Behaviour change techniques and mechanisms of action: identification of the active ingredients in communication partner training for people with acquired brain injury

Background

Cognitive-communication disorders (CCD) are common after acquired brain injury (ABI) and can have a negative impact on a person's life. Training a communication partner can improve the communication skills of the person with ABI; however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners (CPs), though there is variability in the content, dosage and delivery of training; and published programmes are rarely used by speech and language therapists in practice. The strongest evidence is for a single programme, TBI Express, which has three different versions. Therefore, the aim of this study is to identify and describe the active components of existing training programmes for people with CCD.

Method

The treatment manuals from each of the training programmes (i.e., TBI Express, TBI Express-Adapted, and TBIconneCT) were coded using the BCTTv1. Mechanisms of action (MoAs) and each behaviour change technique (BCT) was identified and linked using the Theory and Techniques Tool. Prior to coding, pilot coding was completed on two modules from TBI Express with reliability of coding established (kappa and % agreement) for two modules of the remaining two programmes representing ∼20–33% of treatment content. Coding disagreements were recorded and described and subsequently resolved.

Results

Across the three programmes, between 20 and 25 BCTs were identified and comprised 27 unique BCTs across all manuals. These BCTs were linked to between 15–16 identified MoAs and comprised 16 unique MoAs. The most common BCTs were providing information about social and environmental consequences; instruction on how to perform the behaviour; behavioural practice/rehearsal; and feedback on the behaviour. The most common mechanisms targeted were beliefs about capabilities; skills; and behavioural regulation. Reliability of coding BCTs and MOAs was moderate-to-almost-perfect (kappa = 0.69–0.88, 73–85% agreement). Disagreements in coding were discussed and resolved through consensus agreement.

Conclusions

Applying behaviour change theory to TBI Express has revealed unique insight into the active ingredients of training. CPs are anticipated to improve their communication behaviours via capabilities, skills and regulation, through SLT-delivered CPT which focuses most commonly on information provision, instruction, rehearsal, and feedback. Such insights are gathered to further refine and adapt existing interventions. Further work is needed to identify the most important active ingredients to expert clinicians, to design and test the feasibility of an adapted CPT programme for implementation in public healthcare services.

WHAT THIS PAPER ADDS

What is already known on this subject

Training a communication partner can improve the communication skills of people with ABI however; families are dissatisfied with existing education, training and support. Speech and language therapists face barriers in the workplace and there is variability in the range of evidence-based programmes for training communication partners.

What this study adds to existing knowledge

Through exploration of three existing evidence-based communication partner training programmes, this study identifies the active components required to deliver training to individuals with ABI and their communication partners. Mechanisms of change and behaviour change techniques are identified for each of the three programmes, highlighting areas of commonality between the three programmes.

What are the potential or actual clinical implications of this study?

Training communication partners is a complex and multicomponential intervention. Communication partners are anticipated to improve their communication behaviours via capabilities, skills and regulation, through training that focuses on information provision, instruction, rehearsal, and feedback. This research gives therapists an understanding of what is important when training communication partners and provides insight to researchers to refine and adapt existing training programmes.