Coding of CPT programmes using behavioural change theory

BACKGROUND: Cognitive-communication impairments are common after acquired brain injury (ABI) and can negatively impact a person’s return to work, social functioning, community independence and quality of life. Training a communication partner (e.g., family member, friend and/or carer) can improve the communication skills of the person with ABI, however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners, though there is variability in the content, dosage and delivery of training. The strongest evidence is for a single programme, TBI Express, which has three different versions, though is rarely used by speech and language therapists. There is a need to guide future delivery of CPT to ensure that the minimum active ingredients are delivered regardless of content and dosage. Therefore, the aim of this study is to identify and describe the active components of the three versions of TBI Express for people with cognitive-communication disorders.METHOD: The treatment manual from each of the training programmes (i.e., TBI Express, TBI Express-Adapted, and TBIconneCT) was coded using the BCTTv1. Mechanisms of action (MoA) and each behavioural change techniques (BCT) were identified and linked using the theory and techniques tool. Reliability of coding (% agreement) was conducted for two modules representing ~20-33% of treatment content.RESULTS: 27 unique BCTs (range 20-25) were identified linked to 16 unique MoAs (range 15-16). The most common BCTs were providing information about social and environmental consequences; instruction on how to perform the behaviour; behavioural practice/rehearsal; and feedback on the behaviour. The most common mechanisms targeted were beliefs about capabilities; skills; and behavioural regulation. Reliability of coding BCTs and MOAs ranged from 47-50% for the first programme and increased to 67-81% for the third programme. Agreement increased as coding progressed with clearer guidance needed on the definition of the target behaviour of CPT compared with the desired outcome from achieving the target behaviour.CONCLUSIONS: Applying behaviour change theory to TBI express has revealed unique insight into the active ingredients of training. Communication partners are anticipated to improve their communication behaviours via capabilities, skills and regulation, through SLT-delivered CPT which focuses most commonly on information provision, instruction, rehearsal, and feedback. Such insights are gathered to further refine and adapt existing interventions. The challenge of discriminating between target behaviours and desired outcomes highlights the need for further conceptual work. Future work is now needed to identify the most important active ingredients to practicing clinicians, to design and test the feasibility of an adapted CPT programme for use in the mainstream health service.