Abstract
Background
Implementation strategies are essential for translating evidence into routine clinical practice. Their effectiveness depends on specifying and deploying behavior change techniques (BCTs): observable, irreducible components that target determinants of clinician behavior. The Behavior Change Technique Ontology (BCTO) standardizes the identification and labeling of BCTs, yet it has been applied only sparingly in implementation research to date.
Purpose
To characterize the nature and extent of BCTs explicitly reported or retrospectively identified in implementation trials that targeted evidence-based nursing practice.
Methods
In this secondary analysis of a prior systematic review, we coded BCTs across 151 implementation trials with a manual derived from the 281-item BCTO. One to two coders per study applied coding rules in NVivo; disagreements were resolved by consensus. Feasibility indicators included coder certainty (“Definitely” vs “Probably” present) and the need for extra coding rules.
Results
Trials contained 907 BCT instances: 857 in intervention arms, 50 in controls. We identified 100 of the BCTO’s 281 techniques (35.6%), spanning 17 of its 20 parent groups. Intervention arms featured a median of four BCT instances (IQR 3–7) and four unique BCTs (IQR 3–5). The five most common BCTs were Instruct how to perform behavior (n = 273), Arrange informational support (n = 127), Deliver informational support (n = 83), Demonstrate behavior (n = 62), and Practice behavior (n = 43). Only 37% of BCT instances were coded with high certainty, and 17 supplementary decision rules were required for consistent coding.
Conclusions
Implementation strategies targeting nursing practice rely on instructional and informational BCTs, with limited use of goal-directed, feedback-intensive or context-altering techniques that could enhance impact.
Clinical Trial information
The Clinical Trials Registration PROSPERO CRD42019130446.
Implementation strategies are essential for translating evidence into routine clinical practice. Their effectiveness depends on specifying and deploying behavior change techniques (BCTs): observable, irreducible components that target determinants of clinician behavior. The Behavior Change Technique Ontology (BCTO) standardizes the identification and labeling of BCTs, yet it has been applied only sparingly in implementation research to date.
Purpose
To characterize the nature and extent of BCTs explicitly reported or retrospectively identified in implementation trials that targeted evidence-based nursing practice.
Methods
In this secondary analysis of a prior systematic review, we coded BCTs across 151 implementation trials with a manual derived from the 281-item BCTO. One to two coders per study applied coding rules in NVivo; disagreements were resolved by consensus. Feasibility indicators included coder certainty (“Definitely” vs “Probably” present) and the need for extra coding rules.
Results
Trials contained 907 BCT instances: 857 in intervention arms, 50 in controls. We identified 100 of the BCTO’s 281 techniques (35.6%), spanning 17 of its 20 parent groups. Intervention arms featured a median of four BCT instances (IQR 3–7) and four unique BCTs (IQR 3–5). The five most common BCTs were Instruct how to perform behavior (n = 273), Arrange informational support (n = 127), Deliver informational support (n = 83), Demonstrate behavior (n = 62), and Practice behavior (n = 43). Only 37% of BCT instances were coded with high certainty, and 17 supplementary decision rules were required for consistent coding.
Conclusions
Implementation strategies targeting nursing practice rely on instructional and informational BCTs, with limited use of goal-directed, feedback-intensive or context-altering techniques that could enhance impact.
Clinical Trial information
The Clinical Trials Registration PROSPERO CRD42019130446.
| Original language | English |
|---|---|
| Article number | ibaf046 |
| Number of pages | 14 |
| Journal | Translational Behavioral Medicine |
| Volume | 15 |
| Issue number | 1 |
| Early online date | 23 Sept 2025 |
| DOIs | |
| Publication status | Published - 23 Sept 2025 |
Bibliographical note
AcknowledgementsWe wish to acknowledge Justin Presseau for this support during the elaboration of the methodology.
Data Availability Statement
De-identified data from this study are not available in a public archive. De-identified data from this study will be made available by emailing the corresponding author.Funding
This project is supported by a project grant from the Quebec Health Research Fund (FRQ-S) & Quebec Network on Nursing Intervention Research (RRISIQ) (grant number: 347409). G.F. is supported by a Junior 1 Research Scholar Award from the FRQS. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
| Funders | Funder number |
|---|---|
| Quebec Health Research Fund | |
| Quebec Network on Nursing Intervention Research | 347409 |
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