useful five-step framework that allows researchers to situate their research along this
developmental continuum. Initially, key theories need to be developed and tested to
establish an understanding of determinants and change mechanisms. In this theory-
building stage, small-scale experiments and surveys focus on mechanism rather than
the testing of intervention techniques. Once a clearer idea of mechanism and regulatory
processes emerges modelling phase work begins, which involves testing elements of
the theory and particular change techniques. Once effective techniques are identified
then exploratory trials and feasibility studies can be undertaken (e.g. Hill et al., 2007;
Luszczynska et al., 2007). If these prove effective, particularly if data syntheses studies,
such as systematic reviews and meta-analyses, demonstrate effectiveness across studies,
then investment in larger-scale and definitive trials at national level with detailed,
adequately powered outcome economic and process evaluations is warranted (e.g.
Wight et al., 2002; Wyatt et al., 2013). Finally, if these demonstrate effectiveness then
replicating this effect with sustainable interventions in routine practice is required to
ensure adoption and faithful long-term implementation.
We considered cognitive dissonance theory in Chapter 8. Focus 9.3 presents an
experimental test of a change technique derived from that theory. Specification of the
process of dissonance induction allowed Stone et al.(1994) to develop a technique
combining inducement of commitment to a behavioural standard (such as commitment
to use condoms consistently) and enhanced awareness of personal failures to live up
to that standard (such as a focus on past instances of unprotected intercourse) in order
to generate cognitive dissonance. This cognitive change technique, known as the
‘hypocrisy paradigm’, has been tested in a series of studies with some evidence of
effectiveness. It is not, however, the only technique that has been developed to induce
cognitive dissonance. In a systematic review of such techniques, Freijy and Kothe
(2013) assessed evidence for four additional techniques but concluded that overall,
evidence favoured the hypocrisy paradigm. Thus theoretical specification of simple
regulatory processes (such as dissonance induction) can generate quite distinct change
techniques that may be more or less effective in changing targeted regulatory processes
and, as a result, prompting behaviour change.
Selection of change techniques depends on identification of change objectives during
stage 2 of the intervention mapping process. Consider the use of if-then planning. This
simple technique may be applied differently to distinct real-world problems. Sheeran
and Orbell (2000) found that inclusion of a planning prompt in a questionnaire
increased attendance for cervical cancer screening. The prompt advised questionnaire
recipients that they would be more likely to go for a cervical smear if they decided when
and where to go. They were then given space to write ‘when, where and how you
will make an appointment’. In this case, motivated respondents who had not yet made
an appointment were prompted to make specific action plans (e.g. specifying a time)
to prompt a response that they had the skills to enact (making an appointment). The
technique was effective in changing behaviour; 92 per cent of those offered this
planning opportunity attended for screening compared to 67 per cent in the control
group, despite equivalent levels of reported motivation across the two groups.
This when-where-and-how action-planning technique is distinct in form and
targeted regulatory processes to that employed by Sheeran et al. (2007) to increase
attendance at psychotherapy appointments among those who had already made
appointments. These researchers undertook elicitation research to identify what could
210 MOTIVATION AND BEHAVIOUR