“After training, four BCTs were rated with high confidence by over 90% of trainees: self-monitoring of outcome(s) of behaviour, self-monitoring of behaviour, goal-setting (outcome) and credible source.”

For one-day workshops, the BCT 'material reward' achieved good reliability before training and after training.

“The BCT 'material reward' achieved good reliability before training and this was also achieved after training.”

For one-day workshops, agreement with expert consensus increased for 8 out of the 12 BCTs: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, non-specific reward, goal-setting (outcome), material reward (behaviour), credible source and demonstration of the behaviour (average increase in PABAK = 0.36, SD = 0.33; range = 0.02-0.95).

“Across the BCTs assessed, agreement with expert consensus increased for 8 out of the 12 BCTs: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, non-specific reward, goal-setting (outcome), material reward (behaviour), credible source and demonstration of the behaviour (average increase in PABAK for these eight BCTs = 0.36, SD = 0.33; range = 0.02-0.95).”

For distance group tutorials, there was an increase in self-reported confidence in using the taxonomy from before training (mean = 3.42, SD = 1.00) to after training (mean = 4.08, SD = 0.56), t(51) = -5.27; p < 0.001.

“There was an increase in self-reported confidence in using the taxonomy from before training: mean = 3.42, SD = 1.00 to after training: mean = 4.08, SD = 0.56, t(51) = -5.27;p < 0.001.”

Tutorial trainees also reported increased overall confidence in using the taxonomy.

“Tutorial trainees also reported increased overall confidence in using the taxonomy.”

After one-day workshop training, four BCTs ('demonstration of the behaviour', 'material reward (behaviour)', 'behavioural practice/rehearsal' and 'self-monitoring of behaviour') were rated with high confidence by 90% or more of trainees.

“After training, four of the BCTs -'demonstration of the behaviour', 'material reward (behaviour)', 'behavioural practice/rehearsal' and 'self-monitoring of behaviour'were rated with high confidence by 90% or more of trainees.”

For distance group tutorials, reported intention to use BCT taxonomies in the future remained high from before training (mean = 4.23, SD = 0.74) to after training (mean = 4.16, SD = 1.02); t(51) = 0.44; p = 0.66.

“Reported intention to use BCT taxonomies in the future remained high from before training: mean = 4.23, SD = 0.74 to after training: mean = 4.16, SD = 1.02; t(51) = 0.44; p = 0.66.”

Some BCTs consistently achieved poor reliability before and/or after training, for example goal-setting (outcome), social support (unspecified), and information about social and environmental consequences.

“Some BCTs consistently achieved poor reliability before and/or after training, for example goal-setting (outcome), social support (unspecified), and information about social and environmental consequences.”

Material reward (behaviour) was the only frequently used BCT that achieved good reliability without training for workshops and tutorials.

“There was only one frequently used BCT that achieved good reliability without training for workshops and tutorials: material reward (behaviour).”

For distance group tutorials, across the 17 BCTs assessed, the number of high confidence ratings increased, t(16) = -3.40; p < 0.001.

“Across the 17 BCTs assessed, the number of high confidence ratings increased, t(16) = -3.40;p < 0.001.”

For one-day workshops, change in intercoder agreement across the 12 BCTs was non-significant, t(11) = 0.90; p = 0.39.

“However, change across the 12 BCTs was non-significant, t(11) = 0.90; p = 0.39.”

Overall, training achieved good validity and reliability for between one-quarter and one-third of the BCTs.

“Overall, training achieved good validity and reliability for between one-quarter and one-third of the BCTs.”

For one-day workshops, there was a trend for intercoder agreement between trainees to increase from before training (mean PABAK = 0.39, SD = 0.34) to after training (mean PABAK = 0.50, SD = 0.26), t(54) = 1.77; p = 0.08.

“Intercoder agreement between trainees: there was a trend for intercoder agreement to increase across trainees, t(54) = 1.77; p = 0.08 (before training: mean PABAK = 0.39, SD = 0.34); after training: mean PABAK = 0.50, SD = 0.26).”

For one-day workshops, the number of high confidence ratings increased for 6 out of the 12 BCTs: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, material reward, credible source and demonstration of the behaviour.

“The number of high confidence ratings increased for 6 out of the 12 BCTs: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, material reward, credible source and demonstration of the behaviour.”

For one-day workshops, overall trainee agreement with expert consensus increased from before training (mean PABAK = 0.39, SD = 0.29) to after training (mean PABAK = 0.50, SD = 0.28), t(108) = 3.26; p < 0.0001.

“Agreement with expert consensus: overall, trainee agreement with expert consensus increased, t(108) = 3.26; p < 0.0001 (before training: mean PABAK = 0.39, SD = 0.29; after training: mean PABAK = 0.50, SD = 0.28).”

For distance group tutorials, 'self-monitoring of behaviour' and 'self-monitoring of outcome(s) of behaviour' achieved good reliability before and after training.

“Two further BCTs -'self-monitoring of behaviour' and 'self-monitoring of outcome(s) of behaviour'achieved good reliability before and after training.”

Before distance group tutorial training, 'self-monitoring of behaviour' was rated with high confidence by over 90% of trainees.

“Before training, one of the BCTs -'self-monitoring of behaviour'was rated with high confidence by over 90% of trainees.”

Self-monitoring of behaviour and self-monitoring of outcome(s) of behaviour achieved good reliability without training for tutorial trainees.

“Two other BCTs achieved good reliability without training for tutorial trainees: self-monitoring of behaviour and self-monitoring of outcome(s) of behaviour.”

Compared with workshop trainees, tutorial trainees started with a greater level of experience and expertise in using BCT taxonomies.

“Compared with workshop trainees, tutorial trainees started with a greater level of experience and expertise in using BCT taxonomies.”

Expert consensus was reached about the presence of 17 BCTs in each of the two tutorial descriptions: feedback on behaviour, credible source, information about health consequences, information about social and environmental consequences, social support (unspecified), monitoring of outcome(s) of behaviour without feedback, non-specific reward, demonstration of the behaviour, adding objects to the

“Expert consensus was reached about the presence of 17 BCTs in each of the two descriptions (see Table 9): feedback on behaviour, credible source, information about health consequences, information about social and environmental consequences, social support (unspecified), monitoring of outcome(s) of behaviour without feedback, non-specific reward, demonstration of the behaviour, adding objects to”

Expert consensus was reached about the presence of 12 BCTs in the workshop descriptions: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, non-specific reward, goal-setting (outcome), material reward (behaviour), credible source, problem-solving, demonstration of the behaviour, information about health consequences, goal-setting (behaviour) and social support (un

“The coders reached consensus about the presence of 12 BCTs in the descriptions: self-monitoring of behaviour, feedback on behaviour, behavioural practice/rehearsal, non-specific reward, goal-setting (outcome), material reward (behaviour), credible source, problem-solving, demonstration of the behaviour, information about health consequences, goal-setting (behaviour) and social support (unspecified”

Before one-day workshop training, 'information about health consequences' was rated with high confidence by over 90% of trainees.

“Before training, one of the BCTs, 'information about health consequences' was rated with high confidence by over 90% of trainees.”

Training methods (workshop vs. distance tutorial) were equally effective at increasing competence, F(1,318) = 0.35; p = 0.55.

“Training methods were equally effective at increasing competence, F(1,318) = 0.35; p = 0.55.”

Trainees valued the combination of 'working through practical examples' alongside the 'opportunity to clarify and discuss' any coding they found unclear.

“In particular, trainees valued the combination of 'working through practical examples' alongside the 'opportunity to clarify and discuss' any coding they found unclear.”

