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国家实施的 2 型糖尿病预防计划的理论基础:该计划预计如何改变行为?

The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour?

机构信息

Manchester Centre of Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.

出版信息

Int J Behav Nutr Phys Act. 2021 May 13;18(1):64. doi: 10.1186/s12966-021-01134-7.


DOI:10.1186/s12966-021-01134-7
PMID:33985524
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8117267/
Abstract

BACKGROUND: It is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers' NHS-DPP interventions. METHODS: A logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich's Theory Coding Scheme. RESULTS: The NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation - Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers' programme plans and theory described in staff training. CONCLUSIONS: A variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers' programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers' programmes is not clear.

摘要

背景:提供清晰的理论描述,说明行为改变干预措施应如何导致行为改变,这被认为是最佳实践。国民保健服务糖尿病预防计划(NHS-DPP)的委托方规定,四个独立的供应商组织必须明确描述其干预措施所依据的行为改变理论。该计划于 2016 年启动,旨在通过改变饮食和体育活动行为,防止高危成年人发展为 2 型糖尿病。本研究旨在:(a)制定一个逻辑模型,描述 NHS-DPP 预计如何运作;(b)记录供应商 NHS-DPP 干预措施所依据的行为改变理论。

方法:从 NHS-DPP 的三个规范文件中提取了一个详细说明计划如何改变饮食和活动行为的逻辑模型。为了确定四个供应商中的每一个期望他们的干预措施如何产生行为变化,从他们的计划方案、员工培训材料以及 2018 年参加的强制性员工培训课程的录音观察中提取了信息。所有材料均使用 Michie 和 Prestwich 的理论编码方案进行编码。

结果:NHS-DPP 逻辑模型包括信息提供,以导致行为改变意图,然后是一个自我监管循环,包括行动计划和监测行为。没有一个供应商描述了他们的计划如何产生行为变化的明确逻辑模型。两个供应商表示他们的计划以 COM-B(能力机会动机-行为)框架为依据,另外两个供应商描述了针对自我调节理论和自我决定理论等多个理论的因素。所有供应商都引用了一些理论结构与行为改变技术(BCT)之间的建议联系的例子,但没有一个将所有 BCT 与指定结构联系起来。在供应商的计划和员工培训中描述的理论之间注意到了一些差异。

结论:每个供应商都使用了多种行为改变理论。这可能解释了提供者在干预设计中选择的 BCT 之间的差异,以及提供者计划中描述的理论与员工培训之间的不匹配。由于没有描述他们期望干预措施如何运作的逻辑模型,因此供应商计划中干预内容的理由不清楚。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09f3/8117267/d50542e53fca/12966_2021_1134_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09f3/8117267/d50542e53fca/12966_2021_1134_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09f3/8117267/d50542e53fca/12966_2021_1134_Fig1_HTML.jpg

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本文引用的文献

[1]
Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update.

Health Technol Assess. 2021-9

[2]
Is the NHS Diabetes Prevention Programme Intervention Delivered as Planned? An Observational Study of Fidelity of Intervention Delivery.

Ann Behav Med. 2021-10-27

[3]
The Fidelity of Training in Behaviour Change Techniques to Intervention Design in a National Diabetes Prevention Programme.

Int J Behav Med. 2021-12

[4]
An evaluation of goal setting in the NHS England diabetes prevention programme.

Psychol Health. 2022-2

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BMJ Open Diabetes Res Care. 2020-12

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BMC Health Serv Res. 2020-11-27

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Implement Sci. 2020-7-20

[8]
The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review.

J Antimicrob Chemother. 2020-9-1

[9]
Does the design of the NHS Diabetes Prevention Programme intervention have fidelity to the programme specification? A document analysis.

Diabet Med. 2020-8

[10]
Early Outcomes From the English National Health Service Diabetes Prevention Programme.

Diabetes Care. 2020-1

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