title: Characterising an implementation intervention in terms of behaviour change techniques and theory: the 'Sepsis Six' clinical care bundle.
abstract: BACKGROUND
  Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the 'Sepsis Six' evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27-47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to identify mechanisms of change. The aim of this study was to illustrate this process by using the Behaviour Change Wheel; Behaviour Change Technique (BCT) Taxonomy; Capability, Opportunity, Motivation model of behaviour; and Theoretical Domains Framework to characterise the content and theoretical mechanisms of action of an existing intervention to implement Sepsis Six.
  
  
  METHODS
  Data came from documentary, interview and observational analyses of intervention delivery in several wards of a UK hospital. A broad description of the intervention was created using the Template for Intervention Description and Replication framework. Content was specified in terms of (i) component BCTs using the BCT Taxonomy and (ii) intervention functions using the Behaviour Change Wheel. Mechanisms of action were specified using the Capability, Opportunity, Motivation model and the Theoretical Domains Framework.
  
  
  RESULTS
  The intervention consisted of 19 BCTs, with eight identified using all three data sources. The BCTs were delivered via seven functions of the Behaviour Change Wheel, with four ('education', 'enablement', 'training' and 'environmental restructuring') supported by the three data sources. The most frequent mechanisms of action were reflective motivation (especially 'beliefs about consequences' and 'beliefs about capabilities') and psychological capability (especially 'knowledge').
  
  
  CONCLUSIONS
  The intervention consisted of a wide range of BCTs targeting a wide range of mechanisms of action. This study demonstrates the utility of the Behaviour Change Wheel, the BCT Taxonomy and the Theoretical Domains Framework, tools recognised for providing guidance for intervention design, for characterising an existing intervention to implement evidence-based care.
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK. s.steinmo.11@ucl.ac.uk.
authors.forename: Siri
authors.initials: S
authors.lastname: Steinmo
authors.affiliation: Department of Infection Control, University College London, London, UK. christopher.fuller@ucl.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fuller
authors.affiliation: University College London Medical School, Rowland Hill Street, London, UK. sheldon.stone@ucl.ac.uk.
authors.forename: Sheldon P
authors.initials: SP
authors.lastname: Stone
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK. s.michie@ucl.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
mesh_terms: D006801:Humans; D009042:Motivation; D009936:Organizational Innovation; D064872:Patient Care Bundles / Q000523:psychology*; D010564:Personnel, Hospital / Q000523:psychology; D016730:Program Development; D011582:Psychological Theory; D018805:Sepsis / Q000628:therapy*