Behaviour change techniques in personalised care planning for older people: a systematic review

Sadia Ahmed; Anne Heaven; Rebecca Lawton; Gregg Rawlings; Claire Sloan; Andrew Clegg

doi:10.3399/bjgp20X714017

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Figure 1.
Behaviour change techniques (BCT) within the Comprehensive Personalised Care model.
LTCs = long-term conditions.
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Figure 2.
PRISMA flow diagram.

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Wider implementation of personalised care planning (PCP) is included in national policy in the linked NHS England Personalised Care and Ageing Well programmes, and is expected to be included in the 2021–2022 GP contract negotiations. Behaviour change techniques (BCTs) are central to implementation of PCP, but are contextual, and not all BCTs are appropriate for use with older people (aged ≥65 years). Building on the current policy and operational focus on implementation of PCP for older people in primary care, this review supports the targeted intervention component of the comprehensive personalised care model by identifying six specific BCTs that have been successfully used in interventions to improve quality of life for older people.

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Table 1.

Promising behaviour change techniques

Behaviour change technique	Example	Interventions, n	Controls, n^a
Action planning	Agreeing to eat three light meals a day, with at least one hot meal. Action planning needs to include thought about when, where, and how the behaviour will take place	23	0
Goal setting (outcome)	Goals generally need to be specific, measurable, achievable, relevant, and time bound (SMART), and the result of shared decisions. For example, getting to the shops and home without assistance	21	0
Social support (unspecified)	Getting a ‘blue badge’ to allow the person to go to the shops alone	21	2
Problem solving	Working to identify the barriers preventing individuals from engaging in behaviours and identifying ‘enablers’. For example, not being able to get to a social group because of lack of transport; problem solving should address how they might access the group	19	0
Information on health consequences	General education: information about the benefits of drinking enough water (hydration), or the negative effects of consumption of sugary foods if they have diabetes	19	6
Credible source	Using information from a well-known and respected source, for example, British Heart Foundation chair-based exercises	15	4
Pharmacological support	Using pharmacological support, including appetite stimulation, to improve the appetite in patients with weight loss	14	4
Instructions on how to perform a behaviour	Advising how to use online services from the local council	13	1
Verbal persuasion about capability	Focusing on an individual’s abilities and assets, and providing verbal encouragement	12	0
Review outcome goals	Checking if goals have been achieved, and exploring barriers to achievement	9	0
Biofeedback	Breathing exercises and monitoring with spirometer	4	0

↵a The control groups did not receive the intervention being trialled but in some cases did include BCTs as part of their ‘usual care’ or as a minor ‘add on’ to usual care. BCTs = behaviour change techniques.

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Table 2.

Frequency of intervention functions

Intervention function	Frequency of use, n
Persuasion	23¹⁸^–⁴⁰
Enablement	17¹⁸^,¹⁹^,²¹^–³²^,³⁸^,⁴⁰
Education	17⁸^,²⁰^,²¹^,²³^,²⁵^,²⁷^,²⁹^–³⁶^,³⁸^,³⁹^,⁴⁰
Training	9¹⁸^,²⁴^,²⁵^,²⁷^,²⁸^,³¹^,³³^,³⁷^,⁴⁰
Environmental restructuring	6²³^,²⁴^,²⁶^–²⁸^,³⁷
Modelling	4²⁰^,²⁸^,³³^,³⁶

Supplementary Data

Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.