An ontology of mechanisms of action in behaviour change interventions

Paulina M Schenk; Alison J Wright; Robert West; Janna Hastings; Fabiana Lorencatto; Candice Moore; Emily Hayes; Verena Schneider; Susan Michie

doi:10.12688/wellcomeopenres.19489.1

An ontology of mechanisms of action in behaviour change interventions

Wellcome Open Res. 2023 Aug 11:8:337. doi: 10.12688/wellcomeopenres.19489.1. eCollection 2023.

Authors

Affiliations

¹ Centre for Behaviour Change, University College London, London, England, UK.
² Institute of Pharmaceutical Science, King's College London, London, England, UK.
³ Department of Behavioural Science and Health, University College London, London, England, UK.
⁴ Institute for Implementation Science in Health Care, Universitat Zurich, Zürich, Zurich, Switzerland.
⁵ School of Medicine, University of St Gallen, St. Gallen, St. Gallen, Switzerland.
⁶ Research Department of Epidemiology and Public Health, University College London, London, England, UK.

Abstract

Background: Behaviour change interventions influence behaviour through causal processes called "mechanisms of action" (MoAs). Reports of such interventions and their evaluations often use inconsistent or ambiguous terminology, creating problems for searching, evidence synthesis and theory development. This inconsistency includes the reporting of MoAs. An ontology can help address these challenges by serving as a classification system that labels and defines MoAs and their relationships. The aim of this study was to develop an ontology of MoAs of behaviour change interventions. Methods: To develop the MoA Ontology, we (1) defined the ontology's scope; (2) identified, labelled and defined the ontology's entities; (3) refined the ontology by annotating (i.e., coding) MoAs in intervention reports; (4) refined the ontology via stakeholder review of the ontology's comprehensiveness and clarity; (5) tested whether researchers could reliably apply the ontology to annotate MoAs in intervention evaluation reports; (6) refined the relationships between entities; (7) reviewed the alignment of the MoA Ontology with other relevant ontologies, (8) reviewed the ontology's alignment with the Theories and Techniques Tool; and (9) published a machine-readable version of the ontology. Results: An MoA was defined as "a process that is causally active in the relationship between a behaviour change intervention scenario and its outcome behaviour". We created an initial MoA Ontology with 261 entities through Steps 2-5. Inter-rater reliability for annotating study reports using these entities was α=0.68 ("acceptable") for researchers familiar with the ontology and α=0.47 for researchers unfamiliar with it. As a result of additional revisions (Steps 6-8), 21 further entities were added to the ontology resulting in 282 entities organised in seven hierarchical levels. Conclusions: The MoA Ontology extensively captures MoAs of behaviour change interventions. The ontology can serve as a controlled vocabulary for MoAs to consistently describe and synthesise evidence about MoAs across diverse sources.

Keywords: behaviour; determinant; evidence synthesis; intervention; mechanism of action; mechanism of change; ontology; process of change; reporting.

Grants and funding

This work is supported by the Wellcome Trust through a collaborative award to the Human Behaviour-Change Project [201524].