For distance group tutorials, trainee agreement with expert consensus increased from before training (mean PABAK = 0.57, SD = 0.11) to after training (mean PABAK = 0.72, SD = 0.14), t(51) = 6.60; p < 0.001.

“Agreement with expert consensus: trainee agreement with expert consensus increased, t(51) = 6.60; p < 0.001 (before training: mean PABAK = 0.57, SD = 0.11; after training: mean PABAK = 0.72, SD = 0.14).”

Across the 40 intervention descriptions, mean PABAK scores ranged between 0.73 and 0.96 (mean=0.87, SD=0.05).

“Across the 40 intervention descriptions, mean PABAK scores ranged between 0.73 and 0.96 (mean = 0.87, SD = 0.05).”

Of the 93 BCTs in BCTTv1, 80 (86%) were identified by at least one trained coder at time 1.

“Of the 93 BCTs in BCTTv1, 80 (86%) were identified by at least one trained coder, at time 1.”

The percentage of high confidence ratings significantly differed according to frequency of BCT identification at time 2.

“however, they significantly differed at time 2 [F(2,77) = 3.48; p < 0.05].”

The percentage of high confidence ratings did not differ according to frequency of BCT identification at time 1.

“The percentage of high confidence ratings did not differ according to frequency of BCT identification at time 1 [F(2,77) = 2.55; p = 0.08];”

Mean trained coders' PABAK scores ranged from 0.40 to 0.85 (overall mean=0.70).

“Mean trained coders' PABAK scores ranged from 0.40 to 0.85 (overall mean = 0.70).”

The BCT 'credible source' reduced overall intercoder reliability for both experienced and trained coders (PABAK=0.60 and 0.40, respectively).

“The BCT 'credible source', reduced the overall intercoder reliability for both the experienced coders and the trained coders (PABAK score = 0.60 and 0.40 for experienced coders and trained coders, respectively).”

The pattern of mean PABAK scores across BCTs identified did not significantly change, t(79)=0.56; p=0.58, time 1 mean=0.88, SD=0.17; time 2 mean=0.87, SD=0.17.

“The pattern of mean PABAK scores across the BCTs identified also did not significantly change, [t(79) = 0.56; p = 0.58, time 1 PABAK mean = 0.88, SD = 0.17; time 2 PABAK: mean = 0.87, SD = 0.17].”

Trained coders appeared to be more confident about identifying BCTs at time 2 than the same BCTs at time 1.

“The trained coders appeared to be more confident about identifying BCTs at time 2 than the same BCTs at time 1: t( 79”

The pattern of mean PABAK scores at time 1 and time 2 did not significantly change, t(15)=-0.05; p=0.97.

“The pattern of mean PABAK scores at time 1 and time 2 did not significantly change, t(15) = -0.05;p = 0.97.”

Intercoder reliability at time 1 and time 2 was strongly correlated, r(14)=0.97; p<0.001.

“Intercoder reliability at time 1 and at time 2 was strongly correlated, r(14) = 0.97; p < 0.001.”

Correlational analyses showed the relationship between mean PABAK and mean AC1 scores across BCTs at time 1 was near perfect (r=0.96; p<0.001).

“Correlational analyses showed that the relationship between mean PABAK scores and mean AC1 scores across BCTs at time 1 was near perfect (r = 0.96; p < 0.001, two-tailed).”

Across the 80 BCTs identified, the percentage of identifications judged by coders to have been made with high confidence ranged from 0% to 100%, with an average of 57%.

“The percentage of identifications judged by coders to have been made with high confidence ('++') across the 80 BCTs identified, ranged from 0% to 100% with an average percentage of 57%.”

AC1 was significantly more likely than PABAK to generate reliability scores exceeding the 0.70 threshold [χ2(1, n=160)=10.58; p<0.001].

“AC1 was significantly more likely than PABAK to generate reliability scores that exceeded the 0.70 threshold [χ 2 (degrees of freedom = 1, n = 160) = 10.58;p < 0.001].”

Intercoder reliability remained similar across two tests separated by 1 month.

“and remained similar across two tests separated by 1 month, indicating temporal stability.”

Intercoder reliability was equally good across intervention descriptions.

“Intercoder reliability was equally good across intervention descriptions”

Frequently identified BCTs were rated with more confidence than rarely identified BCTs.

“Frequently identified BCTs were rated with more confidence (mean percentage = 70.45,SD = 9.68) than those BCTs that were rarely identified BCTs [p < 0.05 (mean percentage = 55.33,SD = 32.53)]”

Three of the 12 BCTs highlighted as unclear or requiring refinement were among the 15 BCTs identified by experienced coders achieving mean PABAK validity scores of < 0.70.

“Three of these were among the 15 BCTs identified by the experienced coders achieving mean PABAK validity scores of < 0.70.”

The BCT 'credible source' was the lowest intercoder reliability score among experienced BCT coders.

“It was also the lowest intercoder reliability score among experienced BCT coders.”

The data reported provide good overall intercoder and test-retest reliability for 80 of the BCTTv1 definitions among trained coders.

“The data reported here provide good overall intercoder and test-retest reliability for 80 of those definitions among trained coders.”

Nine of the 12 BCTs highlighted as unclear or requiring refinement were among the 12 BCTs achieving mean PABAK reliability scores of < 0.70.

“Nine of these (75%) BCTs were among the 12 BCTs achieving mean PABAK reliability scores of < 0.70 (listed above).”

There tended to be a negative correlation between trained coders' confidence of BCT identification and intercoder agreement.

“There tended to be a negative correlation between trained coders' confidence of BCT identification and intercoder agreement.”

The confusion between 'instruction on how to perform behaviour' and 'demonstration of the behaviour' was one of four pairs of BCTs with which coders reported difficulty.

“This was one of four pairs of BCTs (including two goal-setting definitions) with which coders reported difficulty.”

Eighty of the 93 BCTs defined in BCTTv1 were identified in 40 intervention descriptions by at least one trained coder.

“Eighty of the 93 BCTs defined in BCTTv1 were identified in 40 intervention descriptions by at least one trained coder,”

There were no significant differences in confidence between rarely and occasionally identified BCTs.

“and there were no significant differences between categories of rarely and occasionally (p = 0.18),”

There was good trained coder agreement with developer consensus about the 15 BCTs agreed on as present.

“There was also good trained coder agreement with developer consensus about the 15 BCTs agreed on as present, thus indicating concurrent validity.”

Of the 93 BCTs in BCTTv1, trained coders highlighted 12 as being unclear or requiring further refinement.

“Of the 93 BCTs in BCTTv1, trained coders highlighted 12 as being unclear or requiring further refinement.”

There were no significant differences in confidence between occasionally and frequently identified BCTs.

“or between categories of occasionally and frequently (p = 1.00) identified BCTs.”

Trained coders' confidence in their identification of the 15 BCTs agreed by experienced consensus was not associated with mean PABAK scores.

“Confidence ratings were not associated with validity; trained coders' confidence in their identification of the 15 BCTs agreed by experienced consensus was not associated with mean PABAK scores [r(13) = 0.27; p > 0.10].”

Forty-seven BCTs were identified in at least six of 40 descriptions.

“and 47 BCTs were identified in at least six of 40 descriptions.”

For the 80 BCTs identified by trained coders, confidence was not correlated with greater reliability.

“For the 80 BCTs identified by trained coders, confidence was not correlated with greater reliability.”

Of the 22 BCTs observed in 16 or more of 40 intervention descriptions, 18 (82%) were also identified in the Abraham and Michie 20 BCT taxonomy.

