Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature

Rachel N Carey, Lauren E. Connell, Marie Johnston, Alexander J. Rothman, Marijn de Bruin, Michael P. Kelly, Susan Michie (Corresponding Author)

Research output: Contribution to journalArticlepeer-review

302 Citations (Scopus)
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Background: Despite advances in behavioral science, there is no widely shared understanding of the "mechanisms of action" (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change.

Purpose: This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature.

Methods: Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link.

Results: Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT-MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were "Beliefs about Capabilities" and "Intention." Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1-5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1-8).

Conclusions: The BCT-MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.

Original languageEnglish
Pages (from-to)693-707
Number of pages15
JournalAnnals of Behavioral Medicine
Issue number8
Early online date10 Oct 2018
Publication statusPublished - 1 Aug 2019

Bibliographical note

We would like to express our gratitude to all those who sent us peer-reviewed behavior change intervention descriptions for this study, to Dr. Emma Beard and Dr. Dan Dediu for their statistical input, and to all the researchers, particularly Holly Walton and Hilary Groarke, who assisted in the coding of reports and preparation of figures. This research is funded by UK Medical Research Council grant number MR/L011115/1.


  • behavior change
  • theory
  • methodology
  • behavior change technique
  • mechanism of action
  • evidence synthesis


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