Research Article

Comparison of Goal Achievement during an Early, Intensive Nutrition Intervention Delivered to People with Upper Gastrointestinal Cancer by Telephone Compared with Mobile Application

Table 1

Behaviour change techniques [16].

Behaviour change techniqueDefinition [16]ExampleClassificationa

1. Goals and planning
1.1 Goal setting (behaviour)Set or agree on a goal defined in terms of the behaviour to be achievedSet the goal of eating 5 pieces of fruit per dayRoutinely used
1.2 Problem-solvingAnalyse or prompt the person to analyse factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitatorsPrompt the patient to identify potential barriers to them drinking a particular supplement (e.g., bad taste) and discuss ways in which they could overcome them (e.g., mix with strawberries)Supplementary
1.3 Goal setting (outcome)Set or agree on a goal defined in terms of a positive outcome of wanted behaviourSet a weight gain goal (e.g., 0.5 kilogram over one week) as an outcome of changed eating patternsSupplementary
1.4 Action planningPrompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration, and intensity). Context may be environmental (physical or social) or internal (physical, emotional, or cognitive)Prompt planning the drinking of a supplement at a particular time (e.g., before work) on certain days of the weekRoutinely used
1.5 Review goal (behaviour)Review behaviour goal(s) jointly with the person and consider modifying goal(s) or behaviour change strategy in light of achievement. This may lead to resetting the same goal, a small change in that goal or setting a new goal instead of (or in addition to) the first, or no changeAsk if the patient drank the supplement as plannedRoutinely used
1.6 Highlight discrepancy between current and goal (behaviour or outcome)Draw attention to discrepancies between a person’s current behaviour (in terms of the form, frequency, duration, or intensity of that behaviour) or outcome and the person’s previously set behavioural goals or action plansPoint out that the recorded supplement intake fell short of the goal setRoutinely used
1.7 Review goal (outcome)Review outcome goal(s) jointly with the person and consider modifying goal(s) in light of achievement. This may lead to resetting the same goal, a small change in that goal or setting a new goal instead of, or in addition to the firstAsk if the patient achieved the weight gain goalSupplementary
2. Feedback and monitoring
2.1 Monitoring of behaviours by others, without feedbackObserve or record behaviour with the person’s knowledge as part of a behaviour change strategyHave the partner observe food intake behaviours and make notes on content and frequencySupplementary
2.3 Self-monitoring of behaviourEstablish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategyAsk the person to record daily, in a diary, the amount of food that they have eatenSupplementary
2.4 Self-monitoring of outcome of behaviourEstablish a method for the person to monitor and record the outcome(s) of their behaviour as part of a behaviour change strategyAsk the person to weigh themselves at the end of each day, over a two-week period, and record their daily weight on a graph to increase food intakeSupplementary
2.5 Monitoring outcomes of behaviours by others, without feedbackObserve or record outcomes of behaviour with the person’s knowledge as part of the behaviour change strategyRecord weight maintenance/gain, blood glucose levelsSupplementary
2.6 BiofeedbackProvide feedback about the body using an external monitoring device as part of a behaviour change strategyInform the person of the blood sugar levels to improve their adoption of insulin useSupplementary
2.7 Feedback on outcome(s) of behaviourMonitor and provide feedback on the outcome of the performance of the behaviourInform the person of their stable weight following implementation of high energy, high protein diet regimenSupplementary
3. Social support
3.1 Social support (unspecified)Advise on, arrange, or provide social support (e.g., from friends, relatives, colleagues, “buddies,” or staff) or noncontingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviourArrange for a partner to encourage patient to use supplementsSupplementary
3.2 Social support (practical)Advise on, arrange, or provide practical help (e.g., from friends, relatives, colleagues, “buddies,” or staff) for performance of the behaviourAsk the partner to mix the supplement with strawberries for the patientSupplementary
3.3 Social support (emotional)Advise on, arrange, or provide emotional social support (e.g., from friends, relatives, colleagues, buddies, or staff) for performance of behaviourAsk a patient to take a partner to their surgeon’s appointmentSupplementary
4. Shaping knowledge
4.1 Instruction on how to perform behaviourAdvise or agree on how to perform the behaviour (includes “Skills training”)Demonstrate or describe to the person how to prepare thickened fluidsRoutinely used
4.2 Information about antecedentsProvide information about antecedents (e.g., social and environmental situations and events, emotions, cognitions) that reliably predict performance of the behaviourDiscuss how people find it difficult to follow their diet when they attend social eventsSupplementary
5. Natural consequences
5.1 Provide information (e.g., written, verbal, visual) about health consequences of performing the behaviourProvide information (e.g., written, verbal, visual) about health consequences of performing the behaviourPresent written information about the positive effect on weight and maintaining nutrition status with adoption of a high energy high protein diet regimenSupplementary
6. Associations
6.1 Prompts/cuesIntroduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour. The prompt or cue would normally occur at the time or place of performancePut a sticker on the fridge to avoid eating cheesecakeSupplementary
7. Repetition and substitution
7.1 Graded tasksSet easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performedAsk patient to consume supplement once per day the first week, then twice per day the second week.Supplementary
8. Comparison of outcomes
8. 1 Consider pros and consAdvise the person to identify and compare reasons for wanting (pros) and not wanting (cons) to change the behaviourAdvise the person to list and compare the advantages and disadvantages of drinking the supplementSupplementary
9. Regulation
9.1 Pharmacological supportProvide or encourage the use of or adherence to drugs to facilitate behaviour changeAdvise the person to take regular antinausea medications when they are nauseatedSupplementary
10. Antecedents
10.1 Restructuring the physical environmentChange or advise to change the physical environment in order to facilitate performance of the wanted behaviourAdvise to make a 1 L jug of Sustagen and keep in the fridge to sip during the daySupplementary
10.2 Restructuring the social environmentChange or advise to change the social environment in order to facilitate performance of the wanted behaviourAdvise the person to sit with a family member/friend at meals and snacksSupplementary
10.3 Body changesAlter body structure, functioning, or support directly to facilitate behaviour changePrompt use of dentures to promote food consumptionSupplementary
11. Self-belief
11.1 Verbal persuasion about capabilityTell the person that they can successfully perform the wanted behaviour, arguing against self-doubts, and asserting that they can and will succeedTell the person that they can successfully maintain their weight despite ongoing treatmentSupplementary
11.2 Focus on past successAdvise to think about or list previous successes in performing the behaviourAdvise to describe or list the times that they were able to drink their prescribed nutrition supplement drinks during chemotherapySupplementary

aBehaviour change techniques have been classified as routinely used techniques to be used with all participants, and supplementary techniques that can optionally be used.