Specifying active components of educational interventions to promote adherence to treatment in glaucoma patients: application of a taxonomy of behavior change techniques

Figures & data

Table 2 Frequency of BCTs coded for the two interventions

Behavior change technique label^Citation1	Text units coded in group intervention, n (%)	Text units coded in individual intervention, n (%)
Provide information about behavior–health link	22 (14)	5 (4)
Prompt intention formation	16 (10)	7 (6)
Relapse prevention	14 (9)	8 (7)
Provide instruction	11 (7)	5 (4)
Prompt specific goal setting	11 (7)	12 (10)
Provide information on consequences	11 (7)	3 (3)
Prompt barrier identification	9 (6)	24 (20)
Prompt practice	9 (6)	3 (3)
Time management	8 (5)	11 (9)
Provide opportunities for social comparison	8 (5)	2 (2)
Provide general encouragement	6 (4)	4 (3)
Prompt self-monitoring of behavior	6 (4)	3 (3)
Model or demonstrate the behavior	5 (3)	2 (2)
Plan social support or social change	4 (3)	9 (8)
Prompt review of behavioral goals	4 (3)	5 (4)
Teach to use prompts or cues	4 (3)	6 (5)
Provide feedback on performance	3 (2)	2 (2)
Provide contingent rewards	2 (1)	(0)
Provide information about others’ approval	1 (1)	(0)
Use follow-up prompts	1 (1)	7 (6)
Prompt identification as a role model	1 (1)	(0)
Prompt self-talk	1 (1)	(0)
Set graded tasks	(0)	(0)
Agree on behavioral contract	(0)	(0)
Stress management	(0)	(0)
Motivational interviewing	(0)	(0)

Notes: Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychology. 27(3):379–387, 2008. APA as publisher, adapted with permission.¹

Abbreviation: BCTs, behavior change techniques.

Table 1 Examples of intervention text units, auxiliary information, and associated coding using BCTs

Text unit and description	Auxiliary information	Behavior change technique(s)
Information session: how eye drops work and their side effects	Description of information session from group intervention developer: the way in which eye drops work was explained, which highlighted the benefits of using the drops as prescribed in terms of ocular pressure and the subsequent consequences if the drops were not instilled correctly.	1. Provide information on consequences: information about the benefits and costs of action or inaction, focusing on what will happen if the person does or does not perform the behavior
Self-assessment session: what problems (if any) did you encounter in the past month related to either diagnosis or drops?	Description of self-assessment session from group intervention developer: this self-assessment assisted people in identifying what specific circumstances led to them not using their drops as prescribed. Ways to better manage these circumstances were then discussed to increase instillation compliance.	1. Prompt barrier identification: identify barriers to performing the behavior and plan ways of overcoming them
Practical session: feeling confident to put in drops (involved facilitator modeling the behavior within the session as well as using photographs of people using particular techniques. Verbal instruction was provided in the practical session).	Description of self-assessment session from group intervention developer: the practical sessions involved the facilitator modeling how to instill the drops, photographs of others were also shown. The people were told in which ways they could instill drops and shown different techniques. They were then asked to try these techniques out for themselves; feedback, praise, and encouragement were provided by the facilitator. Specific praise was given for successful instillation and the person was encouraged to repeat that technique in order to remember it. This was within a group setting so people could discuss it among themselves informally as well as with the facilitator.	1. Model or demonstrate the behavior: an expert shows the person how to correctly perform a behavior, eg, in class or on video
		2. Provide feedback on performance: providing data about recorded behavior or evaluating performance in relation to a set standard or others’ performance, ie, the person receives feedback on his/her behavior
		3. Provide instruction: telling the person how to perform a behavior and/or preparatory behaviors
		4. Provide general encouragement: praising or rewarding the person for effort or performance without this being contingent on specified behaviors or standards of performance
		5. Provide contingent rewards: praise, encouragement, or material rewards that are explicitly linked to the achievement of specified behaviors
		6. Prompt practice: prompt the person to rehearse and repeat the behavior or preparatory behaviors
		7. Provide opportunities for social comparison: facilitate observation of nonexpert others’ performance, eg, in a group class or using video or case study

Abbreviation: BCTs, behavior change techniques.

