Defining Behaviour Change Techniques:
Implications for road safety interventions
L.M. Hurst
April 2011
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Contents
List of Tables......................................................................................................................….....2
1. Executive Summary…………...…………………………………………………………...…………..3
2. Introduction……………………………………………………..……………………………………….4
3. Behavioural Change Techniques…………………………………..……………………...…...…….5 4. Cornwall Council’s Road Safety Education Training and Publicity Interventions.……………..10 5. Recommendations……………………………………………………..……………………………..14 6. Appendices………………………………..…………………………………………………………..15
Appendix 1: Coding manual to identify behaviour change techniques …………...…………….15 Appendix 2: Behaviour change theories…………..………………………………………………..26
7. References………………………………………………………………………………………………28
List of Tables Table 1 Definitions of Abraham and Michie’s 40 behaviour change techniques Table 2 Behaviour change techniques used in Cornwall Council’s current road safety
education, training and publicity interventions
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1. Executive Summary This report identifies and provides a definition of 40 behavioural change techniques (BCTs) and
matches these to Cornwall Council’s current road safety education, training, and publicity (ETP)
interventions. Although there is limited evidence on the effectiveness of each BCT, what evidence
that exists is discussed.
A number of recommendations follow:
• It may be particularly beneficial to include techniques derived from Control Theory in
behavioural change interventions (BCT’s 7,8,9,17,21,22,23,24,26,27,28 and 29). Specifically
those prompting self-monitoring of behaviour and behaviour outcomes (BCT’s 23 and 24) may
improve the effectiveness of an intervention. This could be achieved by asking targets to record
their driving behaviour after the intervention, using for example; a diary or a questionnaire.
• It may be beneficial to include at least one other technique, alongside BCTs 23 and 24,
derived from Control Theory: Goal setting in terms of behaviour - this could be done by asking targets to make a
behavioural resolution at the end of an intervention, for example; not to speed and/or to
wear a seatbelt. This would depend on the aims of the intervention.
Goal setting in terms of outcome – this could be done by adding expected consequence/s
to the behavioural goals, for example; to keep myself and passengers safe in the car.
Action planning – this could be done by encouraging targets to plan how/when/where they
will achieve their goals, for example; leave more time for travelling everyday to work. Graded task setting – this could be done by encouraging targets to add a logical sequence
to their action planning so each stage on builds small successes to achieve their desired
behaviour. Prompting review of behavioural and/or outcome goals – this could be done by
encouraging targets to review the extent to which they have achieved their goals in a
certain time frame. Providing feedback on performance – this could be done during interventions when actual
road safety behaviour is seen/assessed.
• Research has demonstrated the number of BCTs used in an intervention do not influence its
effectiveness; therefore, it may be more beneficial to focus on enhancing the quality of a few
BCTs and focus these on the aims of the intervention, rather than attempting to use numerous
BCTs in a specific intervention.
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2. Introduction
Many of the education, publicity and training (ETP) interventions used in road safety employ
different types of behavioural change techniques (BCTs).1 It is difficult to compare and evaluate
the effectiveness of these interventions without specifying the type of BCTs used.
Researchers have developed standard definitions for 40 BCTs that are based upon a variety of
theoretical accounts of behaviour change (Table 1).2 This report matches these definitions to
Cornwall Council’s current road safety interventions. A coding manual and tick list is also provided
(Appendix 1) so that practitioners can identify the BCT’s used in any intervention. This coding
manual can be used to identify which BCTs an intervention uses and should encourage reflection
on the match between the aims of an intervention and the BCTs employed. It may also facilitate
consideration of the wide range of alternative BCTs. For example; if the aim of an intervention is
to influence long-term behaviour change, then techniques which input knowledge and change
attitudes may not be enough, those that involve planning, supporting and rewarding change may
be more beneficial.
Although there is limited evidence to the effectiveness of each BCT, the evidence that exists is
discussed. Evaluations of road safety interventions have shown that they tend to only use a few of
the BCTs available, and while these may result in large changes in attitudes and intentions, the
changes tend to be short-term only.1 It may be possible to achieve longer lasting change, or
improved rates of change, by including a wider range of BCTs in road safety interventions.
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3. Behavioural Change Techniques Table one defines 40 BCTs, indicates which theory of behaviour change each is derived from and
what type of technique it is. Throughout, the term ‘target’ refers to the individual and/or group of
people the intervention is aimed at. Theories are explained in Appendix 2.
Behaviour
change technique Definition Theory Type of
technique Provides information about the relationship between the behaviour and its possible or likely consequences in the general case, usually based on epidemiological data, and not personalised for the target.
1. Provide information on consequences of behaviour in general
Information Information – Motivation- Behavioural Theory (IMB)
Provides information about the benefits and costs of action or inaction to the target based on those targets characteristics (e.g. demographics, clinical, behavioural or psychological information). This can include any costs/ benefits and not necessarily those related to health, e.g. feelings.
2. Provide information on consequences of behaviour to the target
Information Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Social Cognitive Theory (ScogT), IMB
3. Provide information about others approval
Provides information about what others think about the behaviour and whether others will approve or disapprove of any proposed behaviour change.
TRA, TPB, IMB
Information
4. Provide normative information about others’ behaviour
Provides information about what other people are doing i.e. indicates that a particular behaviour or sequence of behaviours is common or uncommon amongst the population or a specified group.
TRA, TPB, IMB
Information
IMB, TPB Information Provides information concerning how the target
may/will feel if (s)he performs or does not perform the behaviour, including enjoyment and anticipation of regret.
5. Provide information on affective consequences 6. Fear arousal Involves presentation of risk and/or mortality
information relevant to the behaviour as emotive images designed to evoke a fearful response (e.g. “smoking kills!” or images of horrendous collision scenes).
