Links Between Behavior Change Techniques and Mechanisms of Action: An Expert Consensus Study

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

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Background: Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior.

Purpose: To elicit expert consensus on links between BCTs and MoAs.

Methods: In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links.

Results: Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1-4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as "definite" links, 464 (29.2 per cent) as "definitely not" links, and 1,032 (65.1 per cent) as "possible" or "unsure" links. No "definite" links were identified for 10 BCTs (e.g., "Action Planning" and "Behavioural Substitution") and for six MoAs (e.g., "Needs" and "Optimism").

Conclusions: The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies.

Original languageEnglish
Pages (from-to)708-720
Number of pages13
JournalAnnals of Behavioral Medicine
Issue number8
Early online date19 Nov 2018
Publication statusPublished - Aug 2019

Bibliographical note

We would like to express our gratitude to all of the experts in behavior change theory and interventions who participated in this study, and to all the researchers, particularly Hilary Groarke who assisted in the preparation of figures. Support for the preparation of this manuscript was also supported by T32 HL076134 (Connell). This research is funded by UK Medical Research Council grant number MR/L011115/1.


  • behavior change
  • theory
  • methodology
  • behavior change technique
  • mechanism of action
  • expert consensus
  • Methodology
  • Theory
  • Behavior change
  • Expert consensus
  • Behavior change technique
  • Mechanism of action


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