Theory in practice: identifying theory-based techniques in health coaches’ tailored feedback during a weight loss intervention

Abstract

Objective: A taxonomy of ninety-three functionally different behaviour change techniques (BCTs) has been identified. However, it is not fully clear how these and other theory-based techniques are applied in the day-to-day practice of people delivering health behaviour change interventions. This study examines feedback provided by expert health coaches in a behavioural weight-loss intervention, to describe; a) what theory-based techniques are used in sessions, b) which techniques are used most frequently, c) what occurs in sessions, beyond existing theory-based techniques. Main Outcome Measures: Theory-based techniques (BCTs/tailoring strategies); relational/content-based techniques. Design: 10 tailored feedback videos from two health coaches were coded using a hybrid thematic analysis approach. Theory-based techniques were coded deductively; content not matching definitions of theory-based techniques but that addressed a determinant of behaviour change were coded inductively and relational codes were connected into themes. Results: Seventeen BCTs were coded M = 20.88 times (range:1–109). Eight tailoring techniques were coded M = 25.25 times (range:1–91). Relational themes included; ‘Autonomous interpersonal coaching style,’ ‘Supportive accountability,’ and ‘Coach as expert’. Additional behavioural techniques were also identified. Conclusion: This work highlights what and how theory-based techniques are implemented in a weight-loss intervention, drawing attention to the role of tailoring techniques and health coaches in supporting behaviour change.

Keywords:

• Health behaviour change
• tailoring
• behaviour change techniques (BCTs)
• human support
• health coaches
• implementation
• weight loss
• behaviour change theory

Acknowledgements

The authors would like to thank Karen Matvienko-Sikar for her invaluable insight and comments on an early draft of this manuscript. We are also grateful to the health coaches for their contribution to this study.

Disclosure statement

The research was conducted entirely independent to the funders who had no role in the conception, design, analysis or write up of this study.

Additional information

Funding

This work was supported by the Irish Research Council and S3 Connected Health [grant number EPSPG/2016/182].