Process evaluation of a UK school-based alcohol intervention using the Behaviour Change Wheel Framework

Figures & data

Figure 1. Behaviour Change Wheel (BCW) and Theoretical domains Framework (TDF), Michie et al, (2014).

Table 1. Resources provided as part of the TAA programme.

Title	Description	Link
Teacher Workbook	100 pages of lesson plans, games and activities, organised by topic and year group	https://alcoholeducationtrust.org/teacher-area/download-teacher-workbook/
Lesson plans	Six fully planned lessons with accompanying PowerPoints Four lesson plans and accompanying guidance for children with moderate additional learning needs	https://alcoholeducationtrust.org/download-lesson-plans/
Alcohol and You Guide	A guide for young people including top tips and advice for staying safe around alcohol	https://alcoholeducationtrust.org/wp-content/uploads/2020/03/alcohol_and_you.pdf
Talking to Kids Guide	A guide for parents which includes information on topics such as units, guidelines, the effects of alcohol and the law	https://alcoholeducationtrust.org/wp-content/uploads/2015/04/ParentGuide.pdf
Activity Box	Laminated activity cards and BAFTA winning ‘Just a Few Drinks’ films, which is free of charge for those working with special educational needs (SEN) pupils or more vulnerable young people	https://alcoholeducationtrust.org/store/just-a-few-drinks-bafta-award-winning-4-short-films-dvd/
Alcohol Education Trust website	A website which contains more resources for teachers organised by topic and year group	www.alcoholeducationtrust.org
Talk About Alcohol website	A pupil-facing online learning zone including fun and engaging activities and games such as online nightclub, which allows pupils to learn to make safe choices around alcohol in a pupil-friendly way	www.talkaboutalcohol.com
Advice hub for 16–25 year olds	Provides advice on a range of topics including alcohol, drugs, mental health and money	www.life-stuff.org
Resources for FE Colleges and Sixth Forms	Includes detailed films on consent and the associations of alcohol with violence	https://alcoholeducationtrust.org/teacher-area/16plus/16-ice-breakers/

Note: Links to resources were provided by the Alcohol Education Trust. The programme was designed by the Alcohol Education Trust alongside teachers and specialists in PSHE. It takes a harm minimisation approach, is evidence-based and was piloted in 10 secondary schools across the UK before rollout. The intervention aligns with the outcomes of other previous alcohol interventions such as the School Health and Alcohol Harm Reduction Project SHAHRP (McKay et al. 2012) and the Information Psychosocial Competence Protection (IPSY) programme (Spaeth et al. 2010).

Table 2. Participants.

Participant	Role in school	Length of time using resources	Training	Delivered resources	Co-ordinated input of the programme
T1	Teacher and PSHE Lead	2 + years	Yes	Yes	No
T2	Teaching Assistant and PSHE Lead	1 year	Yes	Yes	No
T3	Teacher and Sixth Form Student Support Tutor	1 year	No	Yes	No
T4	Teacher	1 year	Yes	Yes	No
T5	Teacher	6 months	Yes	Yes	No
T6	Teaching Assistant	N/A	Yes	No	No
T7	Teacher and PSHE Lead	1 year	No	Yes	No
P1	Charity lead Facilitator	2 + years	No	Yes	No
P2	Administrative Assistant for SENDepartment	N/A	No	No	Yes
P3	Head of Student Services	N/A	No	No	Yes

Note: T- Teacher, P- Participant .

Figure 2. Map of themes: indicating the relationship between COM-B components with inductive sub-themes and the target behaviour.

Table 3. Inductive sub-themes identified as a barrier or enabler with a description of the sub-themes.

Inductive sub-theme	Barrier/enabler	Description of sub-theme
Increased understanding from resources/training	Enabler	Gaining new knowledge of alcohol related content such as current legislation and alcohol units and how to deliver the resources effectively i.e. without judgment
Existing knowledge or skills	Enabler	Previous knowledge or skills of delivering PSHE lessons about alcohol to pupils; teachers may also bring personal knowledge of alcohol to the lessons
Absent knowledge or skills	Barrier	Knowledge or skills that teachers suggested for additional training on more complex issues related to alcohol use
Effective resource design	Enabler	Beneficial characteristics of how the resources were designed to enable effective delivery, for example, being up to date or easy to understand
The setting of where the resources are delivered	Enabler	Most lessons were delivered within a classroom setting, which helped to keep a consistent learning environment for the students
The role of the trainer	Enabler	Characteristics of the trainer that inspired or made teachers feel comfortable; teachers could also model the style of delivery used by the trainer
Discussions with colleagues	Enabler	Meetings or informal conversations between teaching staff regarding the delivery of the TAA resources and any changes to delivery that were made as a result of these conversations
Social influences on the student	Barrier	The wider context in which students interact with alcohol,for example, peer pressure, parent relationships with alcohol and social norms around alcohol
Confidence to deliver the resources	Enabler	Feeling prepared and comfortable in being able to deliver the resources; this is closely related with having sufficient knowledge to deliver the resources
Beliefs about the overall impact on students	Enabler	Teachers’ beliefs about the effect of delivering the TAA resources to students, for example, equipping the students with better knowledge to make more informed decisions
Feelings about delivering the resources	Enabler	Teachers feel calm and optimistic and enjoy delivering these resources

Table 4. Optimising the main enablers and remaining barriers to delivering the Talk about alcohol programme using Behaviour Change Techniques.

