Applying the COM-B behaviour model and behaviour change wheel to develop an intervention to improve hearing-aid use in adult auditory rehabilitation

Figures & data

Figure 1. The COM-B model of behaviour.

Figure 2. The behaviour change wheel.

Table 1. Intervention function and policy category definitions from the BCW.

	Definition
Intervention function
Education	Increasing knowledge or understanding
Persuasion	Using communication to induce positive or negative feelings or stimulate action
Incentivization	Creating an expectation of reward
Coercion	Creating an expectation of punishment or cost
Training	Imparting skills
Restriction	Using rules to reduce the opportunity to engage in the target behaviour (or to increase the target behaviour by reducing the opportunity to engage in competing behaviours)
Environmental restructuring	Changing the physical or social context
Modelling	Providing an example for people to aspire to or imitate
Enablement	Increasing means/reducing barriers to increase capability (beyond education and training) or opportunity (beyond environmental restructuring)
Policy categories
Communication/marketing	Using print, electronic, telephonic, or broadcast media
Guidelines	Creating documents that recommend or mandate practice. This includes all changes to service provision
Fiscal measures	Using the tax system to reduce or increase the financial cost
Regulation	Establishing rules or principles of behaviour or practice
Legislation	Making or changing laws
Environmental/social planning	Designing and/or controlling the physical or social environment
Service provision	Delivering a service

Figure 3. System of behaviours relevant to hearing-aid use.

Table 2. Specification of the target behaviours.

Target behaviour	Who	What	When	Where
Provide realistic information on benefits of hearing-aid use	Audiologist	Give written info	During each fitting appointment	Fitting room
Provide information on negative consequences on non-use	Audiologist	Give written info	During each fitting appointment	Fitting room
Provide prompts or triggers	Audiologist	Give physical item to act as a cue or discuss other triggers	During each fitting appointment	Fitting room
Develop a plan for using aid(s) that promotes habit formation	Audiologist/person with hearing loss	Work together to create a written plan for when, where, etc., hearing aid will be used	During each fitting appointment	Fitting room

Table 3. Identifying intervention functions.

	Intervention functions
	Education	Persuasion	Incentivization	Coercion	Training	Restriction	Environmental restructuring	Modelling	Enablement
	Physical capability
Psychological capability
Physical opportunity
Social opportunity
Automatic motivation
Reflective motivation

Table 4. The APEASE criteria.

Criterion	Description
Affordability	Interventions often have an implicit or explicit budget. It does not matter how effective, or even cost effective it may be if it cannot be afforded. An intervention is affordable if within an acceptable budget it can be delivered to, or accessed by, all for whom it could be relevant or of benefit.
Practicability	An intervention is practicable to the extent that it can be delivered as designed through the means intended to the target population. For example, an intervention may be effective when delivered by highly trained staff with extensive resources but in routine practice this may not be achievable.
Effectiveness and cost-effectiveness	Effectiveness refers to the effect size of the intervention in relation to the desired objectives in a real world context. It is distinct from efficacy which refers to the effect size of the intervention when delivered under optimal conditions in comparative evaluations. Cost-effectiveness refers to the ratio of effect to cost. If two interventions are equally effective then clearly the most cost-effective should be chosen. If one is more effective but less cost-effective than another, other issues such as affordability come to the forefront of the decision-making process.
Acceptability	Acceptability refers to the extent to which an intervention is judged to be appropriate by relevant stakeholders (public, professional, and political). Acceptability may be different for different stakeholders.
Side effects/safety	An intervention may be effective and practicable but have unwanted side-effects or unintended consequences. These need to be considered when deciding whether or not to proceed.
Equity	An important consideration is the extent to which an intervention may reduce or increase the disparities in standard of living, wellbeing, or health between different sectors of society.