Table 3 BCTs identified within 287 trials of A&F interventions targeting practice change among healthcare professionals
Taxonomy clusters | BCTs | Frequency in treatment arms (N = 360) | Example from treatment arms | Frequency in control/comparator arms (N = 287) | Example from control/comparator arms |
|---|---|---|---|---|---|
1. Goals and planning | 1.1 ‘Goal setting (behaviour)’ | 46 | Avery et al. (2012): ‘Encourage the team to agree on an action plan with clear objectives’ [23] | 4 | Ornstein et al. (2004): ‘The medical director was encouraged to share the reports with others in the practice in order to stimulate motivation for improvement. The 90th percentile was selected as the performance target because it reflected a bold but achievable goal (at least 2 practices were at this level of performance at baseline)’ [24] |
Lemelin et al. (2001): ‘All practices were involved in meetings with the PF to identify opportunities for improvement, assess needs, and select priority areas and strategies for improving preventive care performance’ [25] | |||||
Ganz et al. (2005): ‘Assistance with an organizational strategy/goal meeting to review audit findings and select strategies’ [26] | |||||
Levi et al. (2020): ‘…sites setting own goals and interim targets for increasing tPA rate’ [27] | |||||
Harris et al. (2015): ‘…each practice reviewed their performance and set and reviewed goals specific to their individual circumstances and resources’ [28] | |||||
1.2 ‘Problem-solving’ | 76 | Curtis et al. (2011): ‘Meetings with local champions allowed us to discuss barriers to quality end-of-life care in their units and strategize about ways to address those barriers’ [29] | 7 | Kaminski et al. (2016): ‘Discussion on barriers and solutions to improve ADR (adenoma detection rate)’ [30] | |
1.3 ‘Goal setting (outcome)’ | 6 | Ivers et al. (2013): ‘The worksheet was designed to facilitate goal-setting’ [31] | 2 | Goderis et al. (2010): ‘Targets were set at 7% for HbA1c, 130 mmHg for SBP and 100 mg/dl for LDL-C’ [32] | |
Roos-Blom et al. (2019): ‘Finally participants set their own, internal targets guided by the information presented to increase target’ [21] | |||||
1.4 ‘Action planning’ | 30 | Foy et al. (2004): ‘Immediately after, a brief meeting took place with lead consultants and other key individuals to formulate a local action plan’ [33] | 3 | Verstappen et al. (2003): ‘The next step was to try to implement the guidelines in their own practice, and at the end of each session, plans were drawn up for change, both at individual and group level. Subsequent meetings were used to evaluate whether targets had been met’ [34] | |
Kennedy et al. (2015): ‘An action plan worksheet was completed/updated at each educational meeting, which outlined specific tasks and steps for implementing process/ policy changes’ [35] | |||||
Hogg et al. (2008): ‘Based on the practice’s care goals and their choice of tools, a plan or strategy was agreed upon with the facilitator for reaching the proposed goals’ [36] | |||||
1.5 ‘Review behaviour goal(s)’ | 8 | Gude et al. (2016): ‘Next, the team discussed and reflected upon their most recent feedback report and created or updated their QI plan’ [37] | 0 | N/A | |
Palmer et al. (1985): ‘At a staff meeting 3 months after evaluation findings had been discussed, department chiefs were asked to review the report of actions planned to improve care and to check progress in implementing these plans’ [38] | |||||
1.6 ‘Discrepancy between current behaviour and goal’ | 74 | Wiggers et al. (2017): ‘Reports included comparison against target benchmarks’. [39] | 13 | Mold et al. (2008): ‘Benchmark rates (90th percentiles) were determined from clinician audits done as part of another study done in the previous year that involved 50 network clinicians’ [40] | |
1.9 ‘Commitment’ | 5 | Gascón Cánovas et al. (2009): ‘…committed themselves to perform a complete cycle of assessment and improvement’ [41] | 0 | N/A | |
