Table 2 Development of the intervention (underpinning theories)
Identified target behaviour/problem | Theory | Participant receipt and potential behavioural outcome | Intervention on the STEPWISE course | Mapping to behavioural taxonomy (Michie et al. [19, 20]) |
|---|---|---|---|---|
Erroneous belief about weight problems. | Self-regulation theory (Leventhal, 1984) [28] Specifically illness representations around weight management • Signs of a weight problem • Causes • Consequences • Treatment • How long it will last | To have identified their own potential erroneous beliefs and questioned these in order to directly influence their decisions around weight management. | Your story session Elicit participant’s beliefs about what caused their weight problem, what ‘treatment’ would help to manage it, the consequences for them and their health. Topic sessions Information sessions throughout the course. | Not completely specified but included in • Information about health consequences • Framing/reframing |
Low levels of confidence around being able to engage in successful weight management possibly related to multiple unsuccessful attempts at sustained weight loss. | Self-efficacy (Bandura 1977, 1997) [29, 30] • Mastery (previous successful attempts of the behaviour) • Modelling (observing others engaging in the behaviour) • Verbal persuasion (talking through the process of change expecting success) • Emotional arousal (managing the anxiety around change and fear of failure) | Increased belief in their ability to engage successfully in weight management | Sharing stories session Eliciting what has gone well in terms of behaviour change, problem solving around challenges, and observing others’ successes and problem solving. Discussing feelings as activators and barriers to change. Next STEPS Action planning, problem solving, setting small graded tasks | • Focus on past successes • Self-monitoring of behaviour outcomes of behaviour and consequences • Instruction on how to perform the behaviour • Graded tasks • Behavioural experiments • Credible source • Habit reversal • Review behavioural goals • Social comparison • Focus • Goal setting • Action planning • Problem solving • Information about antecedents • Information about emotional consequences • Reduce negative emotion • Self-incentive • Self-reward |
Strong cues to previous behaviours and thus high likelihood of relapse | Relapse prevention model (Marlatt and Gordon 1985) [31] • High-risk situations with strong cues need to be managed by avoidance or coping strategies. • Coping strategies need to be prepared in advance • Management of relapse will result in increased self-efficacy | Reviewed the situations that would most likely result in relapse. Developed plans of how to manage these when they occur. View relapse as a natural part of the change process and as an opportunity to learn rather than berate themselves and reinforce a potential negative self-perception. | Keeping it Going visual tools and interactive exercises to explore potential sources of relapse and develop plans to overcome these when they occur. | • Self-monitoring of behaviour • Information about antecedents • Behaviour assessment • Goal setting • Problem solving • Action planning • Review behavioural goals • Restructuring physical and social environment • Avoidance/reducing exposure to cues for behaviour • Reduce negative emotion • Prompts • Remove access to the reward • Framing/reframing • Verbal persuasion about capacity |