“Of the 22 BCTs observed in 16 or more of 40 intervention descriptions, 18 (82%) were also identified in the Abraham and Michie 20 BCT taxonomy, confirming the frequent occurrence of these 18 BCTs.”

Three additional BCT definitions were identified by trained coders as being in need of clarification and/or refinement: demonstration of the behaviour, action planning and restructuring the physical environment.

“Three additional BCT definitions were identified by trained coders as being in need of clarification and/or refinement.These were: demonstration of the behaviour, action planning and restructuring the physical environment.”

Intercoder reliability was poor for 'instruction on how to perform behaviour'.

“Intercoder reliability was poor for 'instruction on how to perform behaviour' and individual coder feedback suggested confusion with 'demonstration of the behaviour'.”

Mean PABAK scores tended to be negatively correlated with confidence, r(78) = -0.37, p = 0.07 (two tailed).

“Perhaps surprisingly, mean PABAK scores were not positively correlated with confidence, but rather tended to be negatively correlated, r(78) = -0.37;p = 0.07 (two tailed).”

For the most frequently identified BCTs, the two indices differ significantly in their representation of reliability, with PABAK generating lower reliability scores than AC1.

“We found, however, that for the most frequently indentified BCTs, the two indices differ significantly in their representation of reliability with PABAK generating lower reliability scores than AC1.”

Reliability was consistently higher when represented by the AC1 statistic than the PABAK statistic.

“Reliability was consistently higher when represented by the AC1 statistic than the PABAK statistic.”

Fifty per cent of the BCT definitions judged by trained coders as being in need of further clarification belonged to the same BCT grouping in BCTTv1.

“Fifty per cent of the BCT definitions judged by trained coders as being in need of further clarification belonged to the same BCT grouping in BCTTv1, therefore, referring to the same underlying mechanism of change.”

Individual coder feedback suggested confusion between 'instruction on how to perform behaviour' and 'demonstration of the behaviour'.

“Intercoder reliability was poor for 'instruction on how to perform behaviour' and individual coder feedback suggested confusion with 'demonstration of the behaviour'.”

These frequently identified BCTs were less reliably identified than other BCTs.

“These frequently identified BCTs were less reliably identified than other BCTs.”

The PABAK and AC1 indices generate very similar patterns of intercoder scores across identified BCTs.

“Reassuringly, our findings indicate that these indices generate very similar patterns of intercoder scores across identified BCTs.”

Twenty-two BCTs were identified in at least 16 descriptions.

“22 BCTs were identified in at least 16 descriptions”

In Study 5c, replicability of active ingredients was non-significant, F(1,74) = 3.57; p = 0.06.

“For replicability of active ingredients, this was non-significant F(1,74) = 3.57; p = 0.06.”

There were no significant interaction effects between being trained and video for agreement with expert consensus in study 5a.

“There were no significant interaction effects between being trained and video, F(1,38) = 0.70; p = 0.41.”

In an earlier study, there were no significant interaction effects between being trained and video described, F(1,81) = 3.24; p = 0.08.

“There was no significant interaction effects between being trained and video described, F(1,81) = 3.24; p = 0.08.”

A marginally significant interaction effect suggested that agreement was greater for descriptions written by trained writers using BCTTv1 about video 2.

“A marginally significant interaction effect was found, suggesting that agreement was greater for descriptions written by trained writers using BCTTv1 about video 2, F(1,81) = 3.59; p = 0.06.”

Means for perceived difficulty of the writing task were around the mid-point for both groups of writers.

“Means for perceived difficulty of the writing task were also around the mid-point for both groups of writers.”

In Study 5c, coder agreement with expert consensus was not significantly different for descriptions written before training and after training using BCTTv1, F(1,74) = 1.20; p = 0.28.

“Agreement with expert consensus (RQ 1c): coder agreement with expert consensus was not significantly different for descriptions written before training and after training using BCTTv1, F(1,74) = 1.20; p = 0.28.”

In Study 5c, means for perceived difficulty of the writing task were above the mid-point on both occasions.

“Means for perceived difficulty of the writing task were also above the mid-point on both occasions.”

Despite not explicitly drawing on theory, the BCT groupings appeared to make theoretical sense.

“Despite not explicitly drawing on theory, the BCT groupings appeared to make theoretical sense.”

In Study 5c, means for sufficiency of time allocated were above the mid-point of the scale both before and after training.

“Usability and acceptability (RQ 2): means for sufficiency of time allocated were above the mid-point of the scale both before and after training.”

There were no interaction effects between being trained and video for identification of BCTs in study 5a.

“There were no interaction effects between being trained and video F(1,38) = 0.07; p = 0.79.”

In an earlier study, trained coder agreement with expert consensus did not differ significantly for descriptions written by untrained writers not using BCTTv1 and for descriptions written by trained writers using BCTTv1, F(1,81) = 2.84; p = 0.10.

“Agreement with expert consensus (RQ 1c): trained coder agreement with expert consensus did not differ significantly for descriptions written by untrained writers not using BCTTv1 and for descriptions written by trained writers using BCTTv1, F(1,81) = 2.84; p = 0.10.”

Untrained writers produced descriptions rated higher in quality (clarity and replicability) than untrained writers in study 5b, in which participants were randomised and no practice effects were possible.

“Untrained writers produced descriptions that were rated to be of higher quality (clarity and replicability) than untrained writers in study 5b, in which participants were randomised and no practice effects were possible.”

There were no interaction effects between being trained and video described for any of the dependent variables in study 5b.

“There were no interaction effects between being trained and video described for any of the dependent variables.”

Agreement between trained coders about the absence/presence of BCTs was greater for descriptions written by trained writers using BCTTv1.

“Identification of BCTs in descriptions (RQ 1b): agreement between trained coders about the absence/ presence of BCTs was greater for descriptions written by trained writers using BCTTv1: F(1,81) = 5.02; p < 0.05 (trained: mean = 0.87, SD = 0.06; untrained: mean = 0.84, SD = 0.07).”

Reliability testing revealed that reliable use of BCTTv1 would be enhanced by training in addition to simply publishing BCTTv1 as a list of BCTs for people to use.

“The reliability testing revealed that reliable use of BCTTv1 would be enhanced by training in addition to simply publishing BCTTv1 as a list of BCTs for people to use.”

In Study 5c, agreement between coders about the absence/presence of BCTs did not differ significantly for descriptions written before training and after training using BCTTv1, F(1,74) = 0.46; p = 0.50.

“Identification of BCTs in descriptions (RQ 1b): agreement between coders about the absence/presence of BCTs did not differ significantly for descriptions written before training and after training using BCTTv1, F(1,74) = 0.46; p = 0.50.”

In an earlier study, means for sufficiency of time allocated were above the mid-point of the scale both for writers provided with BCTTv1 and for those who were not.

“Usability and acceptability (RQ 2): means for sufficiency of time allocated were above the mid-point of the scale both for writers provided with BCTTv1 and for those who were not.”

In Study 5c, there were no interaction effects between being trained and video described for any of the dependent variables.

“There were no interaction effects between being trained and video described for any of the dependent variables.”

There was evidence of poorer performance among those who had been trained and had access to BCTTv1 than among those who received no training and BCTTv1.

“In contrast, there was evidence of poorer performance among those who had been trained and had access to BCTTv1 than those who received no training and BCTTv1.”

Trained coder agreement with expert consensus was not significantly different for descriptions written by writers using and not using BCTTv1.