Shen et al. (2018): ‘The public commitment asked each of the participating village doctors in the intervention group to sign a letter of commitment and made the signed letter public by posting it on the walls of his or her clinic and printing it on the back of the patient takeaway information leaflet’ [42] | |||||
2. Feedback and monitoring | 2.0 ‘Feedback (unspecified)’ a | 4 | Yano et al. (2008): ‘Each practice also received quarterly audit-and-feedback progress reports’ [43] | 1 | Yano et al. (2008): ‘…received audit-and-feedback reports’ [43] |
Bahrami et al. (2004): ‘Group 2 participated in Audit and Feedback (A and F)… The exact nature of the A and F was decided within each audit group’ [44] | |||||
Scales et al. (2016): ‘Audit-feedback using monthly enrolment reports of site-specific data compared with anonymous data from other hospitals’ [45] | |||||
2.1 ‘Monitoring of behaviour by others without feedback’ | 9 | Wang et al. (2018): ‘The intervention cluster’s investigators or quality coordinator have access to view the level of implementation of predefined performance measures at any time (recommended once per week) and compare with previous performance and with performance by other clusters (not identified by name)’ [46] | 12 | Boet et al. (2018): ‘The control group had their performance audited, but no feedback was provided as per current hospital practice’ [47] | |
2.2 ‘Feedback on behaviour’ | 320 | Katz et al. (2004): ‘… group and confidential individual feedback on whether intake clinicians had assessed smoking status and whether they had provided cessation counseling’ [48] | 67 | Siriwardena et al. (2002): ‘Control practices undertook baseline data collection and received written feedback on their vaccination rates compared with other participating practices’ [49] | |
2.3 ‘Self-monitoring of behaviour’ | 18 | Clyne et al. (2015): ‘GPs were asked to conduct 1 review per patient using the web-based platform to guide them through the process’ [50] | 5 | Bonevski et al. (1999): ‘…to complete the practitioner checklist’ [51] | |
Buffington et al. (1991): ‘Physicians and their staffs were asked to record all influenza immunizations given to patients aged 65 years or older, to tabulate on a weekly basis the cumulative total, and to calculate the percentage of the target population immunized’ [52] | |||||
Nace et al. (2020): ‘an active monitoring sheet designed to improve identification and documentation of signs and symptoms associated with the diagnosis of UTIs’ [53] | |||||
2.4 ‘Self-monitoring of outcome(s) of behaviour’ | 1 | von Lengerke et al. (2019): ‘2.4 Self-monitoring of outcome(s) of behaviour, e.g. presentation of compliance rates and discussion of options for monitoring on wards’ [54] | 1 | von Lengerke et al. (2019): ‘2.4 Self-monitoring of outcome(s) of behaviour, e.g. presentation of compliance rates and discussion of options for monitoring on wards’ [54] | |
2.5 ‘Monitoring of outcome(s) of behaviour without feedback’ | 0 | N/A | 2 | Crotty et al. (2004): ‘Medication charts were reviewed for prescription and administration of any psychotropic and/or antihypertensive medication and use of aspirin or warfarin. Information was also collected on the number of falls and injurious falls in the last 12 months from incident report forms at each facility’ [55] | |
2.7 ‘Feedback on outcome(s) of behaviour’ | 57 | Boet et al. (2018): ‘The benchmarked feedback group had their performance audited and monthly benchmarked feedback was provided by email. Feedback included their individual performance outcomes’ [47] | 17 | Harris et al. (2013): ‘…summary chart audit data were presented and individual practice-specific “report cards” distributed’ [56] | |
Hermans et al. (2013): ‘The benchmarking procedure comprised feedback given to each investigator regarding the level of control of the preset targets of their patients’ [57] | von Lengerke et al. (2019): ‘2.7 Feedback on outcome(s) of behaviour, e.g. feedback on hospital-wide NI rates’ [54] | ||||
3. Social support | 3.1 ‘Social support (unspecified)’ | 41 | Bregnhøj et al. (2009): ‘Afterwards, the GPs were contacted by telephone by a senior clinical pharmacologist (JS) to discuss any uncertainties concerning the recommendations given…’ [58] | 5 | von Lengerke et al. (2019): ‘3.1 Social support (unspecified), e.g. identification and forwarding of employees’ ideas for improvement’ [54] |
