Systematically analyzing behavior change techniques used in 44 interventions to reduce unprofessional behavior...

Area of Science:

• Health Services Research
• Behavioral Science
• Implementation Science

Background:

• Behavioral and implementation science frameworks are crucial for designing effective organizational interventions.
• Interventions addressing unprofessional behaviors (UBs) like rudeness and bullying among healthcare staff often lack robust design frameworks.
• UBs negatively impact patient safety and staff well-being.

Purpose of the Study:

• To identify active components of interventions targeting unprofessional behaviors (UBs) in healthcare staff.
• To apply the Behavior Change Technique (BCT) Ontology to categorize and understand these interventions.
• To build upon a previous realist review of UB interventions.

Main Methods:

• Updated systematic literature search (MEDLINE, Embase, CINAHL, Google Scholar) up to July 2024.
• Extracted intervention descriptions and coded them using directed content analysis against the BCT Ontology (May 2024 version, 284 BCTs).
• Included 47 reports of 44 interventions from prior review and new search.

Main Results:

• Interventions were categorized into single-session, multi-session, combined session, professional accountability, and structured culture change.
• Complex interventions utilized more BCTs; specific types focused on awareness-raising, roleplay, consequences, or goal-oriented techniques.
• Limited reporting of negative outcomes hindered understanding of which BCTs are most effective.

Conclusions:

• The BCT Ontology is applicable to organizational behavior change in healthcare.
• Complex interventions incorporate consequence-based and goal-oriented BCTs, but effectiveness requires better evaluation.
• Future interventions should adopt the BCT Ontology for improved reporting and demonstrated effectiveness.