“Agreement with expert consensus (RQ 1c): trained coder agreement with expert consensus was not significantly different for descriptions written by writers using and not using BCTTv1, F(1,38) = 0.25; p = 0.62.”

Baseline scores in study 5c were much lower than for the comparable group in study 5b.

“Baseline scores in study 5c, for example, were much lower than for the comparable group in study 5b.”

Agreement between trained coders about the presence/absence of BCTs did not differ significantly for descriptions written by writers using BCTTv1 and for descriptions written by writers not using BCTTv1.

“Identification of BCTs in descriptions (RQ 1b): agreement between trained coders about the presence/ absence of BCTs did not differ significantly for descriptions written by writers using BCTTv1 and for descriptions written by writers not using BCTTv1, F(1,38) = 0.01; p = 0.93.”

Means for sufficiency of time allocated were around the mid-point of the scale both for writers provided with BCTTv1 and for those who were not.

“Usability and acceptability (RQ 2): means for sufficiency of time allocated were around the mid-point of the scale both for writers provided with BCTTv1 and for those who were not.”

Quality of written intervention descriptions did not differ significantly for descriptions written by writers using BCTTv1 and for descriptions written by writers not using BCTTv1.

“did not differ significantly for descriptions written by writers using BCTTv1 and for descriptions written by writers not using BCTTv1.”

Studies 3 and 4 showed that BCTTv1 offers a generally reliable method for specifying the active ingredients of BCIs when used by trained coders.

“Studies 3 and 4 showed that BCTTv1 offers a generally reliable method for specifying the active ingredients of BCIs when used by trained coders.”

In an earlier study, the data for the easy-difficult paired adjective item suggest that both groups considered using BCTTv1 as being a difficult task, as means were above the mid-point of the scale.

“However, the data for the 'easy-difficult' paired adjective item suggest that both groups considered using BCTTv1 as being a difficult task as means were above the mid-point of the scale.”

In Study 5c, the data for the easy-difficult paired adjective item suggest that on both occasions writers considered using BCTTv1 a difficult task, as means were above the mid-point of the scale.

“However, the data for the 'easy-difficult' paired adjective item suggest that on both occasions they considered using BCTTv1 a difficult task as means were above the mid-point of the scale.”

There were no interaction effects between being trained and the video described for any of the dependent variables in study 5a.

“There were no interaction effects between being trained and the video described for any of the dependent variables.”

Taking in detailed information about an intervention by watching a video is not something participants were experienced in doing.

“However, taking in detailed information about an intervention by watching an intervention is not something participants were experienced in doing.”

There was unevenness of disciplines involved in the work, with the majority being psychologists.

“There was also an unevenness of disciplines involved in the work, the majority being psychologists.”

Training by either method increased the percentage of trainees achieving an acceptable standard of coding competence as indicated by agreement with expert consensus, 75% for tutorials and 45% for workshops.

“we showed that training by either method increased the percentage of trainees achieving an acceptable standard of coding competence as indicated by agreement with expert consensus (75% for tutorials and 45% for workshops).”

There was moderate overlap between the obtained structure and an alternative structure generated using a simple integrated classification of theoretical constructs.

“We found moderate overlap between the two structures, suggesting that apparently a theoretical use of BCTs may involve implicit theory.”

In study 4, a subgroup of trained coders successfully applied their knowledge and skills to a more extensive coding exercise, achieving good reliability at baseline and at 1 month later.

“In study 4 (see Chapter 5), a subgroup of trained coders then went on to successfully apply their knowledge and skills to a more extensive coding exercise, achieving good reliability at baseline and at 1 month later.”

Rates of informed choice were significantly higher after reading the informed choice invitation than after the standard invitation.

“Rates of informed choice were significantly higher after reading the informed choice invitation compared to the standard invitation.”

In study 4, coders used 80 BCTs to describe the 40 intervention descriptions.

“Nevertheless, coders in study 4 used 80 BCTs to describe the 40 intervention descriptions and it may therefore be important to expand from the initial 22 BCTs to fully specify the intervention.”

BCTs in earlier taxonomies (e.g. motivational interviewing) were removed from BCTTv1 as they did not meet the definition of a BCT.

“Finally, in contrast to earlier taxonomies, BCTTv1 was developed using robust methods and is based on expert consensus, and BCTs in earlier taxonomies (e.g.motivational interviewing) were removed from BCTTv1 as they did not meet the definition of a BCT.”

The 22 BCTs found to frequently occur in 40 intervention descriptions include 18 of the 22 BCTs included in the Abraham and Michie taxonomy based on more than 200 intervention descriptions.

“These 22 found to frequently occur in 40 intervention descriptions include 18 of the 22 BCTs including in the Abraham and Michie taxonomy 20 based on more than 200 intervention descriptions.”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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The moderate overlap between the groupings indicates some tendency to implicitly conceptualise BCTs in terms of the same theoretical domains.

“The moderate overlap between the groupings indicates some tendency to implicitly conceptualise BCTs in terms of the same theoretical domains.”

The BCTTv1 can be used accurately and reliably by trained coders to specify BCTs in BCIs.

“The BCTTv1 can be used accurately and reliably by trained coders to specify BCTs in BCIs: good intercoder reliability was observed across 80 BCTs identified in the protocols”

Titles and abstracts of published interventions have been found to mention the active components of the intervention in only 56% of published descriptions compared with over 90% in pharmacological interventions.

“Titles and abstracts of published interventions (i.e. the materials screened for inclusion in systematic reviews) have been found to mention the active components of the intervention in only 56% of published descriptions compared with over 90% in pharmacological interventions.42”

• cites [42] McCleary, 2013, Active ingredients are reported more often for pharmacologic than non-pharmacologic interventions: an illustrative review of reporting practices in titles and abstracts, Trials sourceNot checked yet

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Abraham and Michie's taxonomy of 22 BCTs and four BCT packages observed in BCIs was demonstrated to have good intercoder reliability among the taxonomy developers and trained coders across 221 intervention descriptions in papers and manuals.

“Abraham and Michie's 20 taxonomy of 22 BCTs and four BCT packages observed in BCIs was demonstrated to have good intercoder reliability (i.e. the extent to which coders agreed on the presence/absence of BCTs) among the taxonomy developers and trained coders across 221 intervention descriptions in papers and manuals.”

• cites Abraham and MichieNot checked yet

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The first cross-domain BCT taxonomy consisted of 22 BCTs and four BCT packages.

“The first cross-domain BCT taxonomy consisted of 22 BCTs and four BCT packages.”

• cites Abraham and MichieNot checked yet

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It is unclear whether or not BCTTv1 benefits reporting of descriptions of observed interventions.

“It is unclear whether or not BCTTv1 benefits reporting of descriptions of observed interventions.”

The absence of standardised definitions and labels for intervention components means that systematic reviewers develop their own systems for classifying behavioural interventions and synthesising study findings.

“The absence of standardised definitions and labels for intervention components means that systematic reviewers develop their own systems for classifying behavioural interventions and synthesising study findings [e.g.Hardeman et al., 18 Albarracín et al., 19 Mischel (Presidential address given at the Association for Psychological Science Annual Convention, Washington, DC; 2012) and West et al. 46 ]”

• cites Hardeman et al., 18Not checked yet

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• cites Albarracín et al., 19Not checked yet

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• cites West et al. 46Not checked yet

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Study 1 presented the synthesis of existing BCT taxonomies into a single comprehensive, cross-context, overarching BCT taxonomy: BCTTv1.