IMB, TPB Information
Control Theory (CT)
Planning 7. Goal setting (behaviour)
The target is encouraged to make a behavioural resolution (e.g. take more exercise next week). This is directed towards encouraging target to decide to change or maintain a change.
CT Planning 8. Goal setting (outcome)
The target is encouraged to set a general goal that can be achieved by behavioural means but is not defined in terms of behaviour (e.g. to reduce blood pressure or lose/maintain weight), as opposed to a goal based on changing behaviour as such. The goal may be an expected consequence of one or more behaviours, but
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is not a behaviour per se. 9. Action planning Involves detailed planning of what the target will do.
Should include; when, in which situation, and/or where to act. “When” may describe frequency (such as how many times a day/week or duration).
CT Planning
SCogT Planning This presumes the formation of an initial plan to change behaviour. The target is prompted to think about potential barriers and identify ways of overcoming them. Barriers may include competing goals in specified situations. This may be described as “problem solving” in relation to particular behaviours. Examples of barriers may include behavioural, cognitive, emotional, environmental, social and/or physical barriers.
10. Barrier identification/ problem solving
11. Set graded tasks
Breaking down the desired behaviour into smaller easier to achieve tasks and enabling the target to build on small successes to achieve the behaviour. This may include increments towards the desired behaviour, or incremental increases from baseline behaviour.
SCogT Implementing
OC Implementing Once a behaviour is performed in a particular situation, the target is encouraged or helped to try it in another situation. The idea is to ensure that the behaviour is not tied to one situation but becomes a more integrated part of the target’s life that can be performed at a variety of different times and in a variety of contexts.
12. Prompting generalization of a desired behaviour
13. Use of follow up prompts
Sending letters, making telephone calls, visits or follow up meetings after the main intervention has been completed.
OC Implementing
Involves using praise or rewards for attempts at achieve a behavioural goal. This might include efforts made towards achieving the behaviour, or progress made in preparatory steps towards the behaviour, but not merely participation in intervention. This can include self-reward.
14. Prompt rewards contingent on effort or progress towards behaviour
Feeling good Operant Conditioning (OC)
OC Feeling good Reinforcing successful performance of the specific
desired behaviour. This can include praise and encouragement as well as material rewards but the reward/incentive must be explicitly linked to the achievement of the specific behaviour i.e. the target receives the reward if they perform the specified behaviour but not if they do not perform the behaviour. This can include self-reward.
15. Provide rewards contingent on successful behaviour
OC Feeling good 16. Shaping Contingent rewards are first provided for any approximation to the desired behaviour e.g. for any increase in physical activity. Then, later, only for a more demanding performance, e.g. brisk walking for 10 minutes on three days a week would be rewarded. Thus, this is graded use of contingent rewards over time.
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17. Prompting focus on past success
Involves instructing the target to think about or list previous successes in performing the behaviour (or parts of it).
CT Feeling good
SCompT Feeling good Involves focusing on how the target may be an example to others and affect others behaviour e.g. being a good example to children. Also includes providing opportunities for targets to persuade others of the importance of adopting/changing the behaviour, e.g. giving a talk or running a peer-led session.
18. Prompt identification as role model/ position advocate
Planning how to maintain behaviour that has been changed.
19. Relapse prevention/coping planning
Feeling good Relapse Prevention Therapy
20. Stimulate anticipation of future rewards
Create anticipation of future rewards without necessarily reinforcing behaviour throughout the active period of the intervention.
Feeling good
21. Prompt review of behavioural goals
Involves a review or analysis of the extent to which previously set behavioural goals (e.g. take more exercise next week) were achieved.
CT Monitoring
22. Prompt review of outcome goals
Involves a review or analysis of the extent to which previously set outcome goals (e.g. to reduce blood pressure or lose/maintain weight) were achieved.
CT Monitoring
23. Prompt self-monitoring of behaviour
The target is asked to keep a record of specified behaviour/s as a method for changing behaviour. This should be an explicitly stated intervention component.
CT Monitoring
CT Monitoring The target is asked to keep a record of specified measures expected to be influenced by the behaviour change, e.g. blood pressure, blood glucose, weight loss, physical fitness.
24. Prompt self-monitoring of behavioural outcome
OC Monitoring 25. Teach to use prompts/cues
The target is taught to identify environmental prompts which can be used to remind them to perform the behaviour (or to perform an alternative, incompatible behaviour in the case of behaviours aimed at being reduced). Cues could include times of day, particular contexts or technologies such as mobile phone alerts which prompt them to perform the desired behaviour.
26.Environmental restructuring
The target is prompted to alter the environment in ways so that it is more supportive of the desired behaviour.
CT Monitoring
CT Teaching 27. Provide feedback on performance
This involves providing the target with data about their own recorded progress or commenting on a person’s behavioural performance, identifying a discrepancy between behavioural performance and a set goal, or a discrepancy between the targets own performance in relation to others.
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28. Provide information on where and when to perform the behaviour
Involves telling the target when and where they might be able to perform the behaviour. This can be in either verbal or written form.
CT Teaching
Involves telling the target how to perform a behaviour or preparatory behaviours, either verbally or in written form.
CT Teaching 29. Provide instruction on how to perform the behaviour 30. Model/ demonstrate the behaviour
Involves showing the target how to perform a behaviour e.g. through physical or visual demonstrations of behavioural performance, in person or remotely.
SCogT Teaching
OC Agreeing Must involve written agreement on the performance of
an explicitly specified behaviour so that there is a written record of the target’s resolution witnessed by another.
