Impact case study database

The development of a standardised, shared classification system to describe the complex interventions used to tackle behaviour change is key to translating scientific knowledge into improved public health. The research by Aberdeen and UCL has transformed the field of behavioural science by creating a new and shared standard to report behavioural change techniques, which has been widely implemented resulting in more effective practice. The team has developed new training resources to help healthcare practitioners – both in the UK and overseas – to understand and use the new standard. The research has also influenced techniques for behavioural change beyond healthcare, specifically underpinning developments in food and transport safety.

The blueprint for ‘gold standard’ design and reporting of behavioural change interventions

The creation of the BCTTv1 by UCL and University of Aberdeen [ S1] represented the first-of-its-kind taxonomy to universally describe the component blocks of behaviour change interventions, enabling more effective identification and reporting of behavioural change techniques via a common language. The value of the taxonomy is reflected in its adoption by NICE in January 2014 as an example of how to provide a clear definition of the behaviour change techniques used so that each component can be replicated, ensuring consistency of approach to behaviour change interventions within public health guidelines [ S2].

Changing professional training for healthcare providers

BCTTv1 has impacted the training and practice of healthcare professionals who implement behavioural change interventions, both in the UK and overseas. Workshops training UK healthcare professionals, policy makers, and others from both the public and private sectors in behavioural change interventions use the taxonomy as standard, including Public Health England and NICE, as well as a range of universities and CPD and other training providers. The researchers have created a MAP3 mnemonic [ R6] and ‘periodic table’ presentation [ S3i] of the taxonomy to develop a suite of free online training resources. To date over 10,000 people have accessed the online training, which over six sessions introduces users to BCTTv1 to practice identifying BCTs in different intervention descriptions [ S3ii-iv]. A smartphone app detailing each BCT and giving examples of how to implement these, launched in May 2014, to support professional training. Nearly 4,200 people have downloaded the app [ S3v-vi].

The 2018 Public Health Strategy “ Improving people’s health: Applying behavioural and social sciences to improve population health and wellbeing in England” identifies the BCT Taxonomy and associated free online training resources as “ Key frameworks and tools for public health practitioners” [ S4]. The taxonomy has also been used by Manchester Implementation Science Collaboration at the University of Manchester to create ‘Card for Change’, which present BCTTv1 as a deck of cards which can be used to play games that teach the taxonomy in a mobile and accessible way for low- and middle-income countries. Since 2019, over 1,000 decks of cards have been distributed to researchers, practitioners, health workers and educators across 25 countries in five continents. The developers of the cards said: “ We continue to use the BCTTv1 taxonomy/Cards for Change to make an impact in continuing professional development for health workers both in the UK and in low- and middle-income countries by training health professionals in using behaviour change to both design education and training” [ S5; S6i].

Specific examples of where the taxonomy has been incorporated into professional training for healthcare providers include:

NHS Scotland: Behavioural change training by NHS Education for Scotland is based on the MAP mnemonic and BCTTv1 [ S7i], chosen for “ more effective, pragmatic and evidence-based behavioural change training for NHS practitioners” [ S7ii]. This training is provided for all health and social care practitioners to enable behaviour change in the people for whom they care. Since 2015, over 2,500 NHS professionals have been trained using BCTTv1 across eleven of the fourteen Scottish health boards, including a wide range of health and social care professionals: clinicians working in primary and secondary care; dentists; pharmacists; and social care staff. More recently, BCTTv1 is the basis of a novel behaviour change training programme for Early Years staff, including nurses, nursery nurses, oral health practitioners, health visitors and midwives who work with young children, their parents and families. The programme is currently being piloted prior to national roll out across Scotland. Programme Lead for Health Psychology for NHS Education for Scotland said: “ The training using the taxonomy of behaviour change techniques has been robustly evaluated and shown a positive impact on practitioners’ knowledge, engagement with behaviour change and implementation in practice.” [ S7ii].

NHS England: A key priority in the UK and globally is to tackle the serious public health threat posed by antimicrobial resistance. The UK Government is running a 5-year (2019-2024) action plan to tackle this threat. Central to the strategy is the need to change risky behaviours by healthcare practitioners such as inappropriate antibiotic prescribing. The BCTTv1 taxonomy was at the heart of Health Education England training for healthcare practitioners on this need for behavioural change, which provided “ Practical training to apply behavioural science to antimicrobial stewardship” (2019-2020), at which 38 people were trained, who have in turn trained up to 300 colleagues [ S6i-ii].

The Change Exchange led by Manchester University used BCTTv1 to strengthen health partnerships in Africa by translating behavioural science in situ. In a case study from Uganda, BCTTv1 was used to review and code behaviour change therapies identified in the training of around 100 health professionals to further enhance interventions and assessment methods in obstetric care. The Global Health Unit administrator for the Royal College of Obstetrics and Gynaecology said: “ from our perspective it was like a piece of the puzzle that had been missing that we hadn’t realised and … it is a really fundamental part to the work that we are trying to do” [ S6i; S8i-ii].

Underpinning changes in safety-related behaviours

BCTTv1 has underpinned behavioural change in areas beyond health, particularly in food and transport safety. Safefood Ireland, the public body for food safety and healthy eating in the Republic of Ireland and Northern Ireland, used the BCTTv1 to underpin campaign strategy and design, as well as for training of communications and PR agencies producing those campaigns. Safefood Ireland has said of the taxonomy: “ it brings the security of applying best practice and a defensible way of working - based on all the research. We are practitioners….it is a ready-made tool that we can use with some security we are doing the right thing” [ S9; p9, Table 1; p12].

The 93 BCTs of BCTTv1 are central to a 2017 report commissioned by the RAC Foundation, “ Using Behaviour Change Techniques - Guidance for the Road Safety Community” [ S10i]. This report has been promoted by the charity, Roadsafe, and has influenced the development of behaviour change courses at the UK’s national road safety organisation, Road Safety GB. [ S10ii-iii]. BCTTv1 informed the DriveStart Programme, developed by road safety consulting organisation, Agilysis, to reduce risky decisions for novice young drivers and reduce the number of young lives that are lost due to motor vehicle accidents. DriveStart used BCTTv1 to code intervention content [ S11i-ii]. Head of Research at the RAC Foundation has said “ the BCTTv1 taxonomy has been of significant benefit to improving road safety activity in the UK, as it provides both an evidence based and practical approach for deliverers to engage with” [ S10ii]. BCTTv1 was used in designing one of five interventions for Driver2020, a part of the UK government’s The Road Safety Statement 2019 – A Lifetime of Road Safety, involving interventions in >14,000 young drivers to promote safety, confidence and skill in the first year of driving [ S11ii-iv].