Behaviour Change Techniques and Mechanisms of Action: Identification of the Active Ingredients in Communication Partner Training for People With Acquired Brain Injury.
Nicholas Behn, Madeline Cruice, Katerina Hilari and 3 others
PMID 41968884WHAT IT FOUND
Coding three communication partner training manuals found 27 behaviour change techniques and 17 mechanisms of action.
Seven techniques appeared in at least 80% of sessions in all three, including goal setting, feedback and practice. It counts what the manuals contain, not what works.
Key findings
01Across the three communication partner training manuals, 27 different behaviour change techniques and 17 mechanisms of action were identified, and 19 of the 27 techniques appeared in all three programmes. The most techniques were found in TBIconneCT (25) and the fewest in TBI Express-Adapted (20).
02Seven techniques were used in at least 80% of sessions in all three programmes: goal setting (behaviour), behavioural contract, feedback on behaviours, information about social and environmental consequences, behavioural practice/rehearsal, habit formation and generalisation of the target behaviour. Five mechanisms (knowledge, skills, beliefs about capabilities, goals and behavioural regulation) were targeted in every session of all three.
03Agreement between the two raters was strong for identifying behaviour change techniques and moderate to almost perfect for mechanisms of action (kappa 0.82-0.88 and 0.69-0.85; 75-81% and 73-85% agreement respectively).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
No patients were studied and no outcomes were measured. The paper cannot say which technique, which combination, or which of the three programmes works, or whether a single technique or a package is needed. Only two modules from each programme (20-33% of the content) were coded by both raters to check agreement, and the reliability statistics came from just four modules in two of the three programmes. The definitions used for behaviour change techniques and mechanisms of action were developed for health behaviours such as smoking, alcohol use and diabetes, not for rehabilitation with people who have cognitive impairment. The manuals often did not state who a technique was aimed at or what the target behaviour was, so the raters had to make conservative assumptions, which may have changed which techniques were counted. Only one theory and framework was used to identify techniques and mechanisms. One rater had helped develop one of the coded programmes and another team member had helped develop all three, so the coders were not fully independent of the material. The findings describe three programmes only, all delivered by speech and language therapists and largely developed in Australia.
Declared interests
Funded by the UK National Institute for Health and Care Research (NIHR), which also supports the lead author through an Advanced Fellowship. The authors declare no conflicts of interest. The paper states openly that the primary rater had been involved in developing one of the three coded programmes (TBI Express-Adapted) and that another member of the research team had been involved in developing all three.
The easy way to misread this
Do not read the list of 27 techniques as evidence that any of them improves communication. This study only counted what appears in three training manuals. No patients were treated and no outcomes were measured, and the authors state that the presence of a technique does not show it is effective or that it changes behaviour.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →