Table 3 Behaviour change techniques in the intervention

Training day (core)

• Identification of self as a role model

Investigators were invited to attend a training day where the intervention was showcased and key behaviour change techniques to be communicated to their trainees were covered.

• Instruction on how to perform the behaviour

• Salience of consequences

• Action planning

• Credible source

• Identity associated with changed behaviour

Action planning meeting (core)

• Action planning

After attending the training day, investigators were asked meet to plan how best to implement the intervention package. This included actively scheduling the educational sessions and assigning personnel to keep the lumbar puncture boxes refilled.

• Goal setting

• Identification of selves as role models

• Problem solving

• Social support

• Commitment

• Review behaviour/outcome goal

Audit and feedback newsletter (core)

• Goal setting

A newsletter will be produced for local dissemination with personalised audit data which will be fed back to each hospital alongside a short clinical update.

• Discrepancy between current behaviour

• Information about others’ approval

• Salience of consequences

• Anticipated regret and goal

• Feedback on behaviour

Lumbar puncture box (core)

• Adding objects to the environment

A refillable box with all the key equipment to perform a lumbar puncture was provided with a page detailing sample collection [51] which could be locally modified as required.

• Instruction on how to perform the behaviour

• Conserving mental resources

• Restructuring the physical environment

• Habit formation

• Prompts/cues

• Action planning

Education (core)

• Persuasive communication

Pre-made lectures with the behaviour change techniques were produced for the following uses: A session aimed at foundation doctors on how to perform a lumbar puncture; A session for the entire department focused upon the management of suspected encephalitis; and a session for nurses on how to help with lumbar punctures. These materials can be locally modified with a core set of slides so preserve behaviour change integrity. Furthermore, these are all modified for use in both an adult and paediatric setting and can be used as often as required by the local team.

• Instruction on how to perform the behaviour

• Credible source

• Information about others’ approval

• Salience of consequences

• Demonstration of the behaviour

• Behavioural practice/ rehearsal

• Discrepancy between current behaviour and goals

• Anticipated regret

• Feedback on behaviour

• Action planning

• Problem solving

• Information about antecedents

• Social support

• Social reward

• Commitment

• Graded tasks

• Review behaviour/outcome goal

• Restructure the social environment

Quiz (optional)

• Action planning

An online multiple choice quiz was developed with tailored questions for doctors and nurses. This quiz can be used during educational sessions or within private study and all participants can download a certificate of completion.

• (Mental) behavioural practice/ rehearsal

• Credible source

• Discrepancy between current behaviour and goal

• Information about consequences

• Instruction on how to perform the behaviour

ClickClinica (optional)

• Conserving mental resources

An app was developed [52] as a tool for clinicians to quickly access up to date guidelines for all conditions. This has been promoted within our package both within the education and also within the personalized invitation letter as a useful tool.

• Instruction on how to perform the behaviour

• Credible source

• Behaviour substitution

• Habit formation

• Goal setting

• Information about antecedents and outcomes

• Personalised message

Encephalitis Society leaflets and video (optional)

• Social reward

The Encephalitis Society YouTube channel was included as a resource which could be incorporated into the education. Furthermore, patient leaflets will be disseminated to the investigators during the study.

• Credible source

• Habit formation

• Salience of consequences

Short audit (optional)

• Discrepancy between current behaviour and goal

A short audit featuring quality improvement cycles (plan, do, study, act PDSA) was developed and included a summary page with the key guideline recommendations along with a short list of key check box items to monitor current practice. An excel sheet which pre-plots the progress was included within the pack.

• Review behaviour goals

• Social comparison

• Anticipated regret

• Feedback on outcome of behaviour

• Self-monitoring of behaviour and outcomes

Basis of modifiable care pathway (optional)

• Conserving mental resources

The front sheet from the audit pack could also be modified to form the basis of a care pathway for suspected encephalitis patients. This will be locally driven and implemented at each site.

• Instruction on how to perform the behaviour

• Habit formation/reversal

• Monitoring of behaviour by others without feedback

• Information about others’ approval

• Restructuring the physical environment

Algorithm (optional)

• Action planning

The algorithm contained within the guidelines was reproduced with two additional features; a QR code which links directly to the guidelines and a box that contained details for local senior support. These were then laminated so that the local information could be updated as required.

• Adding objects to the environment

• Conserving mental resources

• Habit formation

• Identification of self as role model

• Prompts/cues

• Salience of consequences

Posters (optional)

• Action planning

Posters with key symptoms were designed and graphics covered paediatric, adults and geriatrics. Hospitals can request the number of these posters along with the display locations. Posters also contained a QR code which linked directly to the guidelines.

• Adding objects to the environment

• Conserving mental resources

• Habit formation

• Identification of self as role model

• Prompts/cues

• Salience of consequences

Stickers (optional)

• Anticipated regret

Small stickers with ‘Think brain infection’ were produced for application to blood sample bottles. These could be applied to any sample bottle as required by the hospital.

• Associative learning

• Conserving mental resources

• Habit formation/reversal

• Prompts/triggers/cues

Invitation letter (optional)

• Action planning

A template invitation letter from the consultant inviting the junior doctor to attend each of the education session was developed for local modification. Details of the lumbar puncture box and ClickClinica were also included.

• Behavioral contract

• Credible source

• Goal setting

• Information about emotional consequences

• Information about outcomes

• Personalised message