Use of the Behaviour Change Wheel to design an intervention to improve the implementation of family-centred care in adult audiology services

Figures & data

Figure 1. Overall results from the eight steps of the Behaviour Change Wheel (BCW) intervention design.

Table 1. Results from BCW Steps 5–8.

Selected intervention functions	COM-B components served by intervention functions	Selected BCTs to deliver intervention functions	Translation of BCTs within the two-phase intervention
Education (Increasing knowledge or understanding)	Psychological capability: Increase knowledge and understanding of FCC as well as reasons why FM attendance and involvement is beneficial	Information about social and environmental consequences Feedback on outcome(s) of the behaviour Feedback on behaviour	First-phase: Provide information: ‘What is FCC?’ and the ‘Impact of HI on FM’ within workshop 1 Provide information on ‘Benefits of involving FM/FCC in hearing rehab’ & evidence from literature on benefits within workshop 1 Provide information on ‘Why to ask for FM to attend appointment with client’ within workshop 1 Second phase: Provide information on the importance of agenda-setting and seeking a history from both client and FM within workshop 2
Training (Imparting skills)	Psychological capability and reflective/ automatic motivation: Increasing skills, confidence, and comfort. Developing a routine/habit in staff to invite family members to all appointments and consistently involve them in appointments. Staff feeling responsible to carry out the behaviour.	Instruction on how to perform a behaviour Behavioural practice/ rehearsal	First-phase: Instructions when to ask question (e.g. during all appointment bookings and confirmations) Instructions how to ask question of FM attendance Instructions how to explain reason for FM attendance to client and role-playing different explanations with staff Practice responding to difficult questions/concerns of client - explore expected challenges/concerns that may come up and role-play/rehearse different ways to respond to ‘tricky’ questions from client Second phase: Instructions for staff to confirm who client has brought to appointment Instructions for staff to advise clinician who client has with them Instructions for clinicians to greet client and FM by name and invite FM into appointment room Instructions to clinicians for how and when to set agenda and ask FM open history-taking question Practice responding to disagreements between client and FM concerning the client’s hearing difficulties - explore expected challenges/concerns that may come up and role-play/rehearse different ways to respond to disagreements.
Environmental Restructuring (Changing the physical or social context)	Physical opportunity: Providing instructions and tools to assist staff with inviting family members to appointments, setting up the room, and setting an inclusive agenda.	Adding objects to the environment Prompts/cues Restructuring the physical environment	First-phase: Provide prompt card with instructions to use when asking for FM attendance Provide script (e.g. examples of how to word question & explanation to give to clients) Provide individually tailored cue card designed in training to stick on computer/desk Second phase: Individualised help with setting up room to have two chairs next to each other for client and family member Provide script for clinician to set an agenda that includes client and FM involvement Provide script for asking FM an open history-taking question Develop Communication Partner Questionnaire (CPQ) and have staff ask FM to complete it in waiting room.
Incentivisation (Creating an expectation of reward)	Reflective Motivation: To create an expectation of reward for increasing family member attendance and involvement in appointments	Rewarding completion Incentive	First and second-phase: Using a star reward system It allows for staff members to receive rewards for special achievements which are then provided in the form of vouchers.

BCW: Behaviour Change Wheel; FCC: family-centred care; FM: family member; COM-B: Capability, Opportunity, Motivation – Behaviour; BCTs: Behaviour Change Techniques.

Figure 2. Cue cards provided to staff in the first workshop.

Figure 3. Cue cards provided to staff in second workshop.

Figure 4. Example of the triangular seating arrangements suggested in the second workshop (client and family member seated equally distanced from clinician).