31. Agree behavioural contract 32. Prompt practice
Prompt the target to rehearse and repeat the behaviour or preparatory behaviours numerous times.
OC Agreeing
33. Facilitate social comparison
Involves explicitly drawing attention to others’ performance to elicit comparisons.
Supporting Social Comparison Theory (SCompT)
Social support theories
Supporting 34. Plan social support/social change
Involves prompting the target to plan how to elicit social support from other people to help him/her achieve their desired behaviour/outcome. This may include support during interventions e.g. setting up a “buddy” system, or other forms of support from the individuals delivering the intervention, partner, friends and/or family.
35. Prompt self talk
Encourage the target to talk to themselves (aloud or silently) before and during planned behaviours to encourage, support and maintain action.
Managing
36. Prompt use of imagery
Teaching the target to imagine successfully performing the behaviour or to imagine finding it easy to perform the behaviour, including component or easy versions of the behaviour.
IMB, TPB Managing
Stress theories
Managing This is a set of specific techniques (e.g., progressive relaxation) which do not address the behaviour directly but seek to reduce anxiety and stress to facilitate the performance of the behaviour. They might also include techniques designed to reduce negative emotions or control mood or feelings that may interfere with performance of the behaviour, and/or to increase positive emotions that might help with the performance of the behaviour.
37. Stress management/ emotional control training
38. Motivational interviewing
This is a specific set of techniques prompting the target to engage in talk of changing their behaviour to motivate then minimize their resistance to change.
Managing
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39. Time management
This includes any technique designed to teach a target how to manage their time in order to make time for the behaviour. These techniques are not directed towards performance of target behaviour but rather seek to facilitate it by freeing up times when it could be performed.
Managing
Managing 40. General communication skills training
This includes any technique directed at general communication skills but not directed towards a particular behaviour change. Often this may include role play and group work focusing on listening, assertive and/or negotiation skills, and resisting social pressures.
Table 1 Definitions adapted from Abraham and Michie’s 40 behaviour change techniques. Research into the effectiveness of BCT’s is limited, however, the research there has been has
shown the inclusion of techniques derived from Control Theory significantly increases the
effectiveness of interventions compared to those which don’t include techniques from this theory.3
Specifically the inclusion of ‘prompting self-monitoring’ (BCT’s 23 and 24) was found to
significantly increase the effectiveness of interventions aimed at increasing physical activity,
healthy eating3 4, and reducing excessive alcohol consumption . This was found to be most
effective when used with at least one other technique derived from Control Theory; ‘goal setting’
(behaviour and outcome, BCT’s 7 and 8), ‘action planning’ (BCT 9), ‘set graded tasks’ (BCT 11),
‘prompt review of goals’ (BCT 21 and 22), or ‘provide feedback on performance’ (BCT 27). The
number of BCT’s used in an intervention did not influence its effectiveness; quality may be
affected if too many techniques are implemented.3
As yet, no research into specific BCT in road safety interventions has been undertaken, however,
previous research in driving behaviours has shown support for Control Theory techniques;
specifying goals were found to increase driver’s compliance with speed limits.5 Other types of
interventions have also been shown to reduce risky driving behaviour, for example; the use of
rewards and punishments were found to influence the risky driving behaviour of young drivers6,
and providing normative information and prompting anticipated regret were found to effect
offending drivers speeding behaviour7. This provides support for using techniques derived from
Operant Conditioning Theory and the Theory of Planned Behaviour. Interventions including threat
inducing arguments, such as fear arousal, have not been associated with effectiveness for any
audience.3
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4. Cornwall Councils Road Safety Education Training and Publicity Interventions Table two identifies which BCTs are used in Cornwall Council’s current road safety ETP interventions.
Intervention Behaviour Change Techniques Employed
Child Car Seat Awareness Campaign 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 4. Normative information about others’ behaviour 25. Teach to use prompts/cues 26. Environmental restructuring 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour
Driving Safer for Longer 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the
target 11. Set graded tasks 25. Teach to use prompts/cues 26. Environmental restructuring 27. Feedback on performance (if the assessment is taken) 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 34. Plan social support/social change
Learn 2 Live 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 4. Normative information about others’ behaviour 5. Provide information on affective consequences 6. Fear Arousal 10. Barrier identification/problem solving 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 33. Facilitate social comparison
Emergency Services Road Awareness Day (ESRAD)
1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour
Child Pedestrian Training 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 10. Barrier identification/problem solving 12. Prompting generalization of a target behaviour 18. Prompt identification as role model/position advocate 25. Teach to use prompts/cues
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28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour 32. Prompt practice
Junior Life Skills 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour
Senior Life Skills 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour
Operation Cross 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Rev it Right 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the
target 6. Fear Arousal 10. Barrier identification/problem solving 25. Teach to use prompts/cues 26. Environmental restructuring 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour
Older Riders 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 4. Normative information about others’ behaviour 25. Teach to use prompts/cues 26. Environmental restructuring 27. Feedback on performance 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Work Related Road Safety delivery/promotion
1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Crossroads 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the
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target 4. Normative information about others’ behaviour 7. Goal setting (behaviour) 8. Goal setting (outcome) 9. Action planning 10. Barrier identification/problem solving 12. Prompting generalization of a target behaviour 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Year 8 delivery 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 4. Normative information about others’ behaviour 5. Provide information on affective consequences 6. Fear Arousal 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
A2B 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 7. Goal setting (behaviour) 10. Barrier identification/problem solving 17. Prompting focus on past success 18. Prompt identification as role model/position advocate 21. Prompt review of behavioural goals 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Junior Road Safety Officer (JRSO) 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 7. Goal setting (behaviour) 14. Prompt rewards contingent on effort or progress towards behaviour 18. Prompt identification as role model/position advocate 25. Teach to use prompts/cues 26. Environmental restructuring 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour 30. Model/demonstrate the behaviour 31. Agree behavioural contract 40. General communication skills training
Phoenix Project 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the target 4. Normative information about others’ behaviour 5. Provide information on affective consequences 6. Fear Arousal 10. Barrier identification/problem solving 18. Prompt identification as role model/position advocate 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
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Rush 1. Information on consequences of behaviour in general 2. Information on consequences of behaviour to the
target 5. Provide information on affective consequences 6. Fear Arousal 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Migrant Workers 1. Information on consequences of behaviour in general 28. Information on where and when to perform the behaviour 29. Instruction on how to perform the behaviour
Table 2 Behaviour change techniques used in Cornwall Council’s current road safety education, training and publicity interventions Most of Cornwall Council’s current road safety ETP interventions use between 6-10 different
BCTs, except JSRO which uses 12, and Operation Cross, Work Related Road safety delivery,
and Migrant workers which use 2-3. Commonly used techniques include 1, 2 and 4 which focus
on providing information on consequences and normative behaviour, techniques 28, 29 and 30
which focus on providing information on where and when and demonstrating how to perform the
behaviour safely, and technique 18 which involves prompting the person to be a role model.