Campbell et al. (2006): ‘Facilitators attempted to maintain phone contact with clinics at least once a month for as long as these contacts seemed useful’ [59] | |||||
3.2 ‘Social support (practical)’ | 88 | Harris et al. (2015): ‘Trained practice facilitators visited and met with practice staff (for at least three 1–2 h) to develop and support the implementation of a plan to improve the prevention of vascular disease in the practice population’ [28] | 11 | Ayieko et al. (2019): ‘…peer to peer networking through twice yearly meetings and a simple WhatsApp group’ [60] | |
3.3 ‘Social support (emotional)’ | 5 | von Lengerke et al. (2019): ‘3.3 Social support (emotional), e.g. active listening in feedback discussions to evoke reflection on balancing benefits and costs’ [54] | 0 | N/A | |
4. Shaping knowledge | 4.0 ‘Education (unspecified)’ a | 112 | Mertens et al. (2015): ‘At 6 months, clinics received a 30-min “booster” training’ [61] | 28 | Beeckman et al. (2013): ‘The standard protocol was presented by the senior nurse in a standardized 30 min group lecture (attended by all members of nursing staff)’ [62] |
Zwar et al. (1999): ‘An educational visit was undertaken with those trainees who at survey 2 were prescribing an antibiotic on more than one occasion for every ten URTI problems managed’ [63] | |||||
Ferguson et al. (2003): ‘Sites were informed that they may periodically receive supplemental educational reports in addition to the standard site-specific semi annual reports’ [64] Scholes et al. (2006): ‘This was accompanied by notification of a new guideline on the intranet guideline homepage… The posting included a summary of supporting evidence’ [65] | |||||
Gude et al. (2016): ‘Educational outreach visits were conducted by one and typically lasted 2.5 h’ [37] | |||||
Kaboré et al. (2019): ‘Quarterly educational outreach visits’ [66] | |||||
4.1 ‘Instruction on how to perform the behaviour’ | 255 | Awad et al. (2006): ‘They also received written specific recommendations for improvement according to their baseline prescribing quality levels’ [67] | 77 | Ayieko et al. (2019): ‘Clinicians in all hospitals were also supplied with updated protocol booklets that contained information on the new pneumonia guidance including specific pneumonia algorithms articulating the key clinical signs and how these are to be used in classification together with dosage tables for oral amoxicillin’ [60] | |
DeVore et al. (2015): ‘For this study, the control hospitals continued to receive access to the usual on-demand reports, GWTG-HF quality improvement tools, and publicly available GWTG-HF webinars’ [68] | |||||
4.2 ‘Information about antecedents’ | 1 | Carney et al. (2012): ‘Module 3 presented information on the possible impact of medical malpractice concerns on recall rates’ [20] | 0 | N/A | |
4.4 ‘Behavioural experiments’ | 2 | von Lengerke et al. (2019): ‘4.4 Behavioural experiments, e.g. Fluorescence behaviour training by fluorescence methods using ultraviolet light boxes’ [54] | 0 | N/A | |
5. Natural consequences | 5.1 ‘Information about health consequences’ | 66 | Brunette et al. (2015): ‘Topics included facts about nicotine dependence in people with mental illness, nicotine withdrawal’ [69] | 11 | Abgrall et al. (2015): ‘We sent to all participating centers (including those in the simple information arm) a letter reminding them of the importance of adequate CKD management in people living with HIV’ [70] |
Bregnhøj et al. (2009): ‘The meeting included background information on the causes and consequences of polypharmacy, areas of concern in the treatment of the elderly and group discussions on patient cases’ [58] | |||||
5.2 ‘Salience of consequences’ | 3 | Hallsworth et al. (2016): ‘Public health catastrophe’ [71] | 1 | Hallsworth et al. (2016): ‘Public health catastrophe’ [71] | |