Table 3 Group intervention

Group topic (from presentation)	Behavioral change technique	Components of overall target behavior: correct instillation of drops
Group discussion: why are you here today?
Info session: how the eye works; what is glaucoma? Different types of diagnosis; how might glaucoma affect my eyesight? info session: drops acquisition, storage, and safety; how to put them in (verbal instruction)	Provide information about behavior–health link Provide information on consequences Prompt intention formation Provide instruction Prompt specific goal setting Prompt self-monitoring of behavior Teach to use prompts or cues Relapse prevention Time management Prompt barrier identification	Acquire correct drops Acquire them in time Store them correctly Put them in safely
Practical session: putting in drops	Provide general encouragement Provide instruction Model or demonstrate the behavior Prompt specific goal setting Prompt review of behavioral goals Prompt self-monitoring of behavior Provide feedback on performance Provide contingent rewards Prompt practice Provide opportunities for social comparison	Develop an effective technique for instilling drops
Info session: how drops work and their side effects	Provide information on consequences Prompt barrier identification
Info session: self-assessment: common problems with managing eye drops	Provide information about behavior–health link Prompt barrier identification Prompt review of behavioral goals Prompt self-monitoring of behavior Relapse prevention Time management	Adhere to their drops
Practical session: self-assessment: making an action plan	Prompt barrier identification Prompt specific goal setting Prompt self-monitoring of behavior Prompt practice	Adhere to their drops
Info session: further information: leaflets; organizations, book appointment for individual chat with specialist nurse	Relapse prevention	Seek out further information
Group discussion: how have the action plans helped them to put in drops?	Prompt barrier identification Provide general encouragement Prompt review of behavioral goals Provide feedback on performance Provide contingent rewards Prompt practice Use follow-up prompts	Review their progress and what has been contributed
Info session: what to expect at an eye hospital clinic visit and how to maximize its usefulness	Teach to use prompts or cues Prompt self-monitoring of behavior Prompt specific goal setting Provide instruction Prompt barrier identification	Make full use of their appointments
Info session: lifestyle and glaucoma: emotions, diet, exercise, driving, and glaucoma	Provide instruction Provide general encouragement Prompt intention formation Provide information on consequences Provide information about behavior–health link	Make lifestyle changes where necessary Inform the DVLA when appropriate

Abbreviation: DVLA, Driver Vehicle Licensing Authority.

Table 4 Individual intervention

Individual intervention topic	BCT	Target behavior
Assessment: referral, diagnosis, prescription, medical and surgical history, risk factors, factors affecting patients’ ability to instill drops, beliefs and experience about medications, glaucoma, and drops Practical session: drop instillation training	Provide information about behavior health link Prompt barrier identification Provide general encouragement Time management Prompt barrier identification Provide instruction Prompt practice	Develop an effective technique for instilling drops
Information session: facts about ocular hypertension or glaucoma given verbally according to diagnosis; different types of glaucoma; how might it affect my sight information session: medication	Provide information about behavior–health link Provide information on consequences Prompt specific goal setting Provide information about behavior–health link Prompt barrier identification Teach to use prompts or cues Time management
Information session: adherence to therapy	Prompt barrier identification Time management Prompt intention formation Prompt barrier identification Prompt specific goal setting Teach to use prompts or cues Provide opportunities for social comparison Prompt intention formation Prompt specific goal setting Provide contingent rewards	Acquire correct drops Acquire them in time Store them correctly Put them in safely
Information session: prognosis and future management	Provide general encouragement Provide instruction Prompt intention formation Prompt specific goal setting Prompt self-monitoring of behavior Provide opportunities for social comparison Plan social support or social change Time management
Follow-up consultations	Prompt intention formation Prompt barrier identification Prompt specific goal setting Prompt review of behavioral goals Prompt self-monitoring of behavior Use follow-up prompts Time management Relapse prevention	Review their progress and what has been contributed

Abbreviation: BCT, behavior change technique.

AbrahamCMichieSA taxonomy of behavior change techniques used in interventionsHealth Psychol200827337938718624603

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