Table 6 Suggested intervention functions and BCTs to target key themes influencing NHS Health Check behaviours
From: Influences on NHS Health Check behaviours: a systematic review
TDF domain (COM-B) | Theme (barrier, facilitator, both barrier and facilitator) | Potential intervention functionsa | Potential policy categories | Potential BCTs |
|---|---|---|---|---|
HCP issuing invitation | ||||
 Environmental context and resources (physical opportunity) | Difficulty identifying eligible patients from records | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |
Patient attendance | ||||
 Knowledge (psychological capability) | Lack of understanding of CVD risk and purpose of NHS Health Checks | Education | Communication/ marketing Guidelines Regulation Legislation Service provision | Biofeedback (provide feedback about the body (e.g. physiological or biochemical state) using an external monitoring device as part of a behaviour change strategy) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Information about antecedents (provide information about antecedents) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) |
 Environmental context and resources (physical opportunity) | Timing and location of NHS Health Checks increased attendance | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |
Conducting NHS Health Checks in pharmacies | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) | |
 Social influences (social opportunity) | Family history of illness | Restriction Environmental restructuring Modelling Enablement | Communication/ marketing (modelling only) Guidelines (not modelling) Fiscal measures (not modelling or restriction) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (not modelling or restriction) Service provision (not restriction or environmental restructuring) | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour) Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance) Information about others’ approval (provide information about what other people think about the behaviour. The information clarifies whether others will like, approve or disapprove of what the person is doing or will do) Social reward (arrange verbal or non-verbal reward if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) |
Interactions with GP/ being told to change | Restriction Environmental restructuring Modelling Enablement | Communication/ marketing (modelling only) Guidelines (not modelling) Fiscal measures (not modelling or restriction) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (not modelling or restriction) Service provision (not restriction or environmental restructuring) | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour) Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance) Information about others’ approval (provide information about what other people think about the behaviour. The information clarifies whether others will like, approve or disapprove of what the person is doing or will do) Social reward (arrange verbal or non-verbal reward if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) | |
 Beliefs about consequences (reflective motivation) | NHS Health Checks not always perceived beneficial for early detection | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
NHS Health Checks provided opportunity to be proactive about health | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) | |
 Emotion (automatic motivation) | Anxiety at receiving high risk result | Persuasion Incentivisation Coercion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (not persuasion or modelling) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (enablement only) Service provision | Reduce negative emotions (advise on ways of reducing negative emotions to facilitate performance of the behaviour (includes ‘stress management’)) |
Reassurance as a motivation to attend | Persuasion Incentivisation Coercion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (not persuasion or modelling) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (enablement only) Service provision | Reduce negative emotions (advise on ways of reducing negative emotions to facilitate performance of the behaviour (includes ‘stress management’)) | |
HCP delivering NHS Health Check | ||||
 Knowledge (psychological capability) | HCPs perceptions of patients understanding of CVD risk | Education | Communication/ marketing Guidelines Regulation Legislation Service provision | Biofeedback (provide feedback about the body (e.g. physiological or biochemical state) using an external monitoring device as part of a behaviour change strategy) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Information about antecedents (provide information about antecedents) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) |
HCPs familiarity with guidelines and associated tools | Education | Communication/ marketing Guidelines Regulation Legislation Service provision | Biofeedback (provide feedback about the body (e.g. physiological or biochemical state) using an external monitoring device as part of a behaviour change strategy) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Information about antecedents (provide information about antecedents) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) | |
 Cognitive and interpersonal skills (psychological capability) | HCPs perceived need for training to deliver behavioural support | Training | Guidelines Fiscal measures Regulation Legislation Service provision | Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Behavioural practice/rehearsal (prompt practice or rehearsal of the performance of the behaviour one or more times in a context or at a time when the performance may not be necessary, in order to increase habit and skill) Graded tasks (set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed) |
HCP training to communicate risk | Training | Guidelines Fiscal measures Regulation Legislation Service provision | Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Behavioural practice/rehearsal (prompt practice or rehearsal of the performance of the behaviour one or more times in a context or at a time when the performance may not be necessary, in order to increase habit and skill) Graded tasks (set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed) | |
 Memory attention decision processes (psychological capability) | Behavioural intervention before pharmacological intervention | Training Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/social planning (not training) Service provision (not environmental restructuring) | Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Conserving mental resources (advise on ways of minimising demands on mental resources to facilitate behaviour change) |
