Table 6 Mapping of fidelity findings and previous research onto Steps 1–4 of the BCW [25], along with resulting recommendations
Behaviour Change Wheel step | Summary of outcome | Details of outcome and rationale |
|---|---|---|
1) Understand the behaviour | One target behaviour developed | - Who? Providers |
 - What do they need to do? Deliver components that were infrequently delivered within the PRIDE feasibility trial, including tailoring (providing resources for chosen topics and discussing) and problem solving | ||
 - When? During each of the three sessions | ||
 - Where? Participants’ home | ||
 - How often? To all participants | ||
 - With whom? Person with dementia and supporter | ||
Three COM-B domains were identified as frequent barriers:  - Psychological capability  - Physical opportunity  - Social opportunity | - Psychological capability (e.g. skills to deliver PRIDE as planned and remembering information from training) | |
 - Physical opportunity (e.g. appropriate PRIDE resources and time to practice delivering) | ||
 - Social opportunity (e.g. participant engagement and support from researchers) | ||
2) Identify intervention functions and policy categories | Three intervention functions were identified: - Training - Modelling - Enablement | • Training (to improve skills) |
  - Review of 152 education and training interventions for staff involved in dementia care suggests training increases knowledge, staff confidence and facilitates behaviour change [52] | ||
  - Poor training = one reason why interventions not effective [7] | ||
  - Requires more time and money [53] | ||
  - Acceptable as providers spoke about wanting more training in the interviews | ||
 • Modelling (to show providers how to deliver PRIDE) | ||
  - Seeing procedures facilitates acquisition of clinical skills [54] | ||
  - Role modelling - acceptable to providers who spoke about wanting more guidance about how to deliver PRIDE in interviews | ||
 • Enablement (to increase capability or opportunity) | ||
  - Findings indicated fidelity differed across providers and sites   - Interview findings highlighted differences in work environments and social support | ||
  - Development of effective training for behaviour change may include expert clinical supervision/staff champions [52] | ||
  - Broader work environment needs to be facilitative to deliver high-quality person-centred dementia care [55] | ||
  - Acceptable to providers who spoke about importance of social support during interviews - individual training/supervision may be beneficial | ||
One policy category was relevant | Service provision | |
3) Identify intervention content (BCTs) | Four BCTs were identified: - Social support (unspecified) (BCT 3.1) - Instruction on how to perform the behaviour (BCT 4.1) - Demonstration of behaviour (BCT 6.1) - Behavioural practice and rehearsal (BCT 8.1) | • Social support (unspecified) (BCT 3.1) |
  - Interview findings indicated social support from researchers and peers was acceptable | ||
  - Social support was identified as a key theme facilitating fidelity in the interviews | ||
 • Instruction on how to perform the behaviour (BCT 4.1) | ||
  - Interventions containing this BCT may improve GPs’ delivery of two recommendations from clinical practice guidelines for back pain management in primary care [56, 57] | ||
  - Interview findings indicated instructions would be acceptable to providers who reported needing more step-by-step guidance on how to deliver practical elements (e.g. adapting PRIDE to participants) | ||
 • Demonstration of behaviour (BCT 6.1) | ||
  o Interventions containing demonstration may improve delivery of healthcare interventions [52, 56, 57] | ||
  o Review of 152 dementia education and training interventions found that training interventions which consisted of active learning approaches and examples showing how to deliver an intervention through written materials, video or DVD were useful to demonstrate good practice to staff working with dementia [52] | ||
  o Interview findings indicated that providers wanted more step-by-step guidance on how to deliver PRIDE as planned | ||
 • Behavioural practice and rehearsal (BCT 8.1) | ||
  - Interventions using this BCT found to improve delivery of guidelines in primary care (56,557) | ||
  - Providers wanted more opportunities to practice delivering PRIDE components | ||
4) Mode of delivery | Four types of mode were identified as suitable to deliver the four BCTs: - Human interactions (face-to-face) - Human interactions (remote) - Printed materials - Digital delivery | • Social support (unspecified) (BCT 3.1) |
  - Could be delivered either face-to-face during PRIDE training day or via telephone | ||
  - Providers are based at different sites, so face-to-face contact not always possible - telephone calls maybe more suitable for PRIDE | ||
 • Instruction on how to perform the behaviour (BCT 4.1) | ||
  - Could be delivered through human contact, printed materials or digitally   - Printed materials may be more suitable in PRIDE as providers spoke about difficulties remembering information | ||
  - Provided on the training day during the interviews | ||
 • Demonstration of behaviour (BCT 6.1)   - Could be delivered through human contact or digitally | ||
  - All providers need to receive standardized training [58]   - Therefore, demonstration could be delivered digitally or by somebody who has been trained to demonstrate the intervention consistently | ||
 • Behavioural practice and rehearsal (BCT 8.1)   - Could be delivered face-to-face during the PRIDE training day | ||
5) Resulting recommendations | Four recommendations were developed: 1) Show a video of how to deliver PRIDE 2) Give an instruction sheet about how to deliver PRIDE 3) Give providers time to practice delivering PRIDE 4) Provide continued support from researchers for delivery | 1) • Show a video of how to deliver PRIDE |
  - Aims to increase skills, reduce anxieties and improve social support | ||
  - Targets training & modelling using BCT 6.1   - Implemented using a digital mode of delivery (providers shown a video during PRIDE training) | ||
2) • Give an instruction sheet about how to deliver PRIDE | ||
  - Aims to increase providers’ skills and reduce anxieties | ||
  - Targets training, using BCT 4.1 | ||
  - Providers would be given a printed instruction sheet summarizing information in manual - clear and step by step for standardized and tailored components | ||
3) • Give providers time to practice delivering PRIDE | ||
  - Aims to increase skills | ||
  - Targets training using BCT 8.1 | ||
  - Delivered face-to-face during training (paired up and asked to practice delivering and tailoring based on a case study) | ||
4) • Provide continued support from researchers for delivery | ||
  - Aims to improve social support | ||
  - Targets enablement using BCT 3.1 | ||
  - Delivered over the phone + additional phone calls to address individual differences |