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. 2020 Feb 12;10(2):e033070. doi: 10.1136/bmjopen-2019-033070

Table 2.

Summary of behaviour change intervention components, targeted determinants and behaviour change techniques used in the TaSINI study following the behaviour change wheel framework

Intervention component Primary message or resource Intervention function and coded behaviour change techniques
1. Brief advice consultations delivered by a GP, facilitated by information leaflet
1.1 Review of blood cholesterol level and discussion of CVD risk.

  • Explanation of what LDL and HDL cholesterol is.

  • Review blood test results to indicate to participant what their cholesterol is.

  • Explanation of how cholesterol relates to CVD risk.

  1. Education

    • Information about health consequences.

    • Information about antecedents.

  2. Persuasion

    • Information about health consequences.

    • Biofeedback.

    • Credible source (GP).
1.2 Discussion of physiological effect of statins and motivational advice from GP.

  • Explanation of how statins reduce LDL cholesterol in the blood.

  • Explanation of the extent to which statins reduce CVD risk (reframe taking statins as buying insurance for house).

  1. Education

    • Information about health consequences.

  2. Persuasion

    • Credible source (GP).

    • Information about health consequences.

  3. Enablement

    • Framing/ reframing.
1.3 Discussion of scientific evidence of statin safety and side effects.

  • Provide reassurance that best scientific evidence shows statins are safe

  • Provide reassurance that scientific evidence suggests people experience side effects on placebos and statins.

  1. Education

    • Information about health consequences.

    • Pros and cons.

  2. Persuasion

    • Credible source (GP).

    • Information about health consequences.
1.4 Discussion of self-experimentation (n-of-1 trial).

  • Explanation of experimentation with medication (ie, n-of-1 trial) with GP support being the only way to know true cause of adverse effects.

  • Encourage ‘thinking like a scientist’ to work out the effects of statin medication.

  • Explanation of ‘win-win’ situation: at the end of the experiment patient will know whether to continue to take statins or not.

  • Explanation of threat appraisals (ie, the tendency to feel anxious when one experiences symptoms and appraises this to a new medicine) and how to deal with them.

  1. Education

    • Re-attribution.

  2. Training

    • Behavioural experiments.

    • Instructions on how to perform a behaviour.

  3. Enablement

    • Pharmacological support? (Prompt use/ adherence to a drug to support behaviour change).

    • Social support (GP).

    • Pros and cons. Problem solving.

    • Commitment.

    • Reduce negative emotions.

  4. Persuasion

    • Verbal persuasion about capability.

    • Information about emotional consequences.

    • Credible source (GP).

    • Framing/ reframing

  5. Environmental restructuring

    • Exposure
2. Self-monitoring of adherence, symptoms and attributions
2.1 Automatic text message (reminder and link to survey)

  • Reminder to complete daily survey

  1. Enablement

    • Prompts/cues
2.2 Participant completion of adherence, symptoms and attributions survey.

  • Resource of daily survey to record adherence to statin, current symptoms and what the symptoms are attributable to.

  1. Training

    • Self-monitoring of outcome of behaviour.

    • Associative learning.

  2. Enablement

    • Monitoring of emotional consequences.
3. Review consultation with GP (8 weeks post intervention).
3.1 Review of cholesterol following 4 weeks of statin medication and discussion of first 8 weeks of n-of-1.

  • Show participant updated blood cholesterol and explain any changes.

  • Reiterate benefit of statin medication for CVD risk.

  • Troubleshoot any problems participant has experienced in first 8 weeks in preparation for remaining 16 weeks.

  1. Education

    • Feedback on outcome of behaviour

  2. Persuasion

    • Biofeedback

    • Credible source (GP).

    • Problem solving.

  3. Incentivisation

    • Feedback on outcome of behaviour.

    • Biofeedback.
4. Review consultation with GP (6 months post intervention).
4.1 Feedback daily self-monitoring data.

  • Show participant overview of adherence, symptom, and attribution data (provided by research team).

  • Discuss experience of self-experimentation with participant.

  • Reiterate benefit and safety of statin medication.

  • Ask participants’ decision of whether to resume statin therapy full time.

  1. Education

    • Feedback on outcome of behaviour.

  2. Persuasion

    • Biofeedback.

    • Credible source (GP).

    • Commitment.

CVD, cardiovascular disease; GP, general practitioner; HDL, High-density lipoprotein; LDL, low-density lipoprotein; TaSINI, Tackling statin intolerance with n-of-1 trials.