Using the behaviour change wheel approach to optimise self-sampling packs for sexually transmitted infection and blood borne viruses
Authors: Flowers P. , Vojt G. , Pothoulaki M. , Mapp F. , Woode Owusu M. , Cassell J. A. , Estcourt C. , Saunders J. 
Published: July 2021

AbstractPurposeThis paper describes the process of optimising a widely offered intervention - the self-sampling pack for sexually transmitted infections (STIs) and blood born viruses (BBVs). We drew upon the BCW approach, incorporating the theoretical domains framework (TDF) and the behaviour change technique taxonomy (BCTT) to systematically specify potential intervention components that may optimise the packs.MethodsA behaviour change wheel analysis built upon prior thematic analyses of qualitative data collected through focus groups and interviews with members of the public and people recruited from sexual health clinics in Glasgow and London (n=56). Salient barriers and facilitators to specific sequential behavioural domains associated with wider behavioural system of pack-use were subjected to further analyses, coding them in relation to the TDF, the BCW’s intervention functions, and finally specifying potential optimisation in relation to behaviour change techniques (BCTs).ResultsOur TDF analysis suggested that across the overall behavioural system of pack use the most important theoretical domains were ‘beliefs about consequences’ and ‘memory, attention and decision-making’. BCW analysis on the overall pack suggested useful intervention functions should focus on ‘environmental restructuring’, ‘persuasion’, ‘enablement’, ‘education’ and ‘modelling’. Ways of optimising the intervention were also specified in relation to potentially useful behaviour change techniques (BCTs).ConclusionsA detailed behavioural analysis building on earlier qualitative work using the TDF and the BCW provided a systematic approach to optimising an existing intervention. The approach enabled the specification of highly specific, evidence-based, and theoretically informed recommendations for intervention optimisation.What is already known on this subject?The use of self-sampling packs for sexually transmitted infections (STIs) and blood borne viruses (BBVs) has been widely implemented without in-depth assessment of user perspectives, adequate theorisation in relation to behaviour change, or optimisationIn a previous qualitative study we reported on our use of thematic analyses (inductive and deductive) to understand the behavioural system of using self-sampling packs. We identified multiple modifiable barriers, and several important facilitators to using these packs, and their content, correctlyOur thematic analyses showed that self-sampling packs offered a largely acceptable approach to STI and BBV testing and that with some modification it may be possible to increase both the range of people who can benefit from them and increase the return of samplesWhat does this study add?This study theorises key barriers and facilitators to each sequential step within the behavioural system of using the self-sampling pack. Across the whole behavioural system of pack use we identified ‘beliefs about consequences’ and ‘memory, attention and decision-making’ as being particularly important theoretical domainsTo optimise self-sampling packs for STIs, our use of the behaviour change wheel suggested that to modify the pack we should use intervention functions that detail environmental restructuring and assist the user using pack contents through persuasion and enablement with some education and modellingThe study provides an exemplar of how to use the behaviour change wheel within the process of intervention optimisation when building upon prior qualitative analyses. The results informed the redesign of the pack and the development of on-line support materials to be used within a large multi-site trial