Table 1 Linkage between learning goals, activities, behaviour change techniques and mechanism of action for Better Back☺ MoC
Target behaviour: Improved HCP confidence and biopsychosocial orientation in treating LBP through adoption of BetterBack☺ MoC | ||||
Rational based on modifiable barriers to be addressed: 1. Low confidence in skills/capabilities for improving LBP patient management; 2. Use of a biomedical treatment orientation rather than a biopsychosocial orientation; 3. Low awareness of the model; 4. Beliefs of negative consequences of the model. | ||||
Strategy to attain target behaviour: Multifaceted implementation of MoC content to overcome modifiable barriers | Mechanism of action | |||
Learning goals | Learning Activities (Intervention functions)a | Behavioural change techniques used and taxonomy code | TDF domains | COM-B model |
1) PTs understand evidence-based guideline recommendations for treatment of LBP. 2) PTs understand the theoretical content and clinical benefits of adopting the BetterBack MoC | • A ‘state-of-the-art’ lecture and web-based resources including an overview of the content of evidence-based guideline recommendations (Ed, P, E) | 4.1 Instruction on how to perform the behaviour 6.3 Information about other’s approval 9.1 Credible source 9.2 Pros and cons 9.3 Comparative imagining of future outcomes | Knowledge | CAPABILITY DOMAIN |
PTs have the skills to practically use the MoC support tools to: 3) Assist clinical reasoning for matching assessment findings with appropriate diagnosis and stratified treatment 4) Deliver the patient education interventions 5) Deliver exercise interventions | • Demonstration of how to use the MoC support tools (Ed, T, En, M) • Case based practical skills training and role play in small groups using MoC support tools (Ed, T, En) • Peer discussion and reflections upon how they can practically apply the MoC support tools in clinical practice (T, En, M) | 1.2 Problem solving 2.2 Feedback on behaviour 3.1 Social support 4.1 Instruction on how to perform the behaviour 6.1 Demonstration of behaviour 6.3 Information about other’s approval 8.1 Behavioural practice/rehearsal 8.7 Graded task 13.2 Framing/re-framing 15.1 Verbal persuasion about capability | Skills | |
6) PTs have a plan how to start and maintain use of the MoC | • Clinical champion presents an administrative action plan (designed earlier in consensus with clinical colleagues) for the implementation of the MoC at their clinic (Ed, En) • Web-based chat forum for question and feedback (Ed, En) | 1.4 Action planning 4.1 Instruction on how to perform the behaviour 12.5 Adding objects to the environment | Behavioural regulation | |
7) PTs know that their workplace supports delivering the MoC | • Outreached visits before and during the study with managers and clinical champions involved (E, Ed, En) | 3.1 Social support 6.3 Information about others’ approval | Organisation | OPPORTUNITY DOMAIN |
8) PTs share knowledge and work together and know whom to ask when they experience difficulty in delivering the MoC | • PTs working together with colleagues in small groups addressing the different parts of the MoC with involvement of the clinical champion (T, M, En) | 3.1 Social support 13.1 Identification of self as role model 13.2 Framing/reframing | Social Influences | |
9) PTs believe that the MoC is appropriate for and accepted by the patient | • A ‘state-of-the-art’ lecture and web-based resources including an overview of the content of evidence-based guideline recommendations (Ed, P, E) | 9.3 Comparative imagining of future outcomes | Patients | |
10) PTs experience that they can tailor the MoC to the patient’s need and clinical practice | • Case based practical skills training working with different patient profiles to address use and tailoring of different components of the MoC (Ed, T, En) | 12.1. Restructuring the physical environment 12.2. Restructuring the social environment 12.5 Adding objects to the environment | Innovation | |
11) PTs feel confident that they can deliver the MoC | • A ‘state-of-the-art’ lecture and web-based resources including an overview of the content of evidence-based guideline recommendations (Ed, P, E) • Demonstration of how to use the MoC support tools (Ed, T, En, M) • Case based practical skills training and role play in small groups using MoC support tools (Ed, T, En) • Peer discussion and reflections upon how they can practically apply the MoC support tools in clinical practice (T, En, M) | 1.2 Problem solving 2.2 Feedback on behaviour 3.1 Social support 4.1 Instruction on how to perform the behaviour 6.1 Demonstration of behaviour 6.3 Information about other’s approval 8.1 Behavioural practice/rehearsal 8.7 Graded task 9.1 Credible source 9.2 Pros and cons 9.3 Comparative imagining of future outcomes 13.2 Framing/re-framing 15.1 Verbal persuasion about capability | Beliefs about Capabilities | MOTIVATION DOMAIN |
12) PTs have positive beliefs about the consequences of adopting the MoC | • Presentation of the benefits of using the MoC support tools for assessment, diagnosis and treatment intervention (Ed, P) • Participants discussed the important future outcomes of the MoC implementation based on: 1. A professional perspective; 2. A patient perspective (M) | 4.1 Instruction on how to perform the behaviour 5.3 Information about social and environmental consequences 6.3 Information about other’s approval 9.1 Credible source 9.3 Comparative imagining of future outcomes | Beliefs about consequences | |
13) PTs intend to use the MoC in their clinics in the future | • Facilitated group discussion about practical organisation of delivery the MoC with examples of solutions with clinical champions involved. (P, En) | 3.1 Social support 4.1 Instruction on how to perform the behaviour 9.1 Credible source 9.3 Comparative imagining of future outcomes | Intentions | |