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Table 1 Behavior change techniques to facilitate theory of planned behavior (TPB) constructs throughout the trial

From: Comparison of high and low intensity contact between secondary and primary care to detect people at ultra-high risk for psychosis: study protocol for a theory-based, cluster randomized controlled trial

TPB construct Behavior change technique Procedures and materials Delivery context
Attitude Provide general information on behavior-benefit link Leaflet: distributed by post, one for each GP in each surgery. Outline the benefits of the early detection of psychosis. Pre-sessions 1 and 2
PowerPoint presentation: provide information about physical, psychological and social benefits of identifying potential individuals at UHR for psychosis. Sessions 1 and 2
DVD: the above points are reiterated by the head of the department of psychiatry, a well-respected authority in the trial’s area. Session 2
Provide information on consequences PowerPoint presentation: provide information on the consequences of employing a ‘wait and see’ strategy with potential individuals at UHR for psychosis; reducing involvement with police and/or hospital admissions that often occur prior to a FEP. Sessions 1 and 2
DVD: include a vignette showing the possible consequences of a GP employing a ‘wait and see’ strategy with a individual at UHR for psychosis. Session 2
Provide information about personal susceptibility to negative consequences PowerPoint presentation: provide peer-reviewed research evidence showing the importance of GPs in the care pathway of individuals at UHR for psychosis; linking with the potential costs of inaction by the GP. Sessions 1 and 2
Provide information about severity of health consequences Leaflet: outline the potential to reduce suicide attempts. Pre-sessions 1 and 2
PowerPoint presentation: outline the link between delayed detection and transition to FEP; provide research data showing the poor outcomes for individuals who transition. Sessions 1 and 2
DVD: the above points are reiterated by the head of the department of psychiatry. Session 2
Subjective norm Provide information about others’ approval Produce newsletter for dissemination to each GP in all surgeries via post and email. 3 × yearly throughout the trial
Include details of the number of surgeries participating and positive quotes from GPs about the consequences of participating in the trial.
Provide normative information about others’ behavior Produce newsletter for dissemination to each GP in all surgeries via post and email. 3 × yearly throughout the trial
Include information about the number of surgeries participating in the trial.
Provide an update of the number of referrals in the trial, and true UHR and FEP cases in the county.
Prompt identification as role model/position advocate Identify a LEGS ‘champion’ within each surgery to promote the identification of individuals at UHR for psychosis and raise any issues or problems at weekly meetings. Post-session 1
Provide opportunities for social comparison Opportunities for peer interactions are facilitated by the group setting, and encouraged by LPs concerning potential advantages and facilitators of the identification of individuals at UHR for psychosis. Sessions 1 and 2
Opportunities for peer interactions are facilitated by the group setting and encouraged by LPs concerning previous referrals, sharing experience and discussing helpful strategies. Session 2
Group discussions and LPs reinforce social approval of the identification of individuals at UHR for psychosis. Sessions 1 and 2
Perceived behavioral control (PBC) Prompt barrier identification Barrier identification based on responses to the PBC items within the TPB questionnaire. Sessions 1 and 2
Group discussions of possible barriers and means to minimize or address them. Sessions 1 and 2
Provision of strategies to overcome barriers, for example educate GPs to ask the most relevant questions to identify UHR for psychosis; therefore, making optimal use of the limited consultation time. Sessions 1 and 2; and throughout the trial when appropriate during telephone and face-to-face contact with GPs
Provide general encouragement LPs to provide general encouragement on a one-to-one basis, as and when needed, and during the educational sessions to the surgery as a whole. Throughout the trial during telephone and face-to-face contact with GPs
Provide instruction PowerPoint presentation: instruction on the appropriate questions to ask potential individuals at UHR for psychosis; how to refer, care pathway slide. Session 1
Leaflet: include examples of the questions to ask patients and tick-box options of the appropriate criteria required for a referral. Pre-sessions 1 and 2
DVD: outline in more detail the early signs and symptoms to be aware of, examples of questions, and how to refer using a question and answer format, with a GP and the head of the department of psychiatry. Session 2
Model/demonstrate the behavior DVD: instructional vignettes showing examples of a GP conducting a consultation with a potential individual at UHR for psychosis, before and after the educational sessions. Session 2
Provide feedback on performance Provided for each GP for every referral, both verbally and in a letter; include detailed feedback on the outcome of the initial assessment to explain why, or why not, the individual met the criteria for UHR for psychosis. Throughout the trial
PowerPoint presentation: feedback table for the previous year’s referrals associated with each surgery, including source, outcome and any signposting to other services. Facilitate discussion around the reasons why they did, or did not, meet criteria. Session 2
Prompt practice LPs to prompt practice on a one-to-one basis, as and when needed, and during the educational sessions to the surgery as a whole. Throughout the trial during telephone and face-to-face contact with GPs
Use of follow-up prompts Leaflet: use as a reminder to prompt practice. Pre-sessions 1 and 2
Newsletter: use as a reminder to prompt practice. 3 × yearly throughout the trial
Time management Leaflet: strategy for optimal use of the limited consultation time. Pre-sessions 1 and 2
PowerPoint presentation: strategy for optimal use of the limited consultation time. Session 1
DVD: strategy for optimal use of the limited consultation time. Session 2
Prompting focus on past success PowerPoint presentation: feedback table for the previous year’s referrals associated with each surgery, prompting focus on the appropriate referrals to increase PBC. Session 2; and when appropriate during telephone and face-to-face contact with GPs
Provision of general information General introduction to rationale and aims of the trial. Sessions 1 and 2
General introduction to UHR for psychosis definitions and concepts.
Information about the early detection-improved outcomes link.
Illustrate the parallels between the trial’s aims and NICE recommendations for early intervention.
Intention Prompt general goal-setting and behavioral resolution Encourage use of leaflet: prompt GPs to develop strategies to help remind them to use the leaflet for potential individuals at UHR for psychosis. Sessions 1 and 2; and throughout the program, every time contact is made with the GP
Prompt review of behavioral goals GPs are asked to review a list of possible goals or plans they may have used to prompt or instigate the process of identification of individuals at UHR for psychosis, and indicate which strategies they used in the last year and which strategies would be useful in the following year. Included within TPB questionnaire in session 2; and a copy provided for each GP for future reference
  1. Based on Michie et al. (2008) [53]. FEP first-episode psychosis, GP general practitioner, LEGS liaison with education and general practices, LP liaison practitioner, NICE National Institute for Health and Care Excellence, PBC perceived behavioral control, TPB theory of planned behaviour, UHR ultra-high risk.