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Behaviour Change Techniques and Mechanisms of Action: Identification of the Active Ingredients in Communication Partner Training for People with Acquired Brain Injury

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Title: Behaviour Change Techniques and Mechanisms of Action: Identification of the Active Ingredients in Communication Partner Training for People with Acquired Brain Injury
Language: English
Authors: Nicholas Behn (ORCID 0000-0001-9356-9957), Madeline Cruice (ORCID 0000-0001-7344-2262), Katerina Hilari (ORCID 0000-0003-2091-4849), Leanne Togher (ORCID 0000-0002-4518-6748), Fiona Johnson (ORCID 0000-0002-4271-1834), Ian Kellar (ORCID 0000-0003-1608-5216)
Source: International Journal of Language & Communication Disorders. 2026 61(3).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 14
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Behavior Change, Head Injuries, Neurological Impairments, Communication Disorders, Communication Skills, Interpersonal Communication, Program Evaluation, Speech Language Pathology, Speech Therapy
DOI: 10.1111/1460-6984.70238
ISSN: 1368-2822
1460-6984
Abstract: Background: Cognitive-communication disorders (CCD) are common after acquired brain injury (ABI) and can have a negative impact on a person's life. Training a communication partner can improve the communication skills of the person with ABI; however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners (CPs), though there is variability in the content, dosage and delivery of training; and published programmes are rarely used by speech and language therapists in practice. The strongest evidence is for a single programme, TBI Express, which has three different versions. Therefore, the aim of this study is to identify and describe the active components of existing training programmes for people with CCD. Method: The treatment manuals from each of the training programmes (i.e., TBI Express, TBI Express-Adapted, and TBIconneCT) were coded using the BCTTv1. Mechanisms of action (MoAs) and each behaviour change technique (BCT) was identified and linked using the Theory and Techniques Tool. Prior to coding, pilot coding was completed on two modules from TBI Express with reliability of coding established (kappa and % agreement) for two modules of the remaining two programmes representing ∼20-33% of treatment content. Coding disagreements were recorded and described and subsequently resolved. Results: Across the three programmes, between 20 and 25 BCTs were identified and comprised 27 unique BCTs across all manuals. These BCTs were linked to between 15-16 identified MoAs and comprised 16 unique MoAs. The most common BCTs were providing "information about social and environmental consequences; instruction on how to perform the behaviour; behavioural practice/rehearsal"; and "feedback on the behaviour." The most common mechanisms targeted were "beliefs about capabilities; skills; and behavioural regulation." Reliability of coding BCTs and MOAs was moderate-to-almost-perfect (kappa = 0.69-0.88, 73-85% agreement). Disagreements in coding were discussed and resolved through consensus agreement. Conclusions: Applying behaviour change theory to TBI Express has revealed unique insight into the active ingredients of training. CPs are anticipated to improve their communication behaviours via capabilities, skills and regulation, through SLT-delivered CPT which focuses most commonly on information provision, instruction, rehearsal, and feedback. Such insights are gathered to further refine and adapt existing interventions. Further work is needed to identify the most important active ingredients to expert clinicians, to design and test the feasibility of an adapted CPT programme for implementation in public healthcare services.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1506862
Database: ERIC
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  Data: Behaviour Change Techniques and Mechanisms of Action: Identification of the Active Ingredients in Communication Partner Training for People with Acquired Brain Injury
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  Data: <searchLink fieldCode="AR" term="%22Nicholas+Behn%22">Nicholas Behn</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9356-9957">0000-0001-9356-9957</externalLink>)<br /><searchLink fieldCode="AR" term="%22Madeline+Cruice%22">Madeline Cruice</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7344-2262">0000-0001-7344-2262</externalLink>)<br /><searchLink fieldCode="AR" term="%22Katerina+Hilari%22">Katerina Hilari</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2091-4849">0000-0003-2091-4849</externalLink>)<br /><searchLink fieldCode="AR" term="%22Leanne+Togher%22">Leanne Togher</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4518-6748">0000-0002-4518-6748</externalLink>)<br /><searchLink fieldCode="AR" term="%22Fiona+Johnson%22">Fiona Johnson</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4271-1834">0000-0002-4271-1834</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ian+Kellar%22">Ian Kellar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1608-5216">0000-0003-1608-5216</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Language+%26+Communication+Disorders%22"><i>International Journal of Language & Communication Disorders</i></searchLink>. 2026 61(3).
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: 10.1111/1460-6984.70238
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  Data: 1368-2822<br />1460-6984
– Name: Abstract
  Label: Abstract
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  Data: Background: Cognitive-communication disorders (CCD) are common after acquired brain injury (ABI) and can have a negative impact on a person's life. Training a communication partner can improve the communication skills of the person with ABI; however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners (CPs), though there is variability in the content, dosage and delivery of training; and published programmes are rarely used by speech and language therapists in practice. The strongest evidence is for a single programme, TBI Express, which has three different versions. Therefore, the aim of this study is to identify and describe the active components of existing training programmes for people with CCD. Method: The treatment manuals from each of the training programmes (i.e., TBI Express, TBI Express-Adapted, and TBIconneCT) were coded using the BCTTv1. Mechanisms of action (MoAs) and each behaviour change technique (BCT) was identified and linked using the Theory and Techniques Tool. Prior to coding, pilot coding was completed on two modules from TBI Express with reliability of coding established (kappa and % agreement) for two modules of the remaining two programmes representing ∼20-33% of treatment content. Coding disagreements were recorded and described and subsequently resolved. Results: Across the three programmes, between 20 and 25 BCTs were identified and comprised 27 unique BCTs across all manuals. These BCTs were linked to between 15-16 identified MoAs and comprised 16 unique MoAs. The most common BCTs were providing "information about social and environmental consequences; instruction on how to perform the behaviour; behavioural practice/rehearsal"; and "feedback on the behaviour." The most common mechanisms targeted were "beliefs about capabilities; skills; and behavioural regulation." Reliability of coding BCTs and MOAs was moderate-to-almost-perfect (kappa = 0.69-0.88, 73-85% agreement). Disagreements in coding were discussed and resolved through consensus agreement. Conclusions: Applying behaviour change theory to TBI Express has revealed unique insight into the active ingredients of training. CPs are anticipated to improve their communication behaviours via capabilities, skills and regulation, through SLT-delivered CPT which focuses most commonly on information provision, instruction, rehearsal, and feedback. Such insights are gathered to further refine and adapt existing interventions. Further work is needed to identify the most important active ingredients to expert clinicians, to design and test the feasibility of an adapted CPT programme for implementation in public healthcare services.
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