These techniques are derived from a variety of behaviour change theories;
1, 2 and 4 are derived from Information-Motivation-Behaviour Skills Model and the Theory
of Planned Behaviour
28 and 29 are derived from Control Theory
30 is derived from Social Cognitive Theory
18 is derived from Social Comparison Theory
Techniques that are never used are 3,13,15,16,19,20,23,24, and 35-39. Some of these may not
be especially important to the road safety behavioural domain, such as; technique 37 – stress
management/emotional control training, which may be more appropriate for addictive behaviours
such as smoking. However, some of these, specifically those derived from Control Theory, have
the potential to increase the effectiveness of behaviour change in road safety interventions.
Cornwall Council’s interventions focus mainly on information and teaching techniques, these may
cause large but short-term changes in attitudes, considering a wider range of BCTs, such as
those around planning and rewarding, may achieve a longer-lasting change.1
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5. Recommendations
• It may be particularly beneficial to include techniques derived from Control Theory in
behavioural change interventions (BCT’s 7,8,9,17,21,22,23,24,26,27,28 and 29). Specifically, those prompting self-monitoring of behaviour and behaviour outcomes (BCT’s 23 and 24) may
improve the effectiveness of an intervention. This could be achieved by asking targets to record
their driving behaviour after an intervention, using for example; a diary or a questionnaire.
Techniques 28 and 29 are already widely used in Cornwall Council’s road safety ETP
interventions and should be continued.
• It may be beneficial to include at least one other technique, alongside BCT’s 23 and 24,
derived from Control Theory: Goal setting in terms of behaviour - this could be done by asking targets to make a
behavioural resolution at the end of an intervention, for example; not to speed and/or to
wear a seatbelt. This would depend on the aims of the intervention.
Goal setting in terms of outcome – this could be done by adding expected consequence/s
to the behavioural goals, for example; to keep myself and passengers safe in the car.
Action planning – this could be done by encouraging targets to plan how/when/where they
will achieve their goals, for example; leave more time for travelling everyday to work. Graded task setting – this could be done by encouraging targets to add a logical sequence
to their action planning so each stage on builds small successes to achieve their desired
behaviour. Prompting review of behavioural and/or outcome goals – this could be done by
encouraging targets to review the extent to which they have achieved their goals in a
certain time frame. Providing feedback on performance – this could be done during interventions when actual
road safety behaviour is seen/assessed.
• Research has demonstrated the number of BCTs used in an intervention do not influence its
effectiveness; therefore, it may be more beneficial to focus on enhancing the quality of a few
BCTs, and focus these on the aims of the intervention, rather than attempting to use numerous
BCTs in a specific intervention.
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6. Appendices Appendix 1: Coding manual to match behaviour change techniques to interventions.
If you would like to know which BCT an intervention uses follow these steps:
• Read the coding guidelines • Read the BCT definitions so you understand each technique • Read through the intervention description using the tick list to check any BCTs
Coding Guidelines
Only code text describing the intervention itself. Do not code aspects of the intervention
evaluation (e.g., completing pre-and post intervention questionnaires) or preparation for
intervention delivery (e.g., training of instructors). Only identify techniques used in the delivery of
the intervention itself. Code for the most intensive or elaborate intervention programme described.
Check introduction and method sections for any additional information on the intervention.
Read each technique description definition carefully before beginning a coding session, ensuring
that you understand and remember distinctions between technique types. Use the technique
checklist as you read the paper checking techniques you are certain of and highlighting those you
need to come back to. As you read the description of the intervention make notes in the margin so
you can identify exactly which section/s of text led you to decide that a particular technique was
included in the intervention. After reading the description of the intervention check each technique
category again – looking through the text for instances you may have missed or pieces of text you
may have misinterpreted on first reading. Never infer use of a technique – if it is not explicitly
mentioned then do not count it. Do not make judgements about the quality of delivery of
techniques. If it is claimed that a technique was delivered and it matches the technique definition
then record use of that technique – even if you have doubts about the intensity or resources used
for delivery. Quality of technique delivery and implementation is a separate aspect of overall
intervention quality.
Sometimes two techniques may be indicated by the same piece of text e.g., instruction (29) and
modelling/demonstrating (30). Make a clear decision as to whether the text indicates one or both,
then, if appropriate, decide which one, i.e., do not just tick both without making a clear decision.
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Behaviour Change Technique Checklist
The following checklist can be used by practitioners to identify the BCTs used in their
interventions.
