Researchers in UCL have developed a reliable method that provides psychologists with an agreed language to report the content of their interventions, that is, their ‘active ingredients’. Behaviour change techniques (BCTs) are the smallest components of behaviour change interventions that on their own in favourable circumstances can bring about change. The Behaviour Change Technique Taxonomy project (2010-2013), funded by the UK’s Medical Research Council led to the development of a consensually agreed, reliable taxonomy of 93 BCTs that can be used across behaviours, disciplines and areas of interest (e.g. health, the environment).
Recently Eimear Morrissey and Teresa Corbett attended a conference that led to a discussion about the concept of behaviour change techniques (BCTs). They were eating cake at the time and so, what emerged was an intricate metaphor of their understanding of what BCTs are and why it is important to recognize key ingredients in behavior change interventions.
Baking and intervention development both demand accuracy and care. The wrong ingredient or a wonky whisk can hamper the process. This is why recipes are so detailed. You cannot improvise or substitute ingredients without understanding the function of the ingredient in the mix. Likewise, behaviour change must be reported with sufficient detail to allow for replication. So we’ve written this blog to share our BCT-cake analogy…
- Copy from a recipe: It would be very difficult to imagine coming up with a recipe from scratch. Likewise with behavior change interventions, before we start it is important to identify BCTs used in previous similar interventions. This allows us to get a taste for what already exists so that we can see if we think we can add anything new to the mix.
- Note any changes you make to the recipe for future reference. We might decide to add in a dash of something new because we think it might add a new flavor to our intervention, but we need to be able to identify these ingredients so we can replicate the recipe later, or if we want to compare it to the original.
- Read your recipe carefully before starting: In developing our intervention, we need to be able to plan and understand the process we are about to engage in. We need to sure that we have the appropriate skills and tools to deliver the intervention and to apply the BCTs effectively and efficiently.
- Measure the quantities correctly: This is a baking must! One common reporting failure is not adequately reporting the “dose” of each intervention component. You can use the best and clearly described ingredients in the world, but if you do not give an indication of how often each BCT was used in an intervention, the intervention may not be replicated properly. For example, one spoon of goal setting could produce a different cake than if we had heaped in four or five sessions of goal setting! While this is important to note in intervention development, the current BCT coding standard does not allow for it when reporting an intervention– i.e. you only code a BCT once no matter how many times it was used. Perhaps these coding standards could learn something from baking?
- Mix Carefully: Each type of baking (and behavior change intervention) has different methods of mixing the ingredients. Perhaps research on your area of behavior change has shown that some BCTs work well together for a certain type of intervention, but others do not work so well together when combined.
- It’ not the amount of ingredients, it’s how they combine: Some cakes are super simple, with only three or four ingredients… and they can still be delicious! Some would even argue that the simple things are better! However, other cakes might involve complex interactions of numerous active ingredients and might be equally as tasty or just might work better for some people in some contexts. In intervention development, depending on the target group and behaviour, some complex behaviours may require clusters of BCTs to be used, whereas other interventions might work best with just one or two.
- How long do we cook for?: How long do you leave the cake in the oven? These are important things to consider in baking, and also in the development of behavior change interventions. It is important to identify how long your intervention (and each stage of it) should last for optimum delivery.
- Timing of each ingredient?: Do some ingredients cook for longer? Do we let it set and come back later and add something else? Sometimes we add a certain ingredient at the end of baking (for example adding the cream on top after the base of the cake has cooked). This makes sense because if we just threw everything in the mix at the same time the recipe would not work out properly. With behavior change interventions, we must consider the timing of each aspect of our intervention. Maybe it makes more sense to get someone to set goals at the beginning of an intervention before we review those goals. Outlining when each BCT is used is crucial to our behavior change recipe.
- Presentation We’re visual creatures, and nothing whets our appetite more than a yummy looking treat! It attracts us, entices us and makes us want to have a taste. Although your behavior change intervention may be delicious in terms of ingredients and scientific content, its not much good if it looks unappetizing. You might choose to deliver your intervention online, or using a manual or using an app, or in person… make sure it looks and feels inviting !
- Sharing our recipe or charging for our secret recipe? If it’s a nice cake and we’re happy with it… Do we market it and sell it so that we can use any profit to continue to test and refine our recipe? Or would it be unethical of us to charge people for a taste of our intervention? Should we let everyone have open access to our recipe so that they can also refine our intervention… the hope of developing the most delectable treat possible?
Hopefully this will add to your understanding of BCTs and why they are useful… and you’ll be cooking up a storm in no time!! Check out the Health Behaviour Change Research Group here at NUIG for more information on behaviour change interventions.