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NIHR Behavioural Science Policy Research Unit (NIHR PRU)

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Principal InvestigatorProfessor Falko Sniehotta (Newcastle University)
Co-investigatorsProfessor Susan Michie (UCL),
Professor Eileen Kaner (Newcastle University),
Professor Ivo Vlaev (University of Warwick),
Professor Michael P. Kelly (University of Cambridge),
Professor Luke Vale (Newcastle University),
Professor Stephen Morris (UCL),
Ms Dawn Craig (Newcastle University),
Professor Paul Burton (Newcastle University),
Professor Clare Bambra (Newcastle University),
Dr Chris Bonell (London School of Hygiene and Tropical Medicine)
UCL team members

Dr Fabiana Lorencatto,
Dr Vivi Antonopoulou,
Dr Carly Meyer

Project start and end dates2019 - 2024
FunderNational Institute for Health Research
Project websiteWebsite: https://research.ncl.ac.uk/behscipru/
Twitter: @PRUBehaviourSci


Project aims

The aim of the PRU is to conduct interdisciplinary behavioural research to provide the Department of Health and Social Care (DHSC) with timely answers to key policy questions.

Specific objectives are to:

PRU Image
  1. conduct strategic analyses of how best to apply behavioural science to major policy areas;

  2. support the development of policies grounded in behavioural science/evidence;

  3. assess behavioural aspects of current policy to enable learning, identify opportunities for optimisation and to facilitate implementation;

  4. advise on the design of policy evaluations;

  5. address evidence gaps relevant to the needs of the DHSC;

  6. use behavioural science methods to identify effective and cost-effective interventions, including for whom interventions are effective in terms of key equality and diversity issues;

  7. engage with stakeholders to raise awareness of behavioural science utilisation in policy development, evaluation and implementation; and

  8. to achieve sustainability of the PRU and to develop capacity in interdisciplinary behavioural policy research.

 

Project details

BACKGROUND
Audit and feedback (A&F) is a type of behaviour change intervention that is commonly used to improve healthcare quality provision. Such types of interventions are typically complex, with lots of interacting components, and designed and delivered in many different ways and therefore outcomes of A&F interventions vary widely in their effectiveness (Ivers et al., 2012). It has not been very clear which components and design characteristics are contributing to this variability in effectiveness due to insufficient use of theory to design intervention components and to synthesise evidence (Colquhoun et al., 2013). Behavioural science has frameworks that can help disentangle this heterogeneity. The development of a comprehensive theory-linked taxonomy has provided a reliable method by which the content of behavioural interventions can be clearly specified and categorised (Abraham & Michie, 2008; Michie, Hyder, Walia, & West, 2011; Michie et al., 2013). Behaviour change techniques (BCTs) have been widely applied in systematic reviews to explore heterogeneity and identify active ingredients (Gardner, Whittington, McAteer, Eccles, & Michie, 2010; Presseau et al., 2015).

We aim to apply this framework to conduct a sub-analysis of interventions included in an updated Cochrane review of A&F interventions that is taking place simultaneously. Firstly, by capturing BCTs in intervention and control groups, this systematic review will highlight the most effective BCTs for behaviour change. Secondly, by applying a theory-based methodology to explore whether variation in A&F effectiveness can be explained by behaviour change techniques linked to theory-informed hypotheses, the outcomes of this review will provide useful information regarding the applicability of theory across different contexts and populations and how to design more effective A&F interventions.

RESEARCH QUESTIONS

  1. Which BCTs have been included in A&F interventions to improve healthcare professional practice?
  2. What is the association between individual and clusters of BCTs and intervention effectiveness?
  3. Are interventions containing theory-based combinations of BCTs more effective?


METHOD
As part of this Cochrane review update, we will seek to code and analyse all instances where behaviour change techniques (BCTs) have been used in the studies. Clarification of the ‘active ingredients’ from the interventions tested in the trials will help to identify which particular key components (and combinations of components) are associated with greater effectiveness. We will use the Behaviour Change Techniques Taxonomy v1, which describes 93 different techniques for changing behaviour, to guide our coding of BCTs. Using this established taxonomy may help support replication of effective A&F interventions. Trained extractors will use a BCT codebook with heuristics for coding different BCTs present in each study arm.

IMPLICATIONS
In summary, the current piece of research is part of a larger systematic review update that aims to optimise the impact of A&F interventions in healthcare settings. The intervening decade since the last A&F review has seen the development of relevant theory and synthesis methods that can help to answer fundamental questions on how to optimize A&F that can be readily implemented. An enhanced and updated evidence synthesis using state-of-the-art methods will help organizations avoid wastefully rehashing sub-optimal approaches.

 

Next steps
Data extraction and BCT coding are currently underway for approximately 330 A&F interventions.