Intervention:
Techniques Included:
general1. Provide information on consequences of behaviour in
2. Provide information on consequences of behaviour to the Target
3. Provide information about others’ approval
4. Provide normative information about others’ behaviour
5. Provide information on affective consequences
6. Fear Arousal
7. Goal setting (behaviour)
8. Goal setting (outcome)
9. Action planning
10. Barrier identification/problem solving
11. Set graded tasks
12. Prompting generalization of a target behaviour
13. Use of follow up prompts
14. Prompt rewards contingent on effort or progress towards behaviour
15. Provide rewards contingent on successful behaviour
16. Shaping
17. Prompting focus on past success
18. Prompt identification as role model/position advocate
19. Relapse prevention/coping planning
20. Stimulate anticipation of future rewards
21. Prompt review of behavioural goals
22. Prompt review of outcome goals
23. Prompt self-monitoring of behaviour
24. Prompt self-monitoring of behavioural outcome
25. Teach to use prompts/cues
26. Environmental restructuring
27. Provide feedback on performance
where and when28. Provide information on to perform the behaviour
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29. Provide instruction on how to perform the behaviour
30. Model/demonstrate the behaviour
31. Agree behavioural contract
32. Prompt practice
33. Facilitate social comparison
34. Plan social support/social change
35. Prompt self talk
36. Prompt use of imagery
37. Stress management/emotional control training
38. Motivational interviewing
39. Time management
40. General communication skills training
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Behaviour Change Technique Definitions:
general1. Provide information on consequences of behaviour in
Information about the relationship between the behaviour and its possible or likely consequences
in the general case, usually based on epidemiological data, and not personalised for the target
(contrast with technique 2).
2. Provide information on consequences of behaviour to the target
Provide information about the benefits and costs of action or inaction to the target based on that
target’s characteristics (i.e. demographics, clinical, behavioural or psychological information). This
can include any costs/ benefits and not necessarily those related to health, e.g. feelings.
3. Provide information about others’ approval
Provide information about what other people think about the target’s behaviour. It clarifies whether
others will like, approve or disapprove of what the target is doing or will do. NB Check that any
instance does not also involve techniques 1 (Provide information on consequences of behaviour
in general) or 2 (Provide information on consequences of behaviour to the target) or 4 (Provide
normative information about others’ behaviour).
4. Provide normative information about others’ behaviour
doing Involves providing information about what other people are i.e. indicates that a particular
behaviour or sequence of behaviours is common or uncommon amongst the population or
amongst a specified group – presentation of case studies of a few others is not normative
information. NB this concerns other people’s actions and is distinct from the provision of
information about others’ approval (technique 3 [Provide information about others’ approval]).
5. Provide information on affective consequences
Provides information concerning how the target may/will feel if (s)he performs or does not perform
the behaviour, including enjoyment and anticipation of regret. Do not also code instances of this
technique as the more generic providing information on consequences (techniques 1 [Provide
information on consequences of behaviour in general and 2 [Provide information on
consequences of behaviour to the target).
6. Fear Arousal
Involves presentation of risk and/or mortality information relevant to the behaviour as emotive
images designed to evoke a fearful response (e.g, horrendous collision pictures). Do not also
code instances of this technique as the more generic providing information on consequences
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(techniques 1 [Provide information on consequences of behaviour in general] and 2 [Provide
information on consequences of behaviour to the target).
7. Goal setting (behaviour)
The target is encouraged to make a behavioural resolution (e.g. always wear seatbelts). This is
directed towards encouraging the target to decide to change or maintain change. NB This is
distinguished from technique 8 (Goal setting - outcome) and 9 (Action planning) as it does not
involve planning exactly how the behaviour will be done or when and where the behaviour or
action sequence will be performed. If the text only states that goal setting was used without
specifying the detail of action planning involved then this would be an example of this technique
(not technique 9 [Action planning]). If the text states that ‘goal setting’ was used and it is not clear
from the report if the goal setting was related to behaviour or to other outcomes, technique 8
should be coded. This includes sub-goals or preparatory behaviours and/or specific contexts in
which the behaviour will be performed. The behaviour in this technique will be directly related to
or be a necessary condition for the desired behaviour (e.g. insuring seatbelts are fastened and not
exceeding the speed limit). NB check if techniques applied to preparatory behaviours should also
be coded as instances of technique 11 (Set graded tasks).
8. Goal setting (outcome)
The target is encouraged to set a general goal that can be achieved by behavioural means but is
not defined in terms of behaviour (e.g. to increase passenger safety), as opposed to a goal based
on changing behaviour. The goal may be an expected consequence of one or more behaviours,
but is not a behaviour per se (see also techniques 7 [Goal setting - behaviour] and 9 [Action
planning]). This technique may co-occur with technique 7 if goals for both behaviour and other
outcomes are set.
9. Action planning
Involves detailed planning of what the target will do including; when, in which situation and/or
where to act. “When” may describe frequency (such as how many times a day/week or duration).
The exact content of action plans may or may not be described in this case. Code as this
technique if it is stated that the behaviour is planned contingent to a specific situation or set of
situations even if exact details are not present. NB The terms “goal setting” or “action plan” are
not enough to ensure inclusion of this technique unless it is clear that plans involve linking
behavioural responses to specific situational cues. When only described as “goal setting” or
“action plan” without the above detail it should be regarded as applications of technique 7 and 8.
19
10. Barrier identification/problem solving
This presumes the formation of an initial plan to change behaviour. The target is prompted to think
about potential barriers and identify ways of overcoming them. Barriers may include competing
goals in specified situations. This may be described as “problem solving”. If it is problem solving in
relation to the performance of a behaviour, then it counts as an instance of this technique.
