A taxonomy of behavior change methods: an Intervention Mapping (Kok et al., 2016)
Introduction
Taxonomies: well-suited for intervention coding, not a good basis for intervention development.
Whereas taxonomies for coding interventions generally consists of descriptions of BCTs, taxonomies for
developing interventions need to acknowledge a number of additional aspects of the dynamics of
behavior change.
1. The selection of behavior change methods should include a careful match with determinants that
they can in fact change;
2. A precursor to intervention development should assure that these determinants indeed predict
the relevant behavior;
3. When change methods are applied, the parameters for a method’s effectiveness must be
satisfied.
Origins, the dynamics of behavior change, and definitions of the proposed taxonomy
1. Conduct a needs assessment or problem analysis by identifying what, if anything, needs to be
changed and for whom;
2. Create matrices of change objectives by combining (sub-)behaviors with behavioral determinants
to identify which beliefs should be targeted by the intervention;
3. Select theory-based intervention methods that match the determinants into which the identified
beliefs aggregate, and translate these into practical applications that satisfy the parameters for
effectiveness of the selected methods;
4. Integrate the practical applications into an organized program;
5. Plan for adoption, implementation and sustainability of the program in real-life contexts by
identifying program users and supporters and determining what their needs are and how these
should be fulfilled;
6. Generate an evaluation plan to conduct effect and process evaluations to measure program
effectiveness.
Determinants
In the case of behavior change, it is necessary to understand why people engage (or do not engage) in the
behavior of interest. These reasons, as far as they exist within an individual are: ideas, cognitions,
emotions, beliefs processes or automatic processes.
Two levels for such reasons:
- The lowest level: containing the individual thoughts, emotions, automatic associations, or
elements of a process.
- Aggregate level: where similar and related thoughts, emotions, automatic associations and
process elements exist aggregated in so-called ‘determinants.
This aggregation is based on functional similarity; attitudinal beliefs have a similar structure and influence
behavior similarly; beliefs underlying self-efficacy are also similar but different. Behavioral determinants
are generic aggregates of beliefs, which instead are specific to behavior population and context.
Beliefs are often defined to be similar to reasons for behavior. Beliefs can also be elements of a process,
and therefore, determinants can also be processes. Determinants are defined generically and cannot be
targeted directly.
For any behavior change method, it must be clear which belief(s) are targeted (and into which
determinant(s) these beliefs aggregate). It is very common in descriptions of behavior change
interventions in the scientific literature to include no, or only cursory, descriptions of the determinants
targeted by the intervention.
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,Theory-based methods for change
Theory-based methods (behavior change methods): general techniques or processes that heave been
shown to be able to change one or more determinants of behavior of members of the at-risk group or of
environmental decision-makers.
General methods are studies for influencing generic determinants, that in turn are supposed to influence
the behavior.
- The generic nature of these determinants and the methods to change them is consistent with
psychologists’ aim to study human behavior and psychology in general; yet that means that such
methods can’t immediately be applied in behavior change interventions.
Practical applications
Practical applications: specific translations of theory-based methods for practical use in ways that fit the
intervention population and the context in which the intervention will be conducted.
- Specifying the mode of delivery would not suffice to describe the application: the exact content
of group discussion protocols or a recording are also part of the application.
To achieve the change objective, theory-based methods might include modelling, guided practice with
feedback and reinforcement.
- The same method can be translated into a myriad of possible applications depending on the
specific population and context.
- Often in the end translating these methods to actual materials and messages are often missing
necessary methods.
Parameters for methods
Translating methods into practical applications demands a sufficient understanding of the theory behind
the method, especially the theoretical parameters under which the theoretical process is effective or not.
- If a practical application embodies a given theoretical method but violates one or more
parameters of effectiveness of that method, it will be less effective or may even be counter
effective.
- All parameters have to be taken into account when translating a method into a practical
application.
This illustrates the importance of distinguishing between theoretical methods of behavioral change
practical applications.
Methods at environmental levels: an ecological approach
Most taxonomies focus on individual behavior change and only a few also include behavior change of
environmental agents.
Various environmental levels: interpersonal, organizational, community and societal levels.
To select methods for changing environmental conditions, the first things to do is to find out who may be
in a position to make the expected change.
- The health promoter then applies methods for influencing the determinants of the agent’s
behavior using methods which are appropriate for changing determinants at environmental
levels.
- Because environmental change always requires human agency, methods at the individual level
can also be used for agents at higher ecological levels.
The potential effect on the image of and profit for the company are typical organizational level
arguments.
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, A taxonomy of behavioral change methods
Behavior change methods
Individual behavior change is almost always embedded in one or more environmental levels and that
methods for individual change need to be complemented with methods for change at those
environmental levels.
Methods described for one determinant may sometimes be used for other determinants as well.
Origins of the definitions
IM originated in response to questions by students how to use theory in intervention development.
Together with the definitions we provide the parameters for use: the conditions under which the theory-
based method will be effective.
Evidence base underlying these tables
The first column of these tables includes a reference to literature syntheses that discuss the method’s
effectiveness and the identified parameters that moderate this effectiveness.
The four conditions for a method to effectively influence behavior:
1. A method can only influence behavior if it targets beliefs that underlie a determinant that the
method can change;
2. These beliefs (and the overarching determinant) must in fact be relevant predictors of the
behavior;
3. The method must be translated into a practical application that fits with the target population, its
culture, and the relevant context;
4. The parameters for effectiveness of the method must be satisfied in the final application.
How to use the tables
This description assumes that the intervention developer has identified which behavior to change, and
whose behavior this is. It also assumes that the relevant determinants and underlying beliefs have been
identified.
- For each potential method, inspect the definition and the parameters to determine whether the
method is applicable given the situation. Then, use the references included in the tables to
study the relevant literature, and use bibliographic databases to locate more recent literature.
Repeat these steps for all determinants, until methods have been identified to target all
determinants and beliefs. Then, translate these methods into practical applications, making
sure that the parameters for effectiveness are respected.
When selecting methods to target environmental agents, the process is similar.
Discussion
Development versus coding taxonomies
In the same way that coding taxonomies are unfit for intervention development, the taxonomy we just
described is unfit for coding in its current form.
- Instruments for intervention development have to acknowledge, and provide a procedure for
dealing with, the dynamics of behavior change as explained above;
- Instruments for intervention coding have to provide clear, mutually exclusive definitions and
categories that are optimized for reliable coding.
A consequence is that in development taxonomy, methods may very in their level of specificality and may
even encompass each other.
These differences mean that there is still work to be done to integrate these two approaches.
Coding with a taxonomy that both acknowledges the dynamics of behavior change and provides mutually
exclusive, reliably applicable categories has clear advantages. Such a coding procedure would yield not
only a list of behavior change methods used in an intervention, but a description of targeted determinants
behavior change methods matched to those determinants, parameters for effectiveness for those
methods, and the applications that together make up the intervention.
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