Behavioral Intervention Components Associated With Cost-effectiveness: A Comparison of Six Domains

Background: To help implement behavior change interventions (BCIs) it is important to be able to characterize their key components and determine their effectiveness.

Purpose: This study assessed and compared the components of BCIs in terms of intervention functions identified using the Behaviour Change Wheel Framework (BCW) and in terms of their specific behavior change techniques (BCTs) identified using the BCT TaxonomyV1, across six behavioral domains and the association of these with cost-effectiveness.

Methods: BCIs in 251 studies targeting smoking, diet, exercise, sexual health, alcohol and multiple health behaviors, were specified in terms of their intervention functions and their BCTs, grouped into 16 categories. Associations with cost-effectiveness measured in terms of incremental cost-effectiveness ratio (ICER) upper and lower estimates were determined using regression analysis.

Results: The most prevalent functions were increasing knowledge through education (72.1%) and imparting skills through training (74.9%). The most prevalent BCT groupings were shaping knowledge (86.5%), changing behavioral antecedents (53.0%), supporting self-regulation (47.7%), and providing social support (44.6%). Intervention functions associated with better cost-effectiveness were those based on training (βlow = -15044.3; p = .002), persuasion (βlow = -19384.9; p = .001; βupp = -25947.6; p < .001) and restriction (βupp = -32286.1; p = .019), and with lower cost-effectiveness were those based on environmental restructuring (β = 15023.9low; p = .033). BCT groupings associated with better cost-effectiveness were goals and planning (βlow = -8537.3; p = .019 and βupp = -12416.9; p = .037) and comparison of behavior (βlow = -13561.9, p = .047 and βupp = -30650.2; p = .006). Those associated with lower cost-effectiveness were natural consequences (βlow = 7729.4; p = .033) and reward and threat (βlow = 20106.7; p = .004).

Conclusions: BCIs that focused on training, persuasion and restriction may be more cost-effective, as may those that encourage goal setting and comparison of behaviors with others.