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Table 2 Intervention themes, potential, and selected intervention functions, and potential and selected behaviour change techniques (BCTs)

From: Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

Intervention themes (and associated TDF domains)

Needs addressed within module

Intervention functions included with description of the context of use

Intervention functions considered and rejected with APEASE rationale

BCTs selected; for full descriptions of BCTs see [29]

BCTs considered and rejected with APEASE rationale

A need to understand treatment (physical skills, knowledge, beliefs about consequences, intentions)

Need to know about the correct treatment-taking procedures, to understand treatment action and the importance of nebuliser treatment

Need to address treatment concerns

Need to believe that treatment is effective and necessary for long-term health, symptom reduction, avoiding IVs/hospital stays

Need to believe that treatment is important irrelevant of perceptions of current wellness

Need to encourage intentions to adhere to treatment and avoid periods of intentional non-adherence

Education (knowledge on the importance of treatment-taking even when well, effectiveness of treatment, and treatment action)

Persuasion (using imagery and other communications strategies to persuade about the importance of consistent long-term adherence)

Modelling (peers who have knowledge and understanding about nebuliser treatment and how they adhere)

Coercion—not acceptable to patients or health professionals to focus on punishment for non-adherence

5.1 Information about health consequences

9.1 Credible source

5.2 Salience of consequences

6.1 Demonstration of the behaviour

16.3 Vicarious consequences

15.4 Self-talk

5.5 Anticipated regret: potentially inducing fear not deemed acceptable (acceptability)

9.2 Pros and cons: Not practical as would take too long to deliver within the intervention (practical)

9.3 Comparative imagining of future outcomes: may be challenging for some patients and could induce fear given life-limiting nature of CF (practical, side-effects, equity).

A need to be able to monitor adherence (behavioural regulation)

Need to monitor adherence behaviour and outcomes

Education (knowledge about own adherence data)

Environmental restructuring (providing a nebuliser, a hub, and a digital platform to track and provide data on nebuliser adherence)

Enablement (providing behavioural support to provide feedback on adherence data)

 

2.3 Self-monitoring of behaviour

12.5 Adding objects to the environment

2.4 Self-monitoring of outcomes of behaviour: no easy mechanism to monitor symptoms or health and changes may be due to factors other than adherence (practical, side-effects)

A need to have treatment goals and feedback (goals, reinforcement)

Need goals for treatment adherence

Need to provide some reinforcement for treatment-taking

Enablement (providing behavioural support to set realistic specific goals for treatment)

Incentivisation (creating an expectation of rewards when goals are met)

Coercion—not acceptable to patients or health professionals to focus on punishment for not meeting goals

Modelling—not clear what feedback on others behaviour might be most effective to produce change, and could backfire

1.1 Goal setting (behaviour)

2.2 Feedback on behaviour

1.6 Discrepancy between current behaviour and goal

1.5 Review behaviour goal

8.7 Graded tasks

10.4 Social reward

1.3 Goal setting (outcome): the achievement of some outcome goals could be impacted on by factors outside of the individual’s control and could result in demotivation (side-effects)

A need to have confidence in the ability to adhere to treatment (beliefs about capability, social opportunity)

Need to have social norms for adherence

Need to develop confidence in the ability to take and adhere to treatment

Modelling (providing role models of people who have increased their adherence for people to aspire to)

Persuasion (using communication to increase feelings of positive self-efficacy)

Environmental restructuring—not practical to change the environmental barriers that make treatments feel difficult to do

Education—not likely to be effective given that confidence likely to be based on past experiences of trying to adhere and potentially failing.

6.1 Demonstration of behaviour

15.1 Verbal persuasion about capability

15.3 Focus on past success

6.2 Social comparison: drawing attention to others (natural) adherence behaviour could create social norms for non-adherence given low median levels (side-effects)

A need to have a treatment plan (behavioural regulation, memory, attention, and decision processes)

Need to remember to take treatment

Need to develop routines, plans and habits for treatment

Environmental restructuring (providing digital tools on which to make and record plans)

Enablement (providing behavioural support to identify appropriate plans)

 

1.4 Action planning

8.3 Habit formation

7.1 Prompts/cues

1.8 Behavioural contract: writing and signing contract would take too much time (practical)

15.2 Mental rehearsal of successful performance: not likely to be effective given that it is not treatment taking that is the challenge but adherence in a range of contexts (effective)

A need to solve problems around treatment adherence (environmental context and resources, goals, social opportunities, beliefs about capability)

Need skills to use nebuliser, prepare treatment, and clean nebuliser

Need to have a time, place and the equipment do take treatment

Need to develop strategies to take treatment around specific barriers or times when treatment-taking is more difficult

Need to develop strategies to address conflicting goals

Need positive support from family, healthcare professionals and/or others to do treatment

Need to develop strategies to take treatment at times or in situations when it is more difficult

Training (skills to be able to adhere use and clean nebuliser and mix treatment)

Education (providing knowledge about support services and strategies to overcome barriers to treatment-taking)

Environmental restructuring (providing digital tools on which to make and record plans, and provide educational information, directly changing the environmental context and resources for some patients where possible)

Enablement (providing behavioural support to identify barriers and make plans about how to overcome them or reduce their effects)

Modelling (role models of others who have developed strategies to overcome barriers to adherence)

Restriction—not acceptable to require patients to focus on treatment and reduce opportunity to engage in behaviours associated with other goals

1.2 Problem solving

12.1 Restructure the physical environment

15.4 self-talk

3.2 social support (practical)

4.1 Instruction on how to perform the behaviour

6.1 Demonstration of the behaviour

8.1 Behavioural practice/rehearsal

9.3 Comparative imaginings of future outcomes (practical)