Inductive subtheme	COM-B Component	Selected BCT	Recommendation
Effective resource design	Physical opportunity	Adding objects to the environment	Regular updates with notifications and new materials for teachers using TAA resources
Increased understanding from the resources/training	Psychological capability	Information about social and environmental consequences Information about health consequences	Increasing the intensity of training sessions by providing optional booster sessions at the beginning of a new academic year
Confidence to deliver resources	Reflective motivation	Credible source	A ‘focus on past successes’ section to top up training for teachers who have used the resources before
Absent knowledge or skills	Psychological capability	Information about social and environmental consequences Information about health consequences	Additional modules to top up training sessions or e-learning modules based on suggestions from teachers
Social influences on the student	Social opportunity	Action planning	Age appropriate first aid and CPR instruction combined alongside the TAA lesson plans to give students skills for real life scenarios

Table

COM B domain	TDF domain	Interview question example
Psychological capability	Knowledge	Can you talk to me about what kind of knowledge you needed to deliver these Talk About Alcohol resources? Which topic areas could you have done with more knowledge in? What did you learn on the training? Main takeaways?
Psychological capability	Skills	Can you talk to me about the skills you needed to deliver these resources? Did you receive training on those skills from the Alcohol Education Trust or were they pre existing?
Psychological capability	Memory, attention and decision processes	Were you able to improvise with these resources? Could the resources have been organized better to support that?
Reflective motivation	Beliefs about capabilities	How confident did you feel about delivering the TAA resources and how could that have been improved?
Reflective motivation	Optimism	How optimistic were you about delivering the resources? e.g. how optimistic were you that they would work/have some effect?
Reflective motivation	Beliefs about consequences	What impact do you think that delivering the TAA programme would have for raising awareness about safety around alcohol?
Reflective motivation	Intentions	Why did you decide to use the Talk About Alcohol resources?
Automatic motivation	Emotion	How did you feel emotionally about delivering the workshops? How did you feel about the resources?
Physical opportunity	Environmental context and resources	To what extent did the classroom setting you were in facilitate or hinder your delivery of the TAA workshops? Do you think it could be delivered better in another environment? How many students did you typically deliver to?
Social opportunity	Social influences	How did talking to others (such as your colleagues) effect how you delivered the intervention? For example, did you make any changes to anything?
N/A	N/A	Final question: In your opinion, what improvements could be made to either the training or the Talk About Alcohol resources themselves?

Table

COM B	TDF	Codes	Inductive sub-theme
Psychological capability	Knowledge	New knowledge from training Prior knowledge before training Knowledge of own pupils Knowledge lacking	Increased understanding form the resources/training Existing knowledge or skills held Absent knowledge or skills
Psychological capability	Skills	Communication skills Teacher training skills Listening skills Facilitation skills ICT skills	Increased understanding form the resources/training
Physical opportunity	Environmental context and resources	Using a classroom setting Using a setting outside of the classroom Class size Who delivers the resources Resources prompt discussion Resource timings Resources are comprehensive Resources are kept up to date Resources were easy to adapt Resources were accessible Resources were age appropriate Adaptation based on: Age of students Adaptation based on: Time constraints Adaptation based on: Student experience Adaptation based on: Student preference Adaptation based on: Ability of students Adaptation based on: Class size Adaptation based on: Context of the local area Adaptation based on: Personal stories Adaptation based on: Teaching practical strategies	The setting of where the resources are delivered Features of the resources
Social opportunity	Social influences	Parental influences on student Social pressure on teenagers Signposting for parents Discussions with Headteacher Positive relationships with students Student feedback Recommending the resources to other teachers In-class conversations with staff who do not drink alcohol Discussing the programme with colleagues The trainer	The role of the trainer Discussions with colleagues Social influences on the student
Reflective motivation	Beliefs about capabilities	Confidence gained from training Confidence gained from resources Feeling able to ask questions during training Benefit of prior knowledge	Confidence to deliver the resources
Reflective motivation	Optimism	Optimism that the programme will have a positive impact on students Optimism that the programme is more effective than previous materials	Optimism about the impact of the resources
Reflective motivation	Beliefs about consequences	Students will gain more in-depth knowledge of alcohol Students will gain more knowledge of the law surrounding alcohol Students take alcohol more seriously Students will enjoy or engage with the resources Students have their beliefs affirmed Students will reduce their alcohol consumption Students were already familiar with role play Teachers can identify safeguarding issues Beliefs about the Teacher Handbook Being able to model what was done in the training Responsive team from AET Reflection on own alcohol consumption Suggested improvements for the training	Beliefs about the overall impact on students
Automatic motivation	Emotions	Feeling nervous Feeling concerned/worried for students Feelings about the training Feeling calmer Feeling prepared Enjoyment of using the resources Feeling optimistic about delivering the resources	Feelings about delivering the Talk About Alcohol resources

Michie, S., M. Richardson, M. Johnston, C. Abraham, J. Francis, W. Hardeman, M. P. Eccles, S. Michie, L. Atkins, and R. West. 2014. The Behaviour Change Wheel: A Guide to Designing Interventions. United Kingdom: Silverback Publishing.

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Spaeth, M., K. Weichold, R. K. Silbereisen, and M. Wiesner. 2010. “Examining the Differential Effectiveness of a Life Skills Program (IPSY) on Alcohol Use Trajectories in Early Adolescence.” Journal of Consulting and Clinical Psychology 78 (3): 334–348. https://doi.org/10.1037/a0019550.

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