What do cost-effective health behaviour-change interventions contain? A comparison of six domains

Abstract

Objectives To help implement behaviour change interventions (BCIs) in practice it is important to be able to characterize their key components. This study compared broad features of cost-effective BCIs that addressed smoking, diet, physical activity, alcohol and sexual health. It also assessed the association of these with the magnitude of the cost-effectiveness estimates. Methods A content analysis of 79 interventions based on 338 intervention descriptions was conducted, using the Behaviour Change Wheel (BCW) to classify intervention content in terms of intervention functions, and the BCT taxonomy to identify and categorise component Behaviour Change Techniques (BCT). Regression analysis identified the association of these with upper (pessimistic) and lower (optimistic) cost-effectiveness estimates. Results The most and least common functions and BCT clusters were education (82.3%) and shaping knowledge (79.7%), and coercion (3.8%) and covert learning (2.5%). Smoking interventions contained the largest (M = 12) number of BCTs and were most cost-effective. Several other factors were associated with worse (coercion function β upper = 36551.24; shaping knowledge BCT β lower = 2427.78; comparison of outcomes BCT β upper = 9067.32; repetition and substitution BCT β upper = 7172.47) and better (modelling function β lower = -2905.3; environmental restructuring function β upper = -8646.28; reward and threat BCT β upper = -5577.59) cost-effectiveness (p<0.05). Discussion Cost-effective BCIs rely heavily on education with smoking interventions exhibiting the most comprehensive range of BCTs. Providing an example to aspire to, restructuring the environment and rewarding positive behaviour may be associated with greater cost-effectiveness.