Examples of barriers may include behavioural, cognitive, emotional, environmental, social and/ or
physical barriers. NB Closely related to techniques 9 (Action planning) and 11 (Set graded task)
but involves a focus on specific obstacles to performance. It contrasts with technique 19 (Relapse
prevention/coping planning) which is about maintaining behaviour that has already been changed.
11. Set graded tasks
Breaking down the desired behaviour into smaller easier to achieve tasks and enabling the target
to build on small successes to achieve the desired behaviour. This may include increments
towards the desired behaviour, or incremental increases from baseline behaviour. NB The key
difference to technique 9 (Action planning) lies in planning to perform a sequence of preparatory
actions (e.g. remembering to ask passengers to put on their seatbelts), task components or
desired behaviours which are in a logical sequence or increase in difficulty over time, as opposed
to planning “if-then” contingencies and when/where to perform behaviours.
12. Prompting generalization of a desired behaviour
Once a behaviour is performed in a particular situation, the target is encouraged or helped to try it
in another situation. The idea is to ensure that the behaviour is not tied to one situation but
becomes a more integrated part of the target’s life that can be performed at a variety of different
times and in a variety of contexts.
13. Use of follow up prompts
Intervention components are gradually reduced in intensity, duration and frequency over time, e.g.
letters or telephone calls instead of face to face and/or provided at longer time intervals.
14. Prompt rewards contingent on effort or progress towards behaviour
Involves using praise or rewards for attempts at achieving a behavioural goal. This might include
efforts made towards achieving the behaviour, or progress made in preparatory steps towards the
behaviour, but not merely participation in intervention. This can include self-reward. NB This
technique is not reinforcement for performing the desired behaviour itself, which is an instance of
technique 15 (Provide rewards contingent on successful behaviour).
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15. Provide rewards contingent on successful behaviour
Reinforcing successful performance of the specific desired behaviour. This can include praise and
encouragement as well as material rewards but the reward/incentive must be explicitly linked to
the achievement of the specific desired behaviour, i.e. the target receives the reward if they
perform the specified behaviour but not if they do not perform the behaviour. This can include self-
reward. Provision of rewards for completing intervention components or materials are not
instances of this technique. NB Check the distinction between this and techniques 9 (Action
planning) and 24 (Prompt self-monitoring of behavioural outcome) and 27 (Provide feedback on
performance).
16. Shaping
Contingent rewards are first provided for any approximation to the desired behaviour e.g. for any
increases in safer driving. Then, later, only for a more demanding performance, e.g. not
exceeding the speed limit, would be rewarded. Thus, this is graded use of contingent rewards
over time.
17. Prompting focus on past success
Involves instructing the target to think about or list previous successes in performing the
behaviour (or parts of it). NB This is not just encouragement but a clear focus on the targets past
behaviour. It is also not feedback because it refers to behaviour preceding the intervention.
18. Prompt identification as role model/position advocate
Involves focusing on how the target may be an example to others and affect their behaviour e.g.
being a good example to children. Also includes providing opportunities for target to persuade
others of the importance of adopting/changing the behaviour, for example, giving a talk or running
a peer-led session.
19. Relapse prevention/coping planning
This relates to planning how to maintain behaviour that has been changed. The target is prompted
to identify, in advance, situations in which the changed behaviour may not be maintained, and
develop strategies to avoid or manage those situations. Contrast with techniques 9 (Action
planning) and 10 (Barrier identification/ Problem solving) which are about initiating behaviour
change.
20. Stimulate anticipation of future rewards
Create anticipation of future rewards without necessarily reinforcing behaviour throughout the
active period of the intervention. Code this technique when the target is told at the onset that they
will be rewarded based on behavioural achievement.
21
21. Prompt review of behavioural goals
Involves a review or analysis of the extent to which previously set behavioural goals (e.g. always
wear seatbelts) were achieved. In most cases this will follow previous goal setting (see technique
7, ‘Goal setting-behaviour’) and an attempt to act on those goals, followed by a revision or
readjustment of goals, and/or means to attain them. NB Check if any instance also involves
techniques 7 (Goal setting - behaviour), 10 (Barrier identification/problem solving), 11 (Set graded
tasks) or 22 (Prompt review of outcome goals).
22. Prompt review of outcome goals
outcomeInvolves a review or analysis of the extent to which previously set goals (e.g. to increase
passenger safety) were achieved. In most cases this will follow previous goal setting (see
technique 8, goal setting-outcome’) and an attempt to act on those goals, followed by a revision of
goals, and/or means to attain them. NB Check that any instance does not also involve techniques
8 (Goal setting - outcome), 10 (Barrier identification/problem solving), 11 (Set graded tasks) or 21
(Prompt review of behavioural goals).
23. Prompt self-monitoring of behaviour
The target is asked to keep a record of specified behaviour/s as a method for changing behaviour.
This should be an explicitly stated intervention component, as opposed to occurring as part of
completing measures for research purposes. This could take the form of a diary or completing a
questionnaire about their behaviour in terms of type, frequency, duration and/or intensity. Check
the distinction between this and techniques 24 (Prompt self-monitoring of behavioural outcome).
24. Prompt self-monitoring of behavioural outcome
The target is asked to keep a record of specified measures expected to be influenced by the
behaviour change, e.g. speeding tickets. NB It must be reported as part of the intervention, rather
than only as an outcome measure. Check the distinction between this and techniques 23 (Prompt
self-monitoring of behaviour).