 Environmental context and resources (physical opportunity) | Limited time/ resources to deliver NHS Health Checks | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |
Appropriate space to deliver NHS Health Checks | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) | |
Computer systems supporting NHS Health Check delivery | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) | |
 Social influences (social opportunity) | Taking account of patients’ social context | Restriction Environmental restructuring Modelling Enablement | Communication/ marketing (modelling only) Guidelines (not modelling) Fiscal measures (not modelling or restriction) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (not modelling or restriction) Service provision (not restriction or environmental restructuring) | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour) Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance) Information about others’ approval (provide information about what other people think about the behaviour. The information clarifies whether others will like, approve or disapprove of what the person is doing or will do) Social reward (arrange verbal or non-verbal reward if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) |
 Social/professional role and identity (reflective motivation) | Role clarity in delivering NHS Health Checks | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour)b Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance)b Credible source (present verbal or visual communication from a credible source in favour of or against the behaviour)b Identity associated with changed behaviour (advise the person to construct a new self-identity as someone who ‘used to engage with the unwanted behaviour’)b |
Diversification of pharmacy staff role | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour)b Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance)b Credible source (present verbal or visual communication from a credible source in favour of or against the behaviour)b Identity associated with changed behaviour (advise the person to construct a new self-identity as someone who ‘used to engage with the unwanted behaviour’)b | |
 Beliefs about consequences (reflective motivation) | Belief that NHS Health Checks were beneficial in terms of preventive healthcare | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
Message framing | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) | |
 Beliefs about capabilities (reflective motivation) | HCP confidence in discussing and initiating behaviour change | Education Persuasion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (enablement only) Regulation (not modelling) Legislation (not modelling) Environmental /social planning (enablement only) Service provision | Problem solving (analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators (includes ‘relapse prevention’ and ‘coping planning’)) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Demonstration of the behaviour (provide an observable sample of the performance of the behaviour, directly in person or indirectly e.g. via film, pictures, for the person to aspire to or imitate (includes ‘modelling’)) Behavioural practice/rehearsal (prompt practice or rehearsal of the performance of the behaviour one or more times in a context or at a time when the performance may not be necessary, in order to increase habit and skill) Graded tasks (set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed) Verbal persuasion about capability (tell the person that they can successfully perform the wanted behaviour, arguing against self-doubts and asserting that they can and will succeed) Focus on past success (advise to think about or list previous successes in performing the behaviour (or parts of it)) Self-talk (prompt positive self-talk (aloud or silently) before and during the behaviour) |
 Optimism (reflective motivation) | HCPs varyingly optimistic about patient behaviour change after NHS Health Checks | Education Persuasion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (enablement only) Regulation (not modelling) Legislation (not modelling) Environmental /social planning (enablement only) Service provision | Review outcome goal(s) (review outcome goal(s) jointly with the person and consider modifying goal(s) in light of achievement. This may lead to re-setting the same goal, a small change in that goal or setting a new goal instead of, or in addition to the first)b |
HCP making referral to specialist service | ||||
 Environmental context and resources (physical opportunity) | Lack of funded services to refer patients to | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |
Patient attending referral | ||||
 Beliefs about consequences (reflective motivation) | Regular attendance is important | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
Patient changing behaviour | ||||
 Knowledge (psychological capability) | Patient understanding of CVD risk and its implications after NHS Health Check | Education | Communication/ marketing Guidelines Regulation Legislation Service provision | Biofeedback (provide feedback about the body (e.g. physiological or biochemical state) using an external monitoring device as part of a behaviour change strategy) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Information about antecedents (provide information about antecedents) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) |
 Environmental context and resources (physical opportunity) | Time and cost as a barrier to adherence | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |
Adherence to behavioural support influenced by mode of communication of risk | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) | |
 Social influences (social opportunity) | Support from others to change | Restriction Environmental restructuring Modelling Enablement | Communication/ marketing (modelling only) Guidelines (not modelling) Fiscal measures (not modelling or restriction) Regulation (not modelling) Legislation (not modelling) Environmental/ Social planning (not modelling or restriction) Service provision (not restriction or environmental restructuring) | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour) Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance) Information about others’ approval (provide information about what other people think about the behaviour. The information clarifies whether others will like, approve or disapprove of what the person is doing or will do) Social reward (arrange verbal or non-verbal reward if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) |
