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Using Behaviour Change Technique (BCT)
analysis to improve fidelity to treatment
manuals in smoking cessation: A case
study
Billie Bonevski, Laura Twyman, Fabiana Lorencatto, Susan
Michie & Robert West
Newcastle, Australia
2
The
Trial
• The primary aim is to evaluate the efficacy of a community
social service case-worker delivered smoking cessation
intervention for socially disadvantaged smokers
• The study design is a randomised controlled trial
• The primary outcome measure is CO verified continuous
abstinence at 6 months follow-up
3
The Call it Quits smoker (n = 309)
4
The case-worker delivered intervention:
Key components
•
•
•
•
•
•
•
Delivered by trained volunteer case-workers
Systematically (electronically) assessing and recording smoking status
in client notes
Tailored (based on print-out)
Provision of advice to quit and behavioural counselling, motivational
interviewing if required over two face-to-face sessions
Free nicotine replacement therapy
Buddy system
Flexible follow-up through telephone calls, or drop-ins
But what are our intervention participants really receiving?
5
The aims of the current study
1. Assess volunteer case-worker fidelity to the Call it
Quits intervention manual using BCT analysis
2. Assess the effectiveness of BCT performance
feedback in improving fidelity to intervention manual
6
Methods
•
Pre and post test study embedded in one intervention trial (Call it Quits)
•
6-week pre-test period of recording counselling sessions
•
6-week period post-intervention of recording counselling sessions
•
Main outcome:
– Proportion of each manual specified BCT delivered pre and post
7
Methods
8
Intervention manual coded using BCT smoking
cessation framework
Pre-test: Counselling sessions audio recorded and
transcribed
Code transcriptions - BCTs
Intervention: Volunteer case-workers provided with
BCT performance feedback
Post-test: Counselling sessions audio recorded and
transcribed
Code transcriptions - BCTs
Results: BCTs coded in the manual
Tailor interaction appropriately
Facilitate goal setting
Boost motivation and self efficacy
Prompt review of set goals
Provide feedback on current behaviour and progress
Advise on stop smoking medication
Provide rewards contingent on not smoking
Advise on/facilitate the use of social support
Prompt commitment from the client there and then
Ask about experience of stop smoking medication
that the smoker is currently using
Provide rewards contingent on effort or progress
Give options for additional and later support
Facilitate identification of reasons for wanting and not
wanting to stop smoking
General communication approach
Explain the importance of abrupt cessation
Facilitate relapse prevention and coping
Conduct motivational interviewing
Promote cut-down-quit
Facilitate barrier identification and problem solving
Advise on management of mental health problems
Information gathering and assessment
Assess alcohol or drug use disorder
Facilitate action planning/develop a treatment plan
Arrange follow-up session
9
Pre-test Results - Volunteer case-worker
session recordings (n=23)
Individual Volunteer
B
1st F2F
A
P
1
2nd F2F
1st t/c
I
G
5
1
2
1
S
K
Total
2
9
3
5
1
2nd t/c
2
2
1
Final t/c
1
1
Total
2
2
3
7
Duration
(mins)
2.13.4
2.533.2
3.47.6
425.6
3
1
1
1
5
3
7.5
312.5
3.146.4
4
2.5 - 46.4
10
Inter-rater reliability
•
50% of pre-test coding
•
Between two coders (BB & LT)
•
Assessed using percentage agreement
•
79% (High - > 75%)
11
Pre-test Results - Number of face to face sessions
each BCT delivered in (out of possible 14)
12
N (%)
BCT label
N (%)
Tailor interaction appropriately
8 (57)
Facilitate goal setting
9 (64)
Boost motivation and self efficacy
3 (21)
Prompt review of set goals
0
Provide feedback on current behaviour and
progress
10 (71)
Advise on stop smoking medication
14 (100)
Provide rewards contingent on not smoking
0
Advise on/facilitate the use of social support
13 (93)
Prompt commitment from the client there and
then
9 (64)
Ask about experience of stop smoking medication
that the smoker is currently using
12 (86)
Provide rewards contingent on effort or progress
6 (43)
Give options for additional and later support
3 (21)
Facilitate identification of reasons for wanting and
not wanting to stop smoking
5 (36)
General communication approach
14 (100)
Explain the importance of abrupt cessation
6 (43)
Facilitate relapse prevention and coping
5 (36)
Conduct motivational interviewing
3 (21)
Promote cut-down-quit
12 (86)
Facilitate barrier identification and problem
solving
6 (43)
Advise on management of mental health problems
1 (7)
Information gathering and assessment
13 (93)
Assess alcohol or drug use disorder
10 (71)
Facilitate action planning/develop a treatment
plan
14 (100)
Arrange follow-up session
14 (100)
Pre-test Results - Number of telephone sessions
each BCT delivered in (out of possible 9)
13
N (%)
BCT label
N (%)
Tailor interaction appropriately
3 (33)
Facilitate goal setting
0
Boost motivation and self efficacy
8 (89)
Prompt review of set goals
2 (22)
Provide feedback on current behaviour and
progress
8 (89)
Advise on stop smoking medication
2 (22)
Provide rewards contingent on not smoking
1 (11)
Advise on/facilitate the use of social support
4 (44)
Prompt commitment from the client there and then
0
Ask about experience of stop smoking medication
that the smoker is currently using
5 (56)
Provide rewards contingent on effort or progress
4 (44)
Give options for additional and later support
8 (89)
Facilitate identification of reasons for wanting and
not wanting to stop smoking
2 (22)
General communication approach
7 (78)
Explain the importance of abrupt cessation
0
Facilitate relapse prevention and coping
2 (22)
Conduct motivational interviewing
0
Promote cut-down-quit
3 (33)
Facilitate barrier identification and problem solving
2 (22)
Advise on management of mental health problems
3 (33)
Information gathering and assessment
2 (22)
Assess alcohol or drug use disorder
3 (33)
Facilitate action planning/develop a treatment plan
0
Arrange follow-up session
5 (56)
BCT Performance feedback intervention
Group feedback session outlining:
– Number of recordings per volunteer
– BCTs specified in manual
– BCTs delivered by each volunteer (anonymous)
– Positive reinforcement
– Discussion of BCTs, identification of aids to help
boost BCT use
Individual performance feedback letters including:
– Length of sessions (in minutes)
– List of BCTs identified and positive reinforcement
– List of BCTs not coded
– Goal setting – increase unused BCTs in 6 months
14
BCT Performance feedback intervention
15
•
Desktop checklist with ‘top 5’ BCTs – goal for improvement
In face-to-face sessions
1. Explain the importance of abrupt cessation
2. Prompt commitment from the client there and then
3. Facilitate action planning/develop a treatment plan
4. Facilitate goal setting
5. Advise on stop smoking medication
In telephone follow-up calls
1. Prompt review of set goals
2. Provide feedback on current behaviour and progress
3. Boost motivation and self-efficacy
4. Facilitate relapse prevention and coping
5. Provide rewards contingent on effort or progress
Next steps
•
Continue coding post-test sessions
•
Compare pre and post test use of manual specified BCTs
•
Assess by
– session type (face to face, telephone follow-up)
– duration,
– volunteer
– BCT
•
Assess inter-rater reliability for new BCTs
16
THANK YOU
Funding:
•National Health & Medical Research
Council
•Cancer Institute NSW
•Hunter Medical Research Institute
•Anglicare Community Care Centre
Wollongong clients, volunteers and staff
Contact me on:
[email protected]
or ph: +61 02 40335710
CRICOS Provider 00109J | www.newcastle.edu.au
17