Soleymani et al. (2019): ‘The first page expresses the purpose of providing feedback and interpreting the colors used in the report and the importance of improving the situation of irrational prescribing signed by secretary of the committee’ [72] | |||||
5.3 ‘Information about social and environmental consequences’ | 18 | Balas et al. (1998): ‘The clinical direct reports combine center specific information or practice patterns with the latest published evidence on the efficacy and cost of various dialysis modalities’ [73] | 5 | von Lengerke et al. (2019): ‘5.3 Information about social and environmental consequences, e.g. knowledge transfer on economic consequences of Nis’ [54] | |
5.6 ‘Information about emotional consequences’ | 1 | von Lengerke et al. (2019): ‘5.6 Information about emotional consequences, e.g. knowledge transfer on psychological consequences of Nis’ [54] | 1 | von Lengerke et al. (2019): ‘5.6 Information about emotional consequences, e.g. knowledge transfer on psychological consequences of Nis’ [54] | |
6. Comparison of behaviour | 6.1 ‘Demonstration of the behaviour’ | 21 | Gilkey et al. (2019): ‘…used video vignettes to demonstrate strategies for communicating with parents about HPV vaccination’ [74] | 4 | Buntinx et al. (1993): ‘During this period all 183 study doctors were provided with a copy of an article with photographs on the correct technique for obtaining cervical smears with different instruments’ [75] |
Kaminski et al. (2016): ‘Demonstration of colonoscopy withdrawal videos (inappropriate fold inspection, inadequate bowel distension, inappropriate suctioning technique)’ [76] | |||||
6.2 ‘Social comparison’ | 190 | Ayieko et al. (2019): ‘Hospital performance in comparison with anonymized performance information of other hospitals’ [60] | 40 | Ayieko et al. (2019): ‘Each hospital’s performance compared to its own performance in the preceding period and also compared anonymously to other network hospitals’ [60] | |
6.3 ‘Information about others’ approval’ | 3 | von Lengerke et al. (2019): ‘6.3 Information about others’ approval, e.g. reflection of perceived recognition by superiors for compliance as assessed in survey’ [54] | 1 | Hallsworth et al. (2016): ‘Many practices are already taking action…’ [71] | |
7. Associations | 7.1 ‘Prompts/cues’ | 83 | Hocking et al. (2018): ‘A computer alert prompting testing of eligible patients’ [77] | 14 | Pape et al. (2011): ‘Automated DM-related point-of-care prompts’ [78] |
8. Repetition and substitution | 8.1 ‘Behavioural practice/rehearsal’ | 9 | Cundill et al. (2015): ‘The final module was aimed at sustaining the change in practice by using challenging role-plays to practice integration of RDTs and demonstrate the capacity to problem solve a RDT logistical challenge’ [79] | 2 | Harris et al. (2013): ‘Hands-on experience with an insulin pen’ [56] |
8.2 ‘Behaviour substitution’ | 2 | Hürlimann et al. (2015): ‘The main focus of the guidelines was to restrict prescriptions to bacterial infections and to preferentially prescribe narrow-spectrum antibiotics, namely penicillins for RTIs and trimethoprim/sulfamethoxazole for uncomplicated lower UTIs’ [80] | 0 | N/A | |
8.6 ‘Generalisation of target behaviour’ | 1 | von Lengerke et al. (2019): ‘8.6 Generalisation of target behaviour, e.g. transfer of problem-solving approaches across indications’ [54] | 1 | von Lengerke et al. (2019): ‘8.6 Generalisation of target behaviour, e.g. transfer of problem-solving approaches across indications’ [54] | |
8.7 ‘Graded tasks’ | 4 | von Lengerke et al. (2019): ‘8.7 Graded tasks, e.g. focusing on individual indications such as before aseptic procedures’ [54] | 0 | N/A | |
9. Comparison of outcomes | 9.1 ‘Credible source’ | 149 | Chaillet et al. (2015): ‘… provided by certified instructors from the Society of Obstetricians and Gynaecologists of Canada’ [81] | 34 | Wells et al. (2000): ‘For usual care, clinic medical directors were mailed the Agency for Healthcare Research and Quality depression practice guidelines, with quick reference guides for clinicians’ [82] |