 Social/professional role and identity (reflective motivation) | Patient engagement is influenced by HCP role | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Social support – unspecified (advise on, arrange or provide social support (e.g. from friends, relatives, colleagues,’ buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour)b Social comparison (draw attention to others’ performance to allow comparison with the person’s own performance)b Credible source (present verbal or visual communication from a credible source in favour of or against the behaviour)b Identity associated with changed behaviour (advise the person to construct a new self-identity as someone who ‘used to engage with the unwanted behaviour’)b |
 Beliefs about capabilities (reflective motivation) | Changes perceived to be achievable | Education Persuasion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (enablement only) Regulation (not modelling) Legislation (not modelling) Environmental /social planning (enablement only) Service provision | Problem solving (analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators (includes ‘relapse prevention’ and ‘coping planning’)) Instruction on how to perform behaviour (advise or agree on how to perform the behaviour (includes ‘Skills training’)) Demonstration of the behaviour (provide an observable sample of the performance of the behaviour, directly in person or indirectly e.g. via film, pictures, for the person to aspire to or imitate (includes ‘modelling’)) Behavioural practice/rehearsal (prompt practice or rehearsal of the performance of the behaviour one or more times in a context or at a time when the performance may not be necessary, in order to increase habit and skill) Graded tasks (set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed) Verbal persuasion about capability (tell the person that they can successfully perform the wanted behaviour, arguing against self-doubts and asserting that they can and will succeed) Focus on past success (advise to think about or list previous successes in performing the behaviour (or parts of it)) Self-talk (prompt positive self-talk (aloud or silently) before and during the behaviour) |
 Beliefs about consequences (reflective motivation) | Contradictory guidelines | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
Perceptions of what constitutes healthy behaviour | Education Persuasion Modelling | Communication/ marketing Guidelines (not modelling) Regulation (not modelling) Legislation (not modelling) Service provision | Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Salience of consequences (use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)) Information about social and environmental consequences (provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour) Anticipated regret (induce or raise awareness of expectations of future regret about performance of the unwanted behaviour) Information about emotional consequences (provide information (e.g. written, verbal, visual) about emotional consequences of performing the behaviour) Pros and cons (advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour (includes ‘decisional balance’)) Comparative imagining of future outcomes (prompt or advise the imagining and comparing of future outcomes of changed versus unchanged behaviour) Material incentive - behaviour (inform that money, vouchers or other valued objects will be delivered if and only if there has been eff ort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) Reward - outcome (arrange for the delivery of a reward if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) | |
 Intentions (reflective motivation) | NHS Health Checks as a ‘wake-up call’ | Education Persuasion Incentivisation Coercion Modelling | Communication/ marketing Guidelines (not modelling) Fiscal measures (incentivisation and coercion only) Regulation (not modelling) Legislation (not modelling) Service provision | Goal setting - behaviour (set or agree a goal defined in terms of the behaviour to be achieved) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
 Optimism (reflective motivation) | Fatalistic views about disease | Education Persuasion Modelling Enablement | Communication/ marketing (not enablement) Guidelines (not modelling) Fiscal measures (enablement only) Regulation (not modelling) Legislation (not modelling) Environmental /social planning (enablement only) Service provision | Review outcome goal(s) (review outcome goal(s) jointly with the person and consider modifying goal(s) in light of achievement. This may lead to re-setting the same goal, a small change in that goal or setting a new goal instead of, or in addition to the f |
Patient attending repeat NHS Health Check | ||||
 Intentions (reflective motivation) | Likelihood of attending future NHS Health Checks | Education Persuasion Incentivisation Coercion Modelling | Communication/ marketing Guidelines (not modelling) Fiscal measures (incentivisation and coercion only) Regulation (not modelling) Legislation (not modelling) Service provision | Goal setting - behaviour (set or agree a goal defined in terms of the behaviour to be achieved) Information about health consequences (provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour) Incentive – outcome (inform that a reward will be delivered if and only if there has been eff ort and/or progress in achieving the behavioural outcome (includes ‘positive reinforcement’)) |
HCP recording NHS Health Check data | ||||
 Environmental context and resources (physical opportunity) | Accuracy of recording is compromised by multiple methods of invitation | Training Restriction Environmental restructuring Enablement | Guidelines Fiscal measures Regulation Legislation Environmental/ Social planning (not training or restriction) Service provision (not restriction or environmental restructuring) | Social support – practical (advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour) Prompts/cues (introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour normally occurring at the time or place of performance) Remove aversive stimulus (advise or arrange for the removal of an aversive stimulus to facilitate behaviour change) Restructuring the physical environment (change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Restructuring the social environment (change, or advise to change the social environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments) Avoidance/reducing exposure to cues for the behaviour (advise on how to avoid exposure to specific social and contextual/physical cues for the behaviour, including changing daily or weekly routines) Adding objects to the environment (add objects to the environment in order to facilitate performance of the behaviour) |