Research Article

Using the Medical Research Council Framework for the Development and Evaluation of Complex Interventions in a Theory-Based Infant Feeding Intervention to Prevent Childhood Obesity: The Baby Milk Intervention and Trial

Table 2

Behaviour change techniques and intervention strategies used in the baby milk intervention [44].

TechniqueaDefinitionaIntervention strategies

(1) Provides information on consequencesInformation about the benefits and costs of action or inaction, focusing on what will happen if the person performs the behaviour.Leaflet explains link between feeding behaviours, rapid weight gain and risk of obesity. This information is reinforced and participant understanding about the information checked during 3 face-to-face and 2 telephone contacts.

(2) Prompts intention formationEncouraging the person to decide to act or set a general goal. Leaflet encourages lower guidelines for formula-milk feeding and suggests a general feeding plan.
Develop a personalised feeding plan (PFP) in intervention contacts.

(3) Prompts barrier identificationIdentifying barriers to performing the behaviour and plan ways of overcoming them.Identify barriers using cost-benefit analysis, motivation ruler and confidence ruler.
Formulation of “if…then…” plans to overcome barriers for example, crying between feeds (“If she cries at night, then I will offer her a dummy”)

(4) Prompts facilitator identificationIdentifying facilitators to performing the behaviour and plan ways to use them to overcome barriers.Cost-benefit analysis, motivation ruler and confidence ruler.

(5) Provides general encouragementPraising or rewarding the person for effort or performance without this being contingent on specified behaviours or standards of performance.Praise all attempts at following guidelines.
Good communication skills: building rapport, empathy, active listening, nonjudgemental, and client-centred.

(6) Sets graded tasksSetting easy task and increasing difficulty until target behaviour is performed. Monthly contact to encourage mothers to set small achievable goals and revise them.
Review of personal feeding plan (PFP) to revise goals.

(7) Provides instructionTelling a person how to perform certain behaviour and/or preparatory behaviours.Two leaflets and discussion about recommended feeding behaviours during 3 face-to-face and 2 telephone contacts.

(8) Models or demonstrates the behaviourAn expert shows the person how to correctly perform behaviour for example, in class or on video.Demonstrate the correct method of formula-feed preparation at baseline visit.

(9) Prompts specific goal settingInvolves detailed planning of what the person will do, including a definition of the behaviour specifying frequency, intensity, or duration and specification of at least one context, that is, where, when, how, or with whom.Personal Feeding plan with goals negotiated with the participant.
Make these goals specific by formulating “if…then…” plans

(10) Prompts review of behavioural goalsReview and/or reconsideration of previously set goals or intentionsReview and revise goals set at each intervention contact using the Personal Feeding plan.

(11) Prompts self-monitoring The person is asked to keep a record of specified behaviour(s) (e.g., in a diary).Encourage participants to record amount fed in the Personal Feeding plan.

(12) Provides feedback on performanceProviding data about recorded behaviour or evaluating performance in relation to a set standard or others’ performance, that is, the person received feedback on their behaviour.Provide feedback on feeding behaviour, based on Personal Feeding plan.
Provide feedback on baby’s growth plotted on growth charts.

(13) Teaches to use prompts or cuesTeaching the person to identify environmental cues that can be used to remind them to perform a behavior,
including times of day or elements of contexts.
Stickers on formula-milk tins which encourage lower formula-milk consumption.

Labels and definitions of the behaviour change techniques are as specified in Abraham and Michie’s Taxonomy of Behaviour Change Techniques [50].