“Study 1 presented the synthesis of existing BCT taxonomies into a single comprehensive, cross-context, overarching BCT taxonomy: BCTTv1.8,17,40”

• cites [8] Michie, 2012, Theories and techniques of behaviour change: developing a cumulative science of behaviour change, Health Psychol Rev sourceNot checked yet

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• cites [17] Michie, 2011, Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol, Implement Sci sourceNot checked yet

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• cites [40] Michie, 2013, The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions, Ann Behav Med sourceNot checked yet

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The BCTs have a hierarchical structure such that deleting overlapping BCTs would leave only the superordinate BCT and lose specific variation.

“During this process, one reason for overlap became evident: there was a hierarchical structure meaning that deleting overlapping BCTs would end up with only the superordinate BCT and a loss of specific variation (e.g.adopting the higher order BCT 'consequences' would have deleted 'reward').”

For BCIs, further information is required to specify the active ingredients.

“However, for BCIs, further information is required to specify the active ingredients, that is 'components within an intervention that can be specifically linked to its effect on outcomes such that, if they were omitted, the intervention would be ineffective'.42”

• cites [42] McCleary, 2013, Active ingredients are reported more often for pharmacologic than non-pharmacologic interventions: an illustrative review of reporting practices in titles and abstracts, Trials sourceNot checked yet

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The UK MRC guidance called for improved methods of specifying and reporting intervention content in order to address the problems of lack of consistency and consensus.

“Consequently, the UK MRC guidance 5 for developing and evaluating complex interventions called for improved methods of specifying and reporting intervention content in order to address the problems of lack of consistency and consensus.”

• cites [5] Craig, 2008, Developing and evaluating complex interventions: the new Medical Research Council guidance, BMJ sourceNot checked yet

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Identifying the presence of BCTs in intervention descriptions included in systematic reviews and national datasets of outcomes has allowed the identification of BCTs associated with effective interventions.

“Identifying the presence of BCTs in intervention descriptions included in systematic reviews and national datasets of outcomes has allowed the identification of BCTs associated with effective interventions.46,47”

• cites [46] West, 2010, Behavior change techniques used by the English Stop Smoking Services and their associations with short-term quit outcomes, Nicotine Tob Res sourceNot checked yet

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• cites [47] West, 2011, Behavior change techniques used in group-based behavioral support by the English stop-smoking services and preliminary assessment of association with short-term quit outcomes, Nicotine Tob Res sourceNot checked yet

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The taxonomy demonstrated reliability in identifying 22 BCTs and four BCT packages.

“The taxonomy demonstrated reliability in identifying 22 BCTs (e.g.'self-monitoring') and four BCT packages (e.g.'relapse prevention').”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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Previous classification systems have mainly been developed for particular behavioural domains (e.g. physical activity, smoking, alcohol consumption or safer sex).

“Previous classification systems have mainly been developed for particular behavioural domains (e.g.physical activity, smoking, alcohol consumption or safer sex).”

Previous BCT groupings have been based on judgements made by the study author.

“Previous BCTs groupings have been based on judgements made by the study author.20,27,32,33”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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• cites [27] Michie, 2011, Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation, Addict Behav sourceNot checked yet

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• cites [32] Michie, 2011, Identifying evidence-based competencies required to deliver behavioural support for smoking cessation, Ann Behav Med sourceNot checked yet

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In light of the 93 BCTs of BCTTv1 and the large number of behaviour change theories and component constructs, grouping by individual theoretical constructs is impractical.

“In light of the 93 BCTs of BCTTv1 and the large number of behaviour change theories and component constructs, 60 grouping by individual theoretical constructs is impractical.”

• cites [60] Hobbs, 2011Not checked yet

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The amendments of BCT labels and definitions were based on a wide range of inputs: data from Delphi participants and coders, expert modification, international advice and lay user improvements.

“Our amendments of the BCT labels and definitions also depend on the expertise available and, therefore, we based our amendments on a wide range of inputsthe data we collected from Delphi participants and coders, expert modification, international advice and lay user improvements.”

The authors made arbitrary decisions such as cut-offs for amending BCT labels and descriptions.

“At various stages we made arbitrary decisions such as the cut-offs for amending BCT labels and descriptions.”

Behavioural medicine researchers and practitioners have reported low confidence in their ability to replicate highly effective behavioural interventions for type 2 diabetes mellitus prevention.

“Further, behavioural medicine researchers and practitioners have reported low confidence in their ability to replicate highly effective behavioural interventions for type 2 diabetes mellitus prevention.45”

• cites [45] Michie, 2005Not checked yet

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A comprehensive, cross-behavioural domain taxonomy of BCTs was used rather than BCTs relevant for a single behavioural domain.

“A second advance was that a comprehensive, cross-behavioural domain taxonomy of BCTs was used rather than BCTs relevant for a single behavioural domain (e.g.road safety, 82 smoking cessation, 32 weight management 83 ).”

• cites [82] Ludwig, 2001Not checked yet

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• cites [32] Michie, 2011, Identifying evidence-based competencies required to deliver behavioural support for smoking cessation, Ann Behav Med sourceNot checked yet

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• cites [83] Hardeman, 2009, Impact of a physical activity intervention program on cognitive predictors of behaviour among adults at risk of type 2 diabetes (ProActive randomised controlled trial), Int J Behav Nutr Phys Act sourceNot checked yet

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Coding BCTs is a highly skilled task requiring familiarity with BCT labels and definitions and complex interpretative judgements.

“The process of coding BCTs is a highly skilled task requiring familiarity with the BCT labels and definitions and one which requires coders to make a series of complex interpretative judgements.87,88”

• cites [87] Hak, 1996, Coder training: theoretical training or practical socialization?, Qual Sociol sourceNot checked yet

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• cites [88] Bernard, 2004, How does distance education compare with classroom instruction? A meta-analysis of the empirical literature, Rev Educ Res sourceNot checked yet

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The BCTs were grouped according to the perceived active ingredients underlying BCTs, rather than by categorisations that may not have reflected how people think about BCTs.

“Third, the BCTs were grouped according to the perceived active ingredients underlying BCTs, rather than by categorisations that may not have reflected how people think about BCTs.”

As a result, the groupings reported here are potentially more robust than those derived using consensus methods among a few people.

“As a result, the groupings reported here are potentially more robust than those derived using consensus methods among a few people.43”

• cites [43] Michie, 2008, From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques, Appl Psychol sourceNot checked yet

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For the two theoretical domains for which no BCTs were reliably assigned, there would appear to be no shared, or recognised, way of changing them.

“For the two theoretical domains for which no BCTs were reliably assigned, there would appear to be no shared, or recognised, way of changing them.”

This suggests that these are the theoretical domains for which there is the greatest number of agreed methods for bringing about change.

“This suggests that these are the theoretical domains for which there is the greatest number of agreed methods for bringing about change.”

Experts did not consistently allocate or rate highly any BCTs to these two domains.

“This indicates that, although both of these domains had BCTs allocated to them during the sort process (15 and 49, respectively), experts did not consistently allocate or rate highly any of the BCTs to these two domains.”

Distinct sets of individual items with semantic similarity can be more easily recalled than a single list of individual items both in the short term and long term, particularly when the semantic category is cued.

“Distinct sets of individual items with semantic similarity can be more easily recalled than a single list of individual items both in the short term and long term, particularly when the semantic category is cued.[84][85][86]”

• cites [84][85][86]Not checked yet

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Achievement of good intercoder reliability is a function of both the clarity of the taxonomy and its coding guidelines and the competence of its coders.

“Achievement of good intercoder reliability (i.e. the extent to which coders agree on the presence/absence of BCTs identified in intervention descriptions using the taxonomy as a coding framework) is therefore not only a function of the clarity of the taxonomy and its coding guidelines, but also of the competence of its coders.”

