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Table 1 Behaviour change techniques (including their relevant numbers from the taxonomy), intervention functions, modes of delivery (bold), examples of the mechanisms of action, expected dose, and intended implementation outcome

From: Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

BCTs Intervention functions Mechanism of action Target barrier(s)/facilitator(s) (TDF domain) Expected dose Intended implementation outcome
1.9. Commitment Incentivisation, enablement Staff appear in a video promoting ChIP Remembering to use protocol (memory, attention, and decision processes) At least one staff member from each of the disciplines involved Increase fidelity/acceptability from all disciplines
2.2. Feedback on behaviour Education, persuasion, incentivisation Staff compliance monitored through audits and staff will be informed of the results informally by clinical champions, through newsletters and emails Belief of consequences of care bundle (belief about consequences)
Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)
Audits to be done monthly for 12 months Increase fidelity
2.7. Feedback on outcome(s) of behaviour Education, incentivisation, training Feedback given to staff from audit results on patients treated with the care bundle through clinical champions Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)
Belief of consequences of care bundle (belief about consequences)
Emotions relating to commencing new protocol (emotion)
Remembering to use protocol (memory, attention, and decision processes)
Confidence in patient assessment skills (physical skills)
For audits after 1, 2, and 3 months then if issues Increase sustainability
3.1. Social support Enablement Clinical champions chosen from each area receive extra training to be able to provide extra support Social supports (social influences) 2 clinical champions from each ED Increase fidelity
4.1. Instruction on how to perform behaviour Training Staff receive instructions on behaviour via a video, educational sessions, and clinical champions Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)
Remembering to use protocol (memory, attention, and decision processes)
Education sessions to be attended by staff Increased fidelity
5.1. Information about health consequences Education, persuasion Staff informed about the improvement in pneumonia rate reduction with the protocol from the previous study through video, educational sessions, flyers, newsletters, and emails Belief of consequences of care bundle (belief about consequences)
Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)
All relevant staff Increased acceptability
6.1. Demonstration of behaviour Training, modelling Staff receive demonstrations of behaviour via a video, educational sessions, and clinical champions Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)
Remembering to use protocol (memory, attention, and decision processes)
Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)
Emotions relating to commencing new protocol (emotion)
All relevant staff Increased fidelity
6.3. Information about others’ approval Education, persuasion Local staff appear in the ChIP video showing support Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity) Senior staff from each discipline Increase acceptabilty
7.1. Prompts/cues Education, environmental restructuring A visual prompt (screen icon) developed for the electronic medical record to flag to staff that patient is eligible for care bundle Remembering to use protocol (memory, attention, and decision processes) On computer system Increase fidelity and sustainability
Flyers put up around the workplace to remind staff of the care bundle In both EDs, ICUs, trauma wards Increase fidelity
8.3. Habit formation Training Staff encouraged to assess all potentially eligible patients systematically in the video and educational sessions Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)
Remembering to use protocol (memory, attention, and decision processes)
Staff from relevant disciplines Increase fidelity
9.1. Credible source Persuasion Senior local staff appear in a video informing staff about and promoting ChIP Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity) At least one staff member from each discipline Increase acceptability
12.1. Restructuring the physical environment Environmental restructuring, enablement Equipment necessary for ChIP placed in a location that ensures ease of access Remembering to use protocol (memory, attention, and decision processes)
Access to protocol, the protocol design, access to equipment (environmental context and resources)
Emotions relating to commencing new protocol (emotion)
HFNC machines and incentive spirometry in ED Increase fidelity
Equipment adequately labelled with instructions All new HFNC machines Increase fidelity
Additional equipment supplied to ensure adequate supply (high-flow machines and incentive spirometry)   
ChIP tested by staff to ensure ease of use Tested once prior to go live Increased fidelity
12.5. Adding objects to the environment Environmental restructuring, enablement An icon added for the electronic medical record to flag to staff that patient is eligible for care bundle Remembering to use protocol (memory, attention, and decision processes)
Access to protocol (environmental context and resources)
Emotions relating to commencing new protocol (emotion)
Add prior to go live Increased fidelity
  A pager setup to be able to contact staff responding to ChIP   Set up prior to go live Increased fidelity
13.1. Identification of self as a role model Persuasion, enablement Staff asked to volunteer for the roles of clinical champions and to be in the video Emotions relating to commencing new protocol (emotion)
Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)
Champions at each site Increased fidelity and sustainability
15.1. Verbal persuasion about capability Persuasion, enablement Staff encouraged during educational sessions and by clinical champions that they are capable of following ChIP Emotions relating to commencing new protocol (emotion) At each session Increased fidelity and acceptability
  1. Definitions for intervention functions: Education: increasing knowledge or understanding, Persuasion: using communication to induce positive or negative feelings or stimulate action, Incentivisation: creating an expectation of reward, Training: imparting skills, Environmental restructuring: changing the physical or social context, Modelling: providing an example to aspire to, Enablement: increasing means/reducing barriers