Do combinations of behavior change techniques that occur frequently in interventions reflect underlying theory?

Lauren Connell Bohlen, Susan Michie DPhil, Marijn de Bruin, Alexander J. Rothman, Michael P. Kelly, Hilary N.K. Groarke, Rachel N. Carey, Joanna Hale, Marie Johnston

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes. Purpose This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified. Methods The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports. Results Five groups of co-occurring BCTs (range: 3-13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group-theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs. Conclusions It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation.

Original languageEnglish (US)
Pages (from-to)827-842
Number of pages16
JournalAnnals of Behavioral Medicine
Issue number11
StatePublished - Nov 1 2020

Bibliographical note

Funding Information:
We would like to express our gratitude to all of the experts in behavior change theory and interventions who committed their time and offered their expertise to participate in this study. We are also grateful to all of the authors who made explicit reference to the behavior change theories underlying their interventions. Further, we would like to give a special thanks to Holly Walton for her assistance in preparing the study data and coding many of the intervention reports included in the literature synthesis (Carey et al. [12]) This research is funded by UK Medical Research Council grant number MR/L011115/1. Support for the preparation of this manuscript was also funded by the National Institutes of Health, grant numbers T32 HL076134 and U54GM115677. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Behavioral Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.


  • Behavior change theory
  • Intervention design
  • Intervention evaluation
  • Multicomponent intervention


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