Behaviour change techniques used in road safety - Cornwall · PDF fileTable 2 Behaviour change techniques used in Cornwall Council’s current ... A coding manual and tick list is

Defining Behaviour Change Techniques:

Implications for road safety interventions

L.M. Hurst

April 2011

1

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

2

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.

3

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.

4

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

5

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.

6

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.

7

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

8

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

9

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

10

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

11

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

12

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

13

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.

14

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.

15

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


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


12. Prompting generalization of a target behaviour




16. Shaping


18. Prompt identification as role model/position advocate







25. Teach to use prompts/cues

26. Environmental restructuring

27. Provide feedback on performance

where and when28. Provide information on to perform the behaviour

16

29. Provide instruction on how to perform the behaviour

30. Model/demonstrate the behaviour

31. Agree behavioural contract

32. Prompt practice


34. Plan social support/social change



37. Stress management/emotional control training


39. Time management

40. General communication skills training

17

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).


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

18

(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.


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.


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.


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).

20


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.


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.


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.


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


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).


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).


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).


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]).

22

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.

23

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”.


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.


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.


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.


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

Documents

Behaviour change techniques used in road safety - Cornwall · PDF fileTable 2 Behaviour change techniques used in Cornwall Council’s current ... A coding manual and tick list is