9.2 ‘Pros and cons’ | 1 | von Lengerke et al. (2019): ‘9.2 Pros and cons, e.g. discussing effects of compliance and noncompliance’ [54] | 1 | von Lengerke et al. (2019): ‘9.2 Pros and cons, e.g. discussing effects of compliance and noncompliance’ [54] | |
10. Reward and threat | 10.1 ‘Material incentive (behaviour)’ | 7 | Petersen et al. (2013): ‘Intervention group participants received up to five incentive payments in their paychecks approximately every four months and were notified each time a payment was posted’ [83] | 1 | Navathe et al. (2020): ‘The third column presents in blue the number of dollars earned per measure’ [84] |
10.2 ‘Material reward (behaviour)’ | 7 | Fairbrother et al. (1999): ‘Physicians assigned to the bonus and feedback group were eligible to receive financial bonuses based on patients' up-to-date coverage for DTP and Haemophilus influenzae type b (Hib), OPV, and MMR’ [85] | 0 | N/A | |
10.4 ‘Social reward’ | 6 | Fuller et al. (2012): ‘If compliance was 100%, the staff member was praised’ [86] | 1 | Houston et al. (2015): ‘For ongoing facilitation, our study team completed a total of six proactive booster facilitation calls (approximately 15–30 min)… reinforcing success’ [87] | |
10.5 ‘Social incentive’ | 2 | Mertens et al. (2015): ‘Incentives to conduct SBIRT were limited to clinic recognition in the quality feedback reports (see “quality feedback reports” above) for high performing clinics’ [61] | 0 | N/A | |
10.8 ‘Incentive (outcome)’ | 1 | Navathe et al. (2020): ‘Primary care providers were each eligible for $75 three and six months after enrollment in the program if the patient’s hemoglobin A1c went down by at least 0.5 points from baseline or achieved a value of 9.0 or lower’ [84] | 0 | N/A | |
12. Antecedents | 12.1 ‘Restructuring the physical environment’ | 7 | Bonds et al. (2009): ‘…making structural changes to the clinic to improve blood pressure control’ [88] | 1 | Huis et al. (2013): ‘Facilities and products—screening and if necessary, adapt products and appropriate facilities [relating to hand hygiene]’ [89] |
12.2 ‘Restructuring the social environment’ | 69 | Baldwin et al. (2010): ‘Selected staff from each intervention home were designated as infection control link workers, their role being to reinforce all aspects of good infection control throughout the study’ [90] | 9 | Lakshminarayan et al. (2010): ‘Clinical opinion leader recruitment in all hospitals’ [91] | |
12.5 ‘Adding objects to the environment’ | 59 | Kennedy et al. (2015): ‘Process Indicator Checklist: This tool assists teams with creating internal processes and policies that support and sustain appropriate prescribing and other osteoporosis and fractures best practices (e.g., admission/quarterly assessment, diagnoses documentation, ongoing staff education and training)’ [35] | 10 | Kennedy et al. (2015): ‘The tool-kit includes: the 10-min DVD (“Meeting the Challenge of Osteoporosis and Fracture Prevention”), informational pocket cards, case studies, and posters’ [35] | |
13. Identity | 13.1 ‘Identification of self as role model’ | 1 | von Lengerke et al. (2019): ‘13.1 Identification of self as role model, e.g. illustration and discussion of the function of role models in hand hygiene compliance’ [54] | 0 | N/A |
13.2 ‘Framing/reframing’ | 1 | von Lengerke et al. (2019): ‘13.2 Framing/Reframing, e.g. raising the issue of compliance as a team task (team cooperation)’ [54] | 0 | N/A | |
14. Scheduled consequences | 14.6 ‘Situation-specific reward’ | 1 | von Lengerke et al. (2019): ‘14.6 Situation-specific reward, e.g. certification of ward with highest compliance with the trial’ [54] | 0 | N/A |
15. Self-belief | 15.1 ‘Verbal persuasion about capability’ | 1 | von Lengerke et al. (2019): ‘15.1 Verbal persuasion about capability, e.g. discussion of positive compliance development’ [54] | 1 | von Lengerke et al. (2019): ‘15.1 Verbal persuasion about capability, e.g. discussion of positive compliance development’ [54] |
15.3 ‘Focus on past success’ | 1 | von Lengerke et al. (2019): ‘15.3 Focus on past success, e.g. discussion of best year’ [54] | 1 | von Lengerke et al. (2019): ‘15.3 Focus on past success, e.g. discussion of best year’ [54] |