Table 3.
Selected behavior change techniques, setting-specific intervention content, and modes of delivery for each of the target behaviors.
| Intervention function | Behavior change technique | Setting-specific intervention content | Mode of delivery | Implement? |
|---|---|---|---|---|
| Agree to contact investigation (index cases) | ||||
| Education | Information about health consequences | See examples below under “Complete TB evaluation.” | Lay health worker | Yes |
| Persuasion | Credible source | See examples below under “Complete TB evaluation.” | Lay health worker | Yes |
| Anticipated regret | See examples below under “Complete TB evaluation.” | Lay health worker | Yes | |
| Information about social & environmental consequences | See examples below under “Complete TB evaluation.” | Lay health worker | Yes | |
| Comparative imaginings of future outcomes | See examples below under “Complete TB evaluation.” | Lay health worker | Yes | |
| Modeling | Demonstration of the behavior | Invite former index TB patient to share the difficult decision to agree to household contact investigation. | Former TB patient | Worth considering |
| Enablement | Restructuring of the social environment | Seek permission for the home visit from the head of household by telephone instead of asking the index patients to consent. | Lay health worker | Yes, only as needed |
| Environmental restructuring | Restructuring of the physical environment | Screen the index patient by phone for greater privacy and convenience, if preferred. | Lay health worker | Yes, only as needed |
| Screen contacts for TB (lay health workers) | ||||
| Education | Instruction on performing the behavior | Provide a lecture about how to carry out TB screening. | TB Program | Yes |
| Training | Behavioral practice/rehearsal | Perform TB counseling role plays with one another. | Lay health worker | Yes |
| Persuasion | Framing/reframing | Describe the first priority of the home visit as supporting the index patient during treatment rather than as performing symptom screening. | Lay health worker | Yes |
| Enablement | Prompts/cues | Provide decision support on which contacts to refer for TB diagnostic evaluation using answers to questions about TB symptoms and predisposing factors. | mHealth / eTablet | Yes |
| Environmental restructuring | Adding objects to the environment | Provide lay health workers with N95 particulate respirators to reduce the risk and fear of contracting TB during household visits. | TB Program | Yes |
| Restructuring the physical environment | Screen unavailable household contacts by phone for greater privacy and convenience if contacts prefer. | Lay health worker | Yes, only as needed | |
| Incentivization | Material incentive (behavior) | Receive a modest allowance for transportation to the community and for meals. | TB Program | Yes |
| Complete TB evaluation (contacts) | ||||
| Education | Information about health consequences | Give positive/negative health information about health consequences of seeking/not seeking TB/HIV evaluation, treatment, and/or prevention. | Lay health worker | Yes |
| Persuasion | Credible source | Explain that index patient/contacts that TB health information has been approved by the leading TB authority in Uganda, the National TB Program. | Lay health worker | Yes |
| Anticipated regret | Describe the regret that the index patient/contact could experience if screen-positive contacts do not receive evaluation & treatment. | Lay health worker | Yes | |
| Information about social & environmental consequences | Give positive/negative health information about social consequences of seeking/not seeking TB/HIV care, including putting other contacts at risk. | Lay health worker | Yes | |
| Comparative imaginings of future outcomes | Invite index patient/contacts to explicitly compare outcomes of screen-positive contacts receiving/not receiving TB/HIV evaluation/care. | Lay health worker | Yes | |
| Environmental restructuring | Restructuring the physical environment | Collect sputum and provide HIV counseling and testing at home instead of in a clinic, using a safe and convenient place in or near the home. | Lay health worker | Yes, but randomize |
| Deliver automated survey about TB symptoms every 6 months for 2 years for those found not to have TB and not treated for latent TB infection. | SMS | Yes, but randomize | ||
| Restructuring the social environment | Provide TB and HIV testing at home, a less threatening social environment than the clinic. | Lay health worker | Yes, but randomize | |
| Training | Instruction on performing the behavior | Instruct screen-positive contacts on how to expectorate sputum for TB examination safely and effectively at home. | Lay health worker | Yes, but randomize |
| Enablement | Action planning | Ask screen-positive contacts to schedule a time to go to clinic for TB/HIV evaluation. | Lay health worker | Yes |
| Commitment | Ask screen-positive contacts to formally commit to going to clinic for TB/HIV evaluation. | Lay health worker | Yes | |
| Social support—emotional | Encourage screen-positive contacts invited to return to clinic together to provide mutual emotional support. | Lay health worker | Yes | |
| Feedback on outcome of behavior | Deliver results of sputum examination to contacts and recommend next steps. | Lay health worker, or Automated SMS | Yes | |
| Incentivization | Non-specific reward | Arrange for screen-positive contacts to bypass the clinic waiting area and go directly to the TB unit when presenting for TB diagnostic evaluation. | Lay health worker | Yes |
| Incentive (outcome) | Provide a small electronic cash transfer if a screen-positive contact returns to clinic for TB diagnostic evaluation. | SMS | No, not feasible | |
SMS, short messaging services; TB, tuberculosis.
The table shows an implementation mapping exercise using the Behavior Change Wheel Framework and Behavior Change Techniques Taxonomy for each of the three key target behaviors (and the individual targeted). The intervention functions identified in Table 2 provide the starting point for Table 3, where candidate behavior change techniques are considered for each intervention function from a matrix listing all possibilities (36). The decision about whether to implement each of these behavior change techniques with their setting-specific content and mode of delivery was based on subjective ratings by implementers and stakeholders using the APEASE (Acceptability, Affordability, Practicality, Effectiveness/cost-effectiveness, Safety, and Equity) criteria, a subjectively assessed set of implementation and service outcomes.