The grouping methods employed in the 'bottom-up' and 'top-down' sort tasks improve on previous attempts to group BCTs using consensus approaches.

“The grouping methods employed in the 'bottom-up' and 'top-down' sort tasks improve on previous attempts to group BCTs using consensus approaches.”

Intercoder reliability has been demonstrated in using BCT taxonomies among coders with varying amounts of training and experience.

“Intercoder reliability has been demonstrated in using BCT taxonomies among coders with varying amounts of training and experience.20,23,[28][29][30]48”

• cites 20,23,[28][29][30]48Not checked yet

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The 'top-down' mapping of BCTs to theoretical domains advances the limited consensus methods used by Michie et al. by using an improved BCT taxonomy, an empirically validated TDF, and a larger number of respondents.

“The 'top-down' mapping of BCTs to theoretical domains advances the limited consensus methods used by Michie et al. 43 by using an improved BCT taxonomy, an empirically validated TDF and a larger number of respondents.”

• cites [43] Michie, 2008, From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques, Appl Psychol sourceNot checked yet

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Results from two initial phases of reliability testing indicated BCTTv1 to be reliable in specifying 26 frequently occurring BCTs when used by the taxonomy developers.

“Results from two initial phases of reliability testing indicated BCTTv1 to be reliable in specifying 26 frequently occurring BCTs when used by the taxonomy developers.40”

• cites [40] Michie, 2013, The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions, Ann Behav Med sourceNot checked yet

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It is not only the content and form of the taxonomy that drives reliable and valid application of BCT labels/definitions but also the extent to which the user has been trained to use the taxonomy.

“However, it is not only the content and form of the taxonomy that drives reliable and valid application of BCT labels/definitions but also the extent to which the user has been trained to use the taxonomy.”

These BCTs may require further definition and/or refinement of labels and examples for trained coders to be able to identify them with high reliability and validity.

“These BCTs may require further definition and/or refinement of labels and examples for trained coders to be able to identify them with high reliability and validity.”

The difference between training methods in the proportion of those achieving an acceptable standard of coding competence may be partly due to differences in the percentage showing competence before training.

“The difference between training methods in the proportion of those achieving an acceptable standard of coding competence may be partly due to differences in the percentage showing competence before training.”

This evidence and these principles reflect the relevance and use of BCTs such as feedback on behaviour, goal-setting, social support and behavioural practice/rehearsal directed at changing skilled behaviours.

“This evidence and these principles clearly reflect the relevance and use of BCTs such as feedback on behaviour, goal-setting, social support and behavioural practice/rehearsal directed at changing skilled behaviours.”

BCTTv1 represents an advance in methods for specifying BCIs.

“Although BCTTv1 represents an advance in methods for specifying BCIs, reliable and valid application of BCTTv1 will require skills and, therefore, training.”

Training incorporating these principles and BCTs improved trainees' coding competence (agreement with expert consensus) in a prior smoking cessation study.

“This study found that training improved trainees' coding competence (i.e.their agreement with expert consensus about which BCTs are present).”

• cites [95] Lorencatto, 2013, Developing a method for specifying the components of behavior change interventions in practice: the example of smoking cessation, J Consult Clin Psych sourceNot checked yet

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This suggests that intercoder reliability remained stable over time.

“This suggests that intercoder reliability remained stable over time.”

These findings suggested that user training may be required because high reliability depends not only on taxonomy content but also on the user's skill.

“It also suggested that user training may be required as high reliability is not only dependent on the content of the taxonomy but also on the extent that the user is skilled in using it.”

These findings demonstrated that BCTs can be reliably identified in published descriptions.

“Thus, these findings demonstrated that BCTs can be reliably identified in published descriptions.”

There was no indication that any particular description or subset of descriptions influenced intercoder reliability.

“There was no indication therefore, that any particular description or subset of the descriptions influenced intercoder reliability.”

Findings showed no significant difference between reliability scores, indicating trained coders could identify BCTs as reliably as coders involved in defining BCTs.

“Findings showed no significant difference between reliability scores indicating that trained coders could identify BCTs as reliably as coders involved in defining BCTs.”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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Abraham and Michie reported >93% agreement between three pairs of coders (including the authors).

“Abraham and Michie 20 reported > 93% agreement between three pairs of coders (including the authors).”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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Since Abraham and Michie's initial paper, intercoder reliability has been demonstrated for various subsequent BCT taxonomies.

“Since Abraham and Michie's 20 initial paper, intercoder reliability has been demonstrated for various subsequent BCT taxonomies.20,23,27,28,30,48”

• cites [20] Abraham, 2008, A taxonomy of behavior change techniques used in interventions, Health Psychol sourceNot checked yet

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• cites [23] Michie, 2009, Effective techniques in healthy eating and physical activity interventions: a meta-regression, Health Psychol sourceNot checked yet

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• cites [27] Michie, 2011, Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation, Addict Behav sourceNot checked yet

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Even PABAK is more appropriate for this type of data than a simple kappa.

“Nevertheless, even PABAK takes account of the high prevalence of negative codes and of the extent to which coders use similar marginal totals and, therefore, is more appropriate for this type of data than a simple kappa.”

Newly trained coders can code accurately as defined by agreement with experienced coder consensus.

“Furthermore, the data suggest that newly trained coders can code accurately as defined by agreement with experienced coder consensus.”

Perceived professional competence of intervention facilitators has been found to predict effectiveness of human immunodeficiency virus preventative interventions.

“Perceived professional competence of intervention facilitators has also been found to predict effectiveness of human immunodeficiency viruspreventative interventions.152”

• cites [152] Durantini, 2006, Conceptualizing the influence of social agents of behavior change: a meta-analysis of the effectiveness of HIV-prevention interventionists for different groups, Psychol Bull sourceNot checked yet

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Training in BCTTv1 improves the identification of BCTs.

“We used trained coders as we showed that training in BCTTv1 improves the identification of BCTs 96”

• cites [96] Wood, 2014, Applying the Behaviour Change Technique (BCT) Taxonomy v1: a study of user training, Transl Behav Med sourceNot checked yet

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The four BCTs with mean PABAK scores of 0.68 and 0.69 at time 1 were considered close enough to the 0.70 threshold to be counted as reliably identified.

“We considered these as being close enough to the 0.70 threshold to be counted as reliably identified.”

At least in some contexts, the two statistics may not be directly interchangeable when data similar to the current data are investigated.

“Thus, our findings suggest that, at least in some contexts, the two statistics may not be directly interchangeable when data similar to the current data are investigated.”

AC1 may be a more appropriate index than PABAK.

“AC1 may therefore be a more appropriate index.”

There was considerable correspondence between coders' individual judgements of BCT definition clarity, BCT intercoder reliability and validity.

“This suggests that there was considerable correspondence between coders' individual judgements of BCT definition clarity, BCT intercoder reliability and validity.”

BCTTv1 can be used by trained coders to reliably identify BCTs included in intervention descriptions.

“In conclusion, our results show that BCTTv1 can be used by trained coders to reliably identify BCTs included in intervention descriptions.”

BCTTv1 provides the most comprehensive listing of BCTs to date.

“The BCTTv1 taxonomy of BCT labels and definitions is an important development of previous work and provides the most comprehensive listing of BCTs to date.”

The BCT definitions judged as needing further clarification that belonged to the same BCT grouping referred to the same underlying mechanism of change.

“Fifty per cent of the BCT definitions judged by trained coders as being in need of further clarification belonged to the same BCT grouping in BCTTv1, therefore, referring to the same underlying mechanism of change.”

