Behaviour Change Update: Stage 1. BCT analysis of existing, cost-effective interventions

Seventy-nine cost-effective interventions across six different health behaviours (smoking cessation, diet, physical activity, alcohol, sexual health, multiple behaviour targets) were identified from 23 economic reports. Interventions were mainly of high intensity, set in primary care or the community, delivered by health professionals and aimed at individuals from the general population, involving pharmacological or other forms of support. Education, enablement, training and persuasion were the focus of the majority of interventions, clustering around BCTs concerning: shaping knowledge; goals and planning; social support; antecedents and natural consequences of behaviour; outcome comparison; and feedback and monitoring. Interventions included an average of ten BCTs with ‘instructions on how to perform a behaviour’, ‘unspecified social support’, ‘information about health consequences’ and ‘problem solving’ included in 81%, 67%, 57% and 53% of interventions, respectively. While the use of ‘choice architecture’ was common, being present in 71% of cost-effective interventions, prevalence was lower (29%) when stricter criteria to define ‘choice architecture’ were applied. Sexual health interventions were least cost-effective but no other characteristics or BCTs were related to cost-effectiveness estimates. However, these findings need to be interpreted cautiously given 1.) the limitations imposed by considering only cost-effective interventions in this report, 2.) the reliance on often incomplete information in published papers (possibly not accurately reflecting intervention content) and 3.) the lack of consensus for a definition of ‘choice architecture’.