25. Teach to use prompts/cues
The target is taught to identify environmental prompts which can be used to remind them to
perform the behaviour (or to perform an alternative, incompatible behaviour in the case of
behaviours aimed at being reduced). Cues could include times of day, particular contexts or
technologies such as mobile phone alerts which prompt them to perform the target behaviour. NB
This technique could be used independently or in conjunction with techniques 7 (Goal setting -
behaviour) and 9 (Action planning) (see also 26 [Environmental restructuring]).
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26. Environmental restructuring
The target is prompted to alter the environment in ways that it is more supportive of the desired
behaviour e.g. altering cues or reinforcers. Interventions in which the interveners directly modify
environmental variables are not covered by this taxonomy and should be coded independently.
27. Provide feedback on performance
This involves providing the target with data about their own recorded behaviour (e.g., following
technique 23 [Prompt self-monitoring of behaviour]) or commenting on a target’s behavioural
performance, e.g. identifying a discrepancy with between behavioural performance and a set goal
(see techniques 7 [Goal setting - behaviour] and 9 [Action planning]), or a discrepancy between
one’s own performance in relation to others’. NB this could also involve technique 33 [Facilitate
social comparison].
where and when28. Provide information on to perform the behaviour
Involves telling the target about when and where they might be able to perform the behaviour (e.g.
tips on places and times). This can be in either verbal or written form. NB Check whether there
are also instances of technique 29 (Provide instruction on how to perform the behaviour).
29. Provide instruction on how to perform the behaviour
Involves telling the target how to perform a behaviour or preparatory behaviours, either verbally or
in written form. Showing a target how to perform a behaviour without verbal instruction would be
an instance of technique 30 only. NB Check whether there are also instances of techniques 7, 9,
10, 11, 30.
30. Model/demonstrate the behaviour
Involves showing the target how to perform a behaviour e.g. through physical or visual
demonstrations of behavioural performance, in person or remotely. NB This is distinct from just
providing instruction (technique 29) because in “demonstration” the target is able to observe the
behaviour being enacted. This technique and technique 29 (Provide instruction on how to perform
the behaviour) may be used separately or together. Instructing parents or peers to perform the
target behaviour is not an instance of this technique as fidelity would be uncertain.
31. Agree behavioural contract
Must involve written agreement on the performance of an explicitly specified behaviour so that
there is a written record of the target’s resolution witnessed by another.
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32. Prompt practice
Prompt the target to rehearse and repeat the behaviour or preparatory behaviours numerous
times. NB This will also include parts of the behaviour (e.g., refusal skills in getting into a car with
a drunk driver). This could be described as “building habits or routines” but is still practice as long
as the target is prompted to try the behaviour (or parts of it) during the intervention or practice
between intervention sessions, e.g. as “homework”.
33. Facilitate social comparison
Involves explicitly drawing attention to others’ performance to elicit comparisons. NB The fact the
intervention takes place in a group setting, or have been placed in groups on the basis of shared
characteristics, does not necessarily mean social comparison is actually taking place. Social
support may also be encouraged in such settings and this would then involve technique 34 (Plan
social support/social change). Group classes may also involve instruction (technique 29 [Provide
instruction on how to perform the behaviour]) demonstration (technique 30 [Model/demonstrate
the behaviour]) and practice (technique 32 [Prompt practice]).
34. Plan social support/social change
Involves prompting the target to plan how to elicit social support from other people to help him/her
achieve their desired behaviour/outcome. This will include support during interventions e.g. setting
up a “buddy” system or other forms of support provided by the individuals delivering the
intervention, partner, friends, and family.
35. Prompt self talk
Encourage the target to use talk to themselves (aloud or silently) before and during planned
behaviours to encourage, support and maintain action, or to imagine finding it easy to perform the
behaviour, including component or easy versions.
36. Prompt use of imagery
Teach the target to imagine successfully performing the behaviour. Distinct from recalling
instances of previous success without imagery (technique 17 [Prompting focus on past success].
37. Stress management/emotional control training
This is a set of specific techniques (e.g., progressive relaxation) which do not target the behaviour
directly but seek to reduce anxiety and stress to facilitate the performance of the behaviour. It
might also include techniques designed to reduce negative emotions or control mood or feelings
that may interfere with performance of the behaviour, and/or to increase positive emotions that
might help with the performance of the behaviour. NB Check whether there are any instances of
technique 10 (Barrier identification/problem solving), which includes identifying emotional barriers
24
to performance, in contrast to the current technique, which addresses stress and emotions
whether they have been identified as barriers or not.
38. Motivational interviewing
This is a clinical method including a specific set of techniques involving prompting the target to
engage in change talk in order to minimize resistance and resolve ambivalence to change
(includes motivational counselling). NB Only rate this technique if explicitly referred to by name,
not if one identifies specific elements of it, this may happen if you have prior experience with this
technique.
39. Time management
This includes any technique designed to teach a target how to manage their time in order to make
time for the behaviour. These techniques are not directed towards performance of target
behaviour but rather seek to facilitate it by freeing up times when it could be performed. NB Only
rate this technique if explicitly referred to by name, not if one identifies specific elements of it, this
may happen if you have prior experience with this technique.