Study 5b was a randomised controlled trial examining the effects of training plus provision of BCTTv1 compared with a control group who received neither BCTTv1 nor training.

“Study 5b also used a RCT design and examined the effects of training plus provision of BCTTv1 compared with a control group who received neither BCTTv1 nor training.”

The consistently higher AC1 scores suggest that the data may have been influenced by random judgement effects that are controlled in AC1 but not PABAK, with resulting lower scores in PABAK.

“The consistently higher AC1 scores suggest that our data may have been influenced by random judgement effects that are controlled in AC1 but not PABAK, with resulting lower scores in PABAK.”

Feedback from coders highlights several BCT definitions that require further classification and refinement before they can be identified reliably.

“Feedback from our coders highlights several BCT definitions that require further classification and refinement before they can be identified reliably.”

Coding intervention descriptions for message source or facilitator characteristics is important.

“This highlights that coding intervention descriptions for message source or facilitator characteristics is important.”

Similarities between intervention facilitators and recipients explained differential effectiveness of interventions.

“Similarities between intervention facilitators and recipients (e.g.age, ethnicity and behaviour risk group membership) explained differential effectiveness of interventions.”

The frequent occurrence of the 18 BCTs also identified in the Abraham and Michie taxonomy is confirmed.

“Of the 22 BCTs observed in 16 or more of 40 intervention descriptions, 18 (82%) were also identified in the Abraham and Michie 20 BCT taxonomy, confirming the frequent occurrence of these 18 BCTs.”

Correspondence between trained coder judgements and experienced developers' judgements was regarded as a measure of the validity of the trained coders' judgements.

“Given the expertise derived from the experience of developing BCT definitions and the previous experience of the developers in identifying BCTs in intervention descriptions, correspondence between trained coder judgements and experienced developers' judgements was regarded as a measure of the validity of the trained coders' judgements.”

Specification of BCIs requires at least this range of BCTs to describe the active content.

“Clearly specification of BCIs requires at least this range of BCTs to describe the active content.”

Perceived confidence does not appear to be a useful indicator of accuracy of identification of BCTs in intervention descriptions.

“This suggests that perceived confidence does not appear to be a useful indicator of accuracy of identification of BCTs in intervention descriptions.”

There is a lack of guidance about how to report intervention descriptions in terms of both the proposed active content (BCTs) and supportive content necessary to engage the participant.

“There is a lack of guidance about how to report intervention descriptions in terms of both the proposed active content (BCTs) and supportive content necessary to engage the participant.32”

• cites [32] Michie, 2011, Identifying evidence-based competencies required to deliver behavioural support for smoking cessation, Ann Behav Med sourceNot checked yet

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The similarity of intercoder reliability across two tests separated by 1 month indicates temporal stability.

“and remained similar across two tests separated by 1 month, indicating temporal stability.”

Good trained coder agreement with developer consensus about the 15 BCTs agreed on as present indicates concurrent validity.

“There was also good trained coder agreement with developer consensus about the 15 BCTs agreed on as present, thus indicating concurrent validity.”

The BCTTv1 taxonomy can be used successfully, with appropriate training, by a wide range of users to identify a wide range of BCTs included in intervention descriptions.

“Therefore, the BCTTv1 taxonomy can be used successfully, with appropriate training, by a wide range of users to identify a wide range of BCTs included in intervention descriptions.”

Coding for source characteristics in intervention descriptions has been shown to predict intervention effectiveness in meta-analytic studies.

“and coding for source characteristics in intervention descriptions has been shown to predict intervention effectiveness in meta-analytic studies.”

Across Studies 5a, 5b and 5c, the results do not show a clear benefit of providing BCTTv1 for reporting observed interventions.

“The results do not show clear benefit of providing BCTTv1 for reporting observed interventions.”

The finding of unexpected negative effects of training is consistent with some counterintuitive findings reported in the psychology literature.

“The finding of unexpected negative effects of training is consistent with some of the counterintuitive findings reported in the psychology literature.”

• cites [156] Baumeister, 1984, Choking under pressure: self-consciousness and paradoxical effects of incentives on skillful performance, J Pers Soc Psychol sourceNot checked yet

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• cites [157] Wegner, 1997, Ironic effects of trying to relax under stress, Behav Res Ther sourceNot checked yet

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• cites [158] Henry, 1993, Effects of training in time-limited dynamic psychotherapy: mediators of therapists’ responses to training, J Consult Clin Psych sourceNot checked yet

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Trained coders had all demonstrated competence in using BCTTv1 to reliably and validly specify the content of BCIs, achieving criteria of satisfactory performance on coding intervention descriptions following training in a formal assessment of coding competence.

“Coders had all demonstrated competence in using BCTTv1 to reliably and validly specify the content of BCIs, that is they achieved criteria of satisfactory performance on coding intervention descriptions following training, in a formal assessment of coding competence.107”

• cites [107] Abraham, 2015, Reliability of identification of behavior change techniques in intervention descriptions [published online ahead of print August 20 2015], Ann Behav Med sourceNot checked yet

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In conclusion, the authors did not find a clear benefit of providing BCTTv1 for reporting observed interventions.

“In conclusion, we did not find a clear benefit of providing BCTTv1 for reporting observed interventions.”

The moderate overlap between the two structures suggests that apparently theoretical use of BCTs may involve implicit theory.

“We found moderate overlap between the two structures, suggesting that apparently a theoretical use of BCTs may involve implicit theory.”

In reviews of interventions to increase physical activity and healthy eating, interventions with the combination of self-monitoring, goal-setting and action planning were twice as effective as those that were not.

“They found that interventions with the combination of self-monitoring, goal-setting and action planning were twice as effective as those that were not.”

• cites Michie et al. 24Not checked yet

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• cites Dombrowski et al.21 Dombrowski, 2012, Optimizing acceptability and feasibility of an evidence-based behavioral intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: an open-pilot intervention study in secondary care, Patient Educ Couns sourceNot checked yet

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Behavioural interventions to increase fidelity of intervention delivery have the potential to bring about as great, or greater, health gains than medical advances on their own.

“Behavioural interventions to increase fidelity of intervention delivery have the potential to bring about as great, or greater, health gains than medical advances on their own.177”

• cites [177] Woolf, 2005, The break-even point: when medical advances are less important than improving the fidelity with which they are delivered, Ann Fam Med sourceNot checked yet

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The theoretically based combination of BCTs associated with provision of information, increasing motivation and enhancing behavioural skills has been found to reduce the frequency of sexual interactions that increase health risk.

“The theoretically based combination of BCTs associated with provision of information, increasing motivation and enhancing behavioural skills 171 has been found to reduce the frequency of sexual interactions that increase health risk.169”

• cites [171] Fisher, 1992, Changing AIDS-risk behavior, Psychol Bull sourceNot checked yet

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• cites [169] Smoak, 2006, Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: a meta-analysis of 174 studies with 116,735 participants, J Acquir Immune Defic Syndr sourceNot checked yet

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Meta-analyses lack power to test the effectiveness of most BCTs, as was evident in the NICE 2014 Behaviour Change guidance which used BCT methodology.

“Meta-analyses lack power to test the effectiveness of most BCTs, as was evident in the National Institute for Health and Care Excellence (NICE) 2014 Behaviour Change guidance which used BCT methodology.166”

• cites [166] NICE, 2014Not checked yet

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BCTTv1 allows both intervention and control conditions to be coded in terms of BCTs, allowing identification of the BCTs used in the intervention over and above those used in control or usual-care conditions.

