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Table 4 Summary of intervention components to target determinants

From: Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Determinant

Intervention component objective

Strategy

Intervention component

Description of intervention component

BCT’s targeted

Theoretical Basis

Management of side effects

Increase ability to self-manage side effects

Reduce impact of side effects

Inform patients of self-management strategies for common side effects

Self-management website

A website for self-management of side effects. Strategies to manage side effects with a summary of the strength of evidence for that side effect in a patient-friendly manner. Side effects included are arthralgia, fatigue, vulvovaginal symptoms, gastrointestinal symptoms, hot flushes and sleep difficulties.

1.2, 3.1, 3.3, 4.1, 5.1, 5.3, 5.6, 6.2, 6.3, 9.1, 11.1, 12.2, 12.5, 12.6

 

Medication and illness beliefs

Increase beliefs about the necessity of using AET beliefs

Provide information on how AET works and the benefits of AET.

Information Leaflet

A written information leaflet with five different elements:

 (1) An explanation of how AET works, including medical diagrams

 (2) Information and infographics about the benefits of AET

 (3) Information about the prevalence of side effects from AET

 (4) Answers to common concerns about AET

 (5) Quotes from breast cancer survivors about their experiences taking AET, and a statement highlighting that the leaflet was co-designed

1.2, 4.1, 4.3, 5.1, 5.2, 5.6, 6.2, 6.3, 9.1, 9.2, 11.2, 13.2

Necessity Concerns Framework, Common Sense Model of Illness Representations

Reduce concerns about AET

Provide information on the prevalence of side effects, answer common concerns about AET.

Support formation of accurate illness perceptions

Provide information on the mechanism of AET and the benefits of AET to enhance coherence, personal and treatment control

Knowledge

Learn about AET, including how it works, the benefits and side effects of it

Provide information about AET, it’s mechanism of action, benefits and side effect information

Information Leaflet

As above

As above

As above

Forgetfulness

Learn strategies to remember to take AET

Support the habit formation of daily medication taking and associated activities such as ordering and collecting prescriptions

SMS messages

SMS messages providing practical strategies to support taking medication regularly each day. Messages are sent in the following frequency:

 • 2 weeks of daily messages

 • 8 weeks of twice weekly messages

 • 6 weeks of weekly messages

1.2, 1.4a, 2.3a, 7.1a, 7.3, 8.3a, 11.3, 12.1)a, 12.5)a

Habit Theory

Psychological distress

Reduce psychological distress

Increase psychological flexibility

ACT

A guided-self help intervention based on ACT principles involving four skills:

 (1) Mindfulness: broad awareness of the here-and-now.

 (2) Unhooking: engaging and disengaging from thoughts as suits your purpose, and letting go of struggles with yourself.

 (3) Follow your values: ongoing engagement with your values; consistently choosing to move in meaningful directions.

 (4) Living beyond labels: Taking a perspective beyond labels and responding to yourself in ways that help you grown and learn

The modules contain home practice tasks and are supported by individual sessions with a psychologist in the following format:

 (1) 15 minute introduction

 (2) 3 × 25 minute sessions following modules 1, 2 and 3

 (3) 15 minute closing session following module 4

1.1, 1.2, 1.5, 1.6b, 1.7, 2.3, 2.4, 3.1c, 4.1, 4.4, 5.2, 5.4, 5.6, 6.1, 6.2, 8.1, 8.2, 8.7, 9.1, 9.2, 10.9, 11.3, 11.4, 13.4, 15.2, 15.3

ACT (based on relational frame theory)

  1. 1.1 Goal setting (behavior); 1.2 Problem solving; 1.4 Action Planning; 1.5 Review behavior goals; 1.6 Discrepancy between current behavior and goal; 1.7 Review outcome goal(s); 2.3 Self-monitoring of behavior; 2.4 Self-monitoring of outcome(s) of behavior; 3.1 Social support (unspecified); 3.3 Social support (emotional); 4.1 Instruction on how to perform a behavior; 4.3 Re-attribution; 4.4 Behavioral Experiments; 5.1 Information about health consequences; 5.2 Salience of Consequences; 5.3 Information about social and environmental consequences; 5.4 Monitoring of emotional consequences; 5.6 Information about emotional consequences; 6.1 Demonstration of the behavior; 6.2 Social comparison; 6.3 Information about others’ approval; 7.1 Prompts/cues; 7.3 Reduce prompts/cues; 8.1 Behavioral practice/ rehearsal; 8.2 Behavior substitution; 8.3 Habit Formation; 8.7; Graded tasks; 9.1 Credible source; 9.2 Pros and Cons; 10.9 Self-reward; 11.1 Pharmacological support; 11.2 Reduce negative emotions; 11.3 Conserving mental resources; 11.4 Paradoxical Instructions; 12.1 Restructuring the physical environment; 12.2 Restructuring the social environment; 12.5 Adding objects to the environment; 12.6 Body changes; 13.2 Framing/ reframing; 13.4 Valued self-identity; 15.2 Mental rehearsal of successful performance; 15.3 Focus on past success
  2. Key: BCT Behavior change technique, AET Adjuvant endocrine therapy, SMS Short messaging service, ACT Acceptance and commitment therapy
  3. aRefers to the BCT's selected for messages to be based on during a 1 day workshop with behavior change experts 
  4. bNote: Goals may be conceptualized differently in ACT (i.e. based on values) to how they are conceptualized in this taxonomy 
  5. cNote: The definition of this BCT states “advise on, arrange or provide social support OR non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling”. The coding of this BCT reflects the encouragement provided as part of the support sessions. It does not reflect ‘non-contingent praise or reward for performance of the behaviour’, which is not consistent with an ACT approach 
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BMC Health Services Research

ISSN: 1472-6963

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