40. General communication skills training
This includes any technique directed at general communication skills but not directed towards a
particular behaviour change. Often this may include role play and group work focusing on
listening, assertive and/or negotiation skills and resisting social pressures. NB Practicing a
particular behaviour-specific interpersonal negotiation, e.g. refusal skills in relation to cigarettes or
alcohol, would not be an instance of this technique.8
Developed jointly by Charles Abraham (University of Sussex, UK, [email protected]) and Susan Michie (University College London, UK,
25
Appendix 2: Behaviour Change Theories
IMB – Information-Motivation-Behavioural skills model:
Behaviour change involves three components; “information” refers to knowledge to support the
behavior change, “motivation” refers to attitude towards behaviour change, and behaviour refers
to the skills acquired that are necessary to maintain the behavior change.9
TRA – Theory of Reasoned Action:
Behaviour can be predicted from behavioural intentions. Behavioural intentions are predicted by
two main variables: person’s attitude towards the behaviour and subjective norms (perception of
what others think you should do). A persons attitude is predicted by expectancy value framework
(desirability of each outcome is weighted by the likelihood of that outcome), and subjective norms
are predicted by the perceived expectations of significant others weighted by the motivation to
conform to these expectations.10
TPB - Theory of Planned Behaviour:
Uses the same model of behaviour as TRA but adds in the component of perceived control.10
SCogT – Social-Cognitive Theory:
Identifies human behaviour as an interaction of personal factors, behaviour and the environment.
The interaction between the person and the environment involves human beliefs and cognitive
competencies that are developed and modified by social influences and structures within the
environment. The interaction between the person and behaviour involves the influences of a
person’s thoughts and actions. The third interaction, between the environment and behaviour,
involves a person’s behaviour influencing the aspects of that environment and, in turn, that
behaviour is influenced by the environment.10
CT – Control Theory:
Behaviour is determined by what a person wants most at a time, not by a response to the
environment. This theory contends individuals have the power to change their lives for the better
based on the choices they make.11
OC – Operant Conditioning:
What happens before and after behaviour influences the occurrence of future behaviours. This
occurs through reinforcement; a consequence that causes a behaviour to occur with greater
frequency, punishment; a consequence that causes a behaviour to occur with less frequency, and
extinction; no consequence following a behaviour which leads a behaviour occurring with less
frequency.10
26
SCompT – Social-Comparison Theory:
People make comparison judgements about their abilities and opinions, emotions, personality and
outcomes, this, in turn, influences behaviour.10
Social Support Theories:
Refer to the function and quality of social relationships, such as perceived availability of help or
support actually received. Social support can motivate behaviour change through participating in a
meaningful behavioural context.12
Relapse Prevention Therapy (RPT):
A cognitive-behavioural approach to the treatment of dangerous behaviours that specifically
addresses the nature of the relapse process and suggests coping strategies useful in maintaining
change. It is based on the idea that behaviours are acquired, over-learned habits with biological,
psychological, and social determinants and consequences. Engaging in a dangerous behaviour
typically provides immediate rewards that increase pleasure and/or decrease pain. In other words,
people engage in dangerous behaviours to “feel good” (enhanced pleasure) or to “feel better” (self
medication of pain) although both motives can exist at the same time. The rewards of following
dangerous behaviours serve to maintain their excessive frequency, intensity, and duration,
despite the delayed negative consequences, which can be quite severe and long lasting.
Changing dangerous behaviours can be seen as a combination of extinguishing the connection
between pleasure seeking and/or pain reduction and subsequent behaviour and helping clients to
build a new behaviour repertoire in which more adaptive coping behaviours replace dangerous
behaviours for the pursuit of pleasure and pain relief.13
Stress Theories:
Stress can be a response to a situation, a stimulus to a situation, or an interaction with a situation.
Any of these may influence behaviour in a given situation by changing thought patterns and
emotions.10
27
28
7. References
1 Fylan, F. (2011) Behavioural change techniques used in road safety schemes for young people. Leeds Metropolitan University. 2 Abraham, C., & Michie, S. (2008). A taxonomy of behaviour change techniques used in interventions.
Health Psychology, 27, 379-387 3 Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy
eating and physical activity interventions: a meta-regression. Health Psychology, 28, 690−701. 4 Michie, S., Whittington, C., Hamoudi, Z., Zarnani, F., Tober, G., & West, R. (In press). Behaviour change
techniques to reduce excessive alcohol use and their associations with outcomes. 5 Elliot, M., & Armitage, C. (2006). Effects of implementation intentions on the self-reported frequency of
driver’s compliance with speed limits. Journal of Experimental Psychology, Applied, 12, 108-117. 6 Scott-Parker, C., Watson, B., & King, M. (2009). Understanding the psychosocial factors influencing the
risky behaviour of young drivers. Transportation Research Port F-Traffic Psychology and Behaviour, 12,
470-482. 7 Elliot, M., & Tomson, J. (2010). The social-cognitive determinants of offending drivers speeding behaviour.
Accident Analysis and Prevention, 42, 1595-1605. 8 Abraham, C., Kok, G., Schaalma, H. & Luszczynska, A. (in press, 2011). Health Promotion. In, P.R.,
Martin, F., Cheung, M., Kyrios, L., Littlefield, L., Knowles, M., Overmier, & J., M., Prieto (Eds.). The
International Association of Applied Psychology Handbook of Applied Psychology. Oxford: Wiley-Blackwell 9 Fisher, W., Fisher, J., & Harman, J. (2003). The Information-Motivation-Behavioral Skills Model: A general
social psychological approach to understanding and promoting health behavior. In: Suls, J., & Wallston, K.
editors. Social Psychological Foundations of Health and Illness, Malden, MA: Blackwell Publishing, Ltd, p.
82-106. 10 Taylor, S., Peplau, L., & Sears, D. (2003). Social Psychology. New Jersey: Pearson Education. 122-165. 11 Webb T., Sniehotta, F., & Michie, S. (2010). Using theories of behaviour change to inform interventions
for addictive behaviours. Addiction, 105, 1879-1892 12 Hupcey, J. (2002). Clarifying the social-support theory-research link. Journal of Advance Nursing, 27,
1231-1241 13 Larimer, M., Palma, R., & Marlatt, A. (1999). Relapse prevention: an overview of Marlatt’s cognitive-
behavioural model. Alcohol, Research and Health, 22, 151-160