Skip to main content

Table 4 BCTs - definitions, examples, frequency and association with intervention outcomes

From: Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

BCT Definitiona Example No. used in very promising intervention No. used in quite promising interventions No. used in not promising interventions Total no. of times used across all interventions Promise ratio
Feedback on behaviour Monitor and provide informative or evaluative feedback on performance of the behaviour (e.g. form, frequency, duration, intensity) “presented local pre-test prescribing in comparison
with overall pre-test data and qualitative data on factors influencing antibiotic prescribing behaviour.” [59]
5 3 1 9 8
Discrepancy between behaviour and goal Draw attention to discrepancies between a person’s current behaviour (in terms of the form, frequency, duration, or intensity of that behaviour) and the person’s previously set outcome goals, behavioural goals or action plans (goes beyond self-monitoring of behaviour) “individualized direct feedback regarding specific instances when inappropriate urine cultures were sent and when ASB was treated” [71] 4 0 0 4
Instruction on how to perform the behaviour Advise or agree on how to perform the behaviour (includes ‘Skills training’) ““a 60-min presentation summarizing treatment recommendations” [69] 7 7 4 18 3.5
Information about health consequences Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour “education was provided regarding the potential adverse effects of unnecessary antibiotic use, including promotion of antibiotic resistance,” [71] 2 2 1 5 4
Prompts/cues Introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour. The prompt or cue would normally occur at the time or place of performance “Posters and other promotional material such as bookmarks were also distributed” [65] 2 5 0 7
Monitoring of behaviour by others without feedback Observe or record behaviour with the person’s knowledge as part of a behaviour change strategy “pharmacists did not interfere with antibiotic prescribing, but collected data on antibiotics prescribed, duration of therapy, laboratory tests, signs and symptoms of infection, and culture and sensitivity results” [67] 0 2 0 2
Demonstration of the behaviour Provide an observable sample of the performance of the behaviour, directly in person or indirectly e.g. via film, pictures, for the person to aspire to or imitate (includes ‘Modelling’). “stimulated interactions between the participants” [60] 1 3 0 4
Adding objects to the environment Add objects to the environment in order to facilitate performance of the behaviour “the introduction of the RAMP antimicrobial stewardship tool” [65] 4 6 3 13 3.33
Problem solving Analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators “prompted to … identify barriers to implementation, to develop strategies for addressing those barriers, and to discuss and clarify their role in implementation” [56] 0 2 2 4 1
Material incentive (Behaviour) Inform that money, vouchers or other valued objects will be delivered if and only if there has been effort and/or progress in performing the behaviour (includes ‘Positive reinforcement’) “the intervention facilities were paid an additional
$1000 each year during the 2 intervention years to incentivize guideline compliance” [53]
0 1 0 1
Social support (practical) Advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour “the providers were given a telephone number for both the infectious diseases physician on call and the antibiotic stewardship pharmacist. They were informed that this number could be called 24 h a day 7 days a week for any infectious disease related questions” [69] 3 3 0 6
Restructuring the social environment Change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) “The homes identified a study liaison nurse who was the facility’s change agent for the study” [53] 2 5 1 8 7
Self-monitoring behaviour Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy “We asked the nurses to complete a one page log of presenting symptoms and signs for every resident in whom urinary tract infection was suspected, as a reminder to use the algorithms.” [23] 2 2 0 4
Self-monitoring outcomes of behaviour Establish a method for the person to monitor and record the outcome(s) of their behavior as part of a behavior change strategy “results of specimens/swabs or ‘not available yet’ or ‘none taken’ recorded; outcome of antibiotic treatment documented” [65] 0 1 0 1
Feedback on outcome(s) of behaviour Monitor and provide feedback on the outcome of performance of the behaviour “use of antibiograms” [69] 1 0 2 3 0.5
Credible source Present verbal or visual communication from a credible source in favour of or against the behaviour “The LID consultation service consisted of an infectious disease physician and nurse practitioner” [57] 7 3 2 12 5
Review behaviour goals Review behaviour goal(s) jointly with the person and consider modifying goal(s) or behaviour change strategy in light of achievement. This may lead to re-setting the same goal, a small change in that goal or setting a new goal instead of (or in addition to) the first, or no change “the identification of opportunities for improved practice (i.e. planning action)” [59] 0 0 1 1
Restructuring the physical environment Change, or advise to change the physical environment in order to facilitate performance of) the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments “Change to default stop dates for some antibiotics - simplified access to guidelines on computers” [62] 0 2 0 2
Shaping Knowledge This is the cluster heading for BCTs that serve an educational purpose in the taxonomy “Residents, their family members, and other NH staff received an informational brochure related to antibiotic prescribing and the QI program, and many attended family night gatherings or a resident council meeting or health fair where this information was presented” [64] 1 1 0 2
  1. BCT Behavioural Change Technique, No. Number
  2. aDefinitions from [42].