“It allows both intervention and control conditions to be coded in terms of BCTs which allows the identification of the BCTs that were used in the intervention over and above those used in the control or usual-care conditions.”

In a recent Cochrane review of audit and feedback interventions, adding the BCTs of goal-setting and action planning to interventions increased the effect of feedback.

“A similar analytic approach was used to investigate audit and feedback interventions 168 in a recent Cochrane review, 49 finding that adding the BCTs of goal-setting and action planning to interventions increased the effect of feedback.”

• cites [168] Gardner, 2010, Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback, Soc Sci Med sourceNot checked yet

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• cites [49] Ivers, 2012, Audit and feedback: effects on professional practice and healthcare outcomes, Cochrane Database Syst Rev sourceNot checked yet

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The authors used consensus following independent judgements by experienced expert coders as their best approximation to a criterion of validity against which judgements could be evaluated.

“We used consensus following independent judgements by experienced, 'expert', coders as our best approximation to a criterion of validity against which judgements could be evaluated.”

• AssumptionRests on an assumption: Consensus following independent judgements by experienced expert coders is the best available approximation to a criterion of validity against which judgements can be evaluated.

Given the typically small number of studies that have used any particular BCT and potential influence of confounders, there are limits to BCT methodology.

“However, given the typically small number of studies that have used any particular BCT and potential influence of confounders, there are limits to this methodology.”

There are several examples of meta-analyses that have investigated both individual BCTs and combinations of BCTs that theory predicts would work synergistically together.

“There are several examples of meta-analyses which have investigated both individual BCTs and combinations of BCTs that theory predicts would work synergistically together.21,24,49,168,169”

• cites [21] Dombrowski, 2012, Optimizing acceptability and feasibility of an evidence-based behavioral intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: an open-pilot intervention study in secondary care, Patient Educ Couns sourceNot checked yet

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• cites [24] Michie, 2009, Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks, J Epidemiol Community Health sourceNot checked yet

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• cites [49] Ivers, 2012, Audit and feedback: effects on professional practice and healthcare outcomes, Cochrane Database Syst Rev sourceNot checked yet

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• cites [168] Gardner, 2010, Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback, Soc Sci Med sourceNot checked yet

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• cites [169] Smoak, 2006, Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: a meta-analysis of 174 studies with 116,735 participants, J Acquir Immune Defic Syndr sourceNot checked yet

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Meta-CART has been used to identify groups of BCTs to predict intervention effects in a reanalysis of data from Michie et al.

“An alternative method of combining BCTs is to use CARTs, referred to as Meta-CART, 39 to analyse meta-analytic data.This has been used to identify groups of BCTs to predict intervention effects in a reanalysis of data from Michie et al. 23”

• cites [39] Dusseldorp, 2014, Combinations of techniques that effectively change health behavior: evidence from Meta-CART analysis, Health Psychol sourceNot checked yet

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• cites [23] Michie, 2009, Effective techniques in healthy eating and physical activity interventions: a meta-regression, Health Psychol sourceNot checked yet

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There were limitations in the methods used in study 5 that limit confidence in the findings.

“As mentioned earlier, there were limitations in the methods used in study 5 that limit our confidence in the findings.”

Many active controls such as usual care involve implementation of multiple BCTs, overlapping with those that constitute the intervention itself.

“The key point here is that many active controls such as 'usual care' involve implementation of multiple BCTs, overlapping with those that constitute the intervention itself.”

• cites de Bruin et al. 162Not checked yet

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Among the studies in that meta-analysis that claimed a theory basis, 90% did not report links between all BCTs and specific theoretical constructs.

“However, 90% of these did not report links between all of the BCTs and specific theoretical constructs.58”

• cites [58] Prestwich, 2014, Does theory influence the effectiveness of health behavior interventions? Meta-analysis, Health Psychol sourceNot checked yet

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A meta-analysis of 190 interventions to increase physical activity and healthy eating found that 56% of studies claimed the interventions were based on a theory.

“For example, a meta-analysis of 190 interventions to increase physical activity and healthy eating interventions found that 56% of studies claimed the interventions were based on a theory.58”

• cites [58] Prestwich, 2014, Does theory influence the effectiveness of health behavior interventions? Meta-analysis, Health Psychol sourceNot checked yet

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The scientific study of behaviours sometimes occurs in 'silos' so that one may miss potentially effective BCTs that are used in other behaviours.

“This needs to be balanced with the potential problem that the scientific study of behaviours sometimes occurs in 'silos' so that one may miss potentially effective BCTs that are used in other behaviours.”

The unevenness in the sample of coders prevented the study from examining reliability across types of coder.

“The unevenness in our sample of coders (as discussed in Chapter 8) prevented us from examining reliability across types of coder”

Information from coding delivery of BCTs aids the interpretation of trial results, e.g. the extent to which any lack of effects is due to the intervention itself or poor fidelity of delivery.

“It also aids the interpretation of trial results, e.g. the extent to which any lack of effects is due to the intervention itself or poor fidelity of delivery.”

There is ample evidence from reviews and primary studies that intervention protocols are often implemented with insufficient fidelity.

“There is ample evidence from reviews and primary studies that intervention protocols are often implemented with insufficient fidelity.12,[179][180][181][182]”

• cites 12,[179][180][181][182]Not checked yet

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Adolescents who received a threshold exposure of A-CRA were significantly more likely to be in recovery at follow-up.

“Similarly, our prior research has shown that adolescents who received a threshold exposure of A-CRA were significantly more likely to be in recovery at follow-up.”

In an intervention to increase physical activity among sedentary adults at risk of type 2 diabetes mellitus delivered by trained and quality-assured facilitators, 58% of BCTs specified in the intervention protocol were not faithfully delivered.

“For example, in an intervention to increase physical activity among sedentary adults at risk of type 2 diabetes mellitus delivered by trained and quality-assured facilitators, 58% of BCTs specified in the intervention protocol were not faithfully delivered.182”

• cites [182] Hardeman, 2007, Fidelity of delivery of a physical activity intervention: predictors and consequences, Psychol Health sourceNot checked yet

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Increasing the number of adolescents who receive Target A-CRA would be expected to increase the likelihood that adolescents have more positive treatment outcomes.

“Increasing the number of adolescents who receive Target A-CRA would be expected to result in a higher likelihood that adolescents would have more positive treatment outcomes.”

This insufficient fidelity was particularly the case for BCTs directed at maintenance of behaviour change.

“This was particularly the case for BCTs directed at maintenance of behaviour change.183”

• cites [183] Carroll, 1994, Implementing treatment and protecting the validity of the independent variable in treatment matching studies, J Stud Alcohol Suppl sourceNot checked yet

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Coding the delivery of BCTs using observations, audio or video recordings of interventions allows researchers and practitioners to find out how many of the intervention's proposed active ingredients are actually delivered.

“Coding the delivery of BCTs using observations, audio or video recordings, of interventions allows researchers and practitioners to find out how many of the intervention's proposed active ingredients are actually delivered.”

At least two journals have editorial policies stating that trials of interventions will only be published if the interventions are described in sufficient detail for replication and implementation, citing BCT methodology as an example.

“At least two journals have editorial policies stating that trials of interventions will only be published if the interventions are described in sufficient detail for replication and implementation, citing BCT methodology as an example.10,178”

• cites [10] Michie, 2009, Specifying and reporting complex behaviour change interventions: the need for a scientific method, Implement Sci sourceNot checked yet

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• cites [178] West, 2008, Providing full manuals and intervention descriptions: addiction policy, Addiction sourceNot checked yet

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