Step one drew upon the evidence base through a systematic review of the literature. The aims of the systematic review were to (1) investigate the effectiveness of workplace-based dietary and/or physical activity interventions targeting healthcare professional groups such as nurses, (2) identify and describe key components of effective interventions, (3) identify theoretical models of behaviour change involved in effective interventions and (4) investigate whether intervention effectiveness in this setting is improved by the extent to which interventions are explicitly developed based on theory. The methods of this systematic review are reported in full elsewhere [15].

This step reflects a behavioral diagnosis, whereby reasons for nurses’ unhealthy eating and physical activity behaviours and what needs to change to improve nurses eating and physical activity behaviors were identified. Semi-structured qualitative interviews followed by a quantitative survey were undertaken based on the TDF. The TDF is an overarching framework that summarises 84 known determinants of behaviour into fourteen theoretical construct domains [21], allowing the systematic investigation of the psychological determinants which may need to be addressed in order to achieve behaviour change [21]. The methods of the qualitative interview component of this step are reported elsewhere [28]. A separate 113-item survey based on the determinants identified in these qualitative interviews was also constructed and completed by 245 nurses (226 females, 17 males; recruited from hospitals based in the UK) [29]. This enabled quantitative estimation of the relative importance of different determinants.

The current paper focusses on step three in more detail. Specifically, how the findings from the behavioural diagnosis above were mapped onto the BCW framework [22] and BCTTv1 [30] to systematically develop a workplace behaviour change intervention for nurses. The current paper therefore builds on the empirical work generated from steps one and two.

Having previously identified the theoretical determinants of nurses’ eating and physical activity behaviour change using the TDF in step two [28], with details outlined in the Results section of the current article, the BCW [22, 23] was used to identify how these theoretical determinants of nurses’ eating and physical activity behaviour could be targeted. The BCW is a synthesis of 19 behaviour change frameworks [22] which helps to organise and identify intervention types (‘intervention functions’) and policy strategies (‘policy categories’) that are likely to be effective in changing particular theoretical determinants (TDF domains) of target behaviours such as eating and physical activity [22, 23]. In the present study, published matrices [23] were used to identify the most appropriate intervention and policy options for changing the theoretical determinants of nurses’ eating and activity behaviour identified during the TDF-informed interviews and survey.

Once broadly appropriate intervention and policy categories had been identified, specific BCTs were selected using published matrices and mapping documents developed by Cane et al. [25] and Michie et al. [23] which allowed specific techniques associated with particular theoretical determinants and intervention types to be identified. The evidence for the potential effectiveness of each selected BCT was evaluated by conducting a rapid scoping review. The likely parameters of effectiveness for each technique (i.e. the circumstances under which each technique would be expected to work) were also established by consulting recommendations of the Iterative Protocol for Evidence Base Accumulation [31] and using the intervention mapping taxonomy of BCTs [32].

This process was guided by the APEASE criteria (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side effects/safety, Equity). In applying these criteria, acceptability, practicability and affordability were considered as they are more appropriate for the early phases of intervention development. By contrