Optimizing Making Every Contact Count (MECC) Interventions: A Strategic Behavioral Analysis

• Published in: Health psychology 2021-12, Vol.40 (12), p.960-973
• Main Authors: Haighton, Catherine, Newbury-Birch, Dorothy, Durlik, Caroline, Sallis, Anna, Chadborn, Tim, Porter, Lucy, Harling, Mandy, Rodrigues, Angela
• Format: Article
• Language: English
• Subjects: Applied behavior analysis; Barriers; Behavior; Behavior Analysis; Behavior Change; Behavior Therapy; Capabilities; Classification; Content analysis; Emotions; England; Environmental Effects; Health care; Health Personnel; Human; Humans; Implementation; Intervention; Medical personnel; Mixed methods research; National identity; Occupational roles; Optimization; Professional identity; Professional Role; Roles; Social skills; Strategic Therapy; Systematic review; Taxonomies; Treatment Barriers
• ISSN: 0278-6133; 1930-7810
• DOI: 10.1037/hea0001100

Objective: This Strategic Behavioral Analysis aimed to: identify barriers and facilitators to health care professionals' implementation of Making Every Contact Count (MECC); code behavioral components of nationally delivered interventions to improve MECC implementation; assess the extent to which these components are theoretically congruent with identified theoretical domains representing barriers and facilitators. Comparing national interventions that aim to support implementation of behavior change related activity to the barriers and facilitators for the target behavior enables identification of opportunities being missed in practice; thereby, facilitating intervention optimization. Method: A mixed-method study involving: a systematic review to identify barriers and facilitators to implementing MECC classified using the COM-B model and Theoretical Domains Framework (TDF); a content analysis of national interventions to improve MECC implementation in England using the Behavior Change Wheel (BCW) and Behavior Change Techniques Taxonomy (BCTTv1); linking intervention content to barriers identified in the systematic review. Results: Across 27 studies, the most frequently reported barriers related to eight TDF domains: Environmental Context and Resources, Beliefs About Capabilities, Knowledge, Beliefs About Consequences, Intentions, Skills, Social Professional Role and Identity, and Emotions. National interventions aimed at supporting MECC implementation included on average 5.1 BCW intervention functions (Education, Modeling, Persuasion, and Training were used in all interventions) and 8.7 BCTs. Only 21% of BCTs potentially relevant to key domains were used across interventions. The majority of BCTs linked to seven of the eight most important domains were not used in any existing interventions. Conclusions: Intervention developers should seize missed opportunities by incorporating more theoretically relevant BCTs to target barriers to implementing MECC.