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Table 1 Behaviour change techniques

From: A process and mechanism of action evaluation of the effect of early and intensive nutrition care, delivered via telephone or mobile application, on quality of life in people with upper gastrointestinal cancer: a study protocol

Behaviour change technique Definition [37] Example Classificationa
1. Goals and Planning
 1.1 Goal setting (behaviour) Set or agree on a goal defined in terms of the behaviour to be achieved Set the goal of eating 5 pieces of fruit per day Routinely Used
 1.2 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 Prompt the patient to identify potential barriers to them drinking a particular supplement (e.g. bad taste) and discuss ways in which they could overcome them (e.g. mix with strawberries) Supplementary
 1.3 Goal setting (outcome) Set or agree on a goal defined in terms of a positive outcome of wanted behaviour Set a weight gain goal (e.g. 0.5 kg over 1 week) as an outcome of changed eating patterns Supplementary
 1.4 Action planning Prompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration and intensity). Context may be environmental (physical or social) or internal (physical, emotional or cognitive) Prompt planning the drinking of a supplement at a particular time (e.g. before work) on certain days of the week Routinely Used
 1.5 Review goal (behaviour) Review behaviour goal(s) jointly with the person and consider modifying goal(s) or behaviour change strategy 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, or no change. Ask if the patient drank the supplement as planned Routinely Used
 1.6 Highlight discrepancy between current and goal (behaviour or outcome) Draw attention to discrepancies between a person’s current behaviour (in terms of the form, frequency, duration, or intensity of that behaviour) or outcome and the person’s previously set behavioural goals or action plans Point out that the recorded supplement intake fell short of the goal set Routinely used
 1.7 Review goal (outcome) Review outcome goal(s) jointly with the person and consider modifying goal(s) in light of achievement. This may lead to resetting the same goal, a small change in that goal or setting a new goal instead of, or in addition to the first Ask if the patient achieved the weight gain goal Supplementary
2. Feedback and Monitoring
 2.1 Monitoring of behaviours by others, without feedback Observe or record behaviour with the person’s knowledge as part of a behaviour change strategy Have partner observe food intake behaviours and make notes on content and frequency Supplementary
 2.3 Self-monitoring of behaviour Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy Ask the person to record daily, in a diary, the amount of food they have eaten Supplementary
 2.4 Self-monitoring of outcome of behaviour Establish a method for the person to monitor and record the outcome(s) of their behaviour as part of a behaviour change strategy Ask the person to weigh themselves at the end of each day, over a two-week period, and record their daily weight on a graph to increase food intake Supplementary
 2.5 Monitoring outcomes of behaviours by others, without feedback Observe or record outcomes of behaviour with the person’s knowledge as part of the behaviour change strategy Record weight maintenance/gain, blood glucose levels Supplementary
 2.6 Biofeedback Provide feedback about the body using an external monitoring device as part of a behaviour change strategy Inform the person of the blood sugar levels to improve their adoption of insulin use Supplementary
 2.7 Feedback on outcome(s) of behaviour Monitor and provide feedback on the outcome of the performance of the behaviour Inform the person of their stable weight following implementation of high energy, high protein diet regimen Supplementary
3. Social Support
 3.1 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 Arrange for a partner to encourage patient to use supplements Supplementary
 3.2 Social support (practical) Advise on, arrange, or provide practical help (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour Ask the partner to mix the supplement with strawberries for the patient Supplementary
 Social support (emotional) 3.3 Advise on, arrange or provide emotional social support (e.g. from friends, relatives, colleagues, buddies or staff) for performance of behaviour Ask a patient to take a partner to your surgeon appointment Supplementary
4. Shaping Knowledge
 4.1 Instruction on how to perform behaviour Advise or agree on how to perform the behaviour (includes ‘Skills training’) Demonstrate or describe to person how to prepare thickened fluids Routinely Used
 4.2 Information about antecedents Provide information about antecedents (e.g. social and environmental situations and events, emotions, cognitions) that reliably predict performance of the behaviour Discuss how people find it difficult to follow their diet when they attend social events Supplementary
5. Natural consequences
 5.1 Provide information (e.g. Written, verbal, visual) about health consequences of performing the behaviour Provide information (e.g. Written, verbal, visual) about health consequences of performing the behaviour Present written information about the positive effect on weight and maintaining nutrition status with adoption of high energy high protein diet regimen Supplementary
7. Associations
 7.1 Prompts / cues Introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour. The prompt or cue would normally occur at the time or place of performance Put a sticker on fridge to avoid eating cheesecake Supplementary
8. Repetition and substitution
 8.7 Graded tasks Set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed Ask patient to consume supplement once per day the first week, then twice per day the second week. Supplementary
9. Comparison of outcomes
 9. 2 Consider pros and cons Advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behaviour Advise the person to list and compare the advantages and disadvantages of drinking the supplement Supplementary
11. Regulation
 11.1 Pharmacological Support Provide, or encourage the use of or adherence to drugs to facilitate behaviour change Advise the person to take regular anti-nausea medications when they are nauseated Supplementary
12. Antecedents
 12.1 Restructuring the physical environment Change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour Advise to make a 1 L jug of Sustagen and keep in the fridge to sip during the day Supplementary
 12.2 Restructuring the social environment Change, or advise to change the social environment in order to facilitate performance of the wanted behaviour Advise a person the to sit with a family member/friend at meals and snacks Supplementary
 12.6 Body changes Alter body structure, functioning or support directly to facilitate behaviour change Prompt use of dentures to promote food consumption Supplementary
15. Self-belief
 15.1 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 Tell the person that that can successfully maintain their weight despite ongoing treatment Supplementary
 15.3 Focus on past success Advise to think about or list previous successes in performing the behaviour Advise to describe or list the times they were able to drink their prescribed nutrition supplements drinks during chemotherapy Supplementary
  1. aBehaviour change techniques have been classified as routinely used techniques to be used with all participants, and supplementary techniques that can be optionally be used *Adapted from BCT Taxonomy V1: 93 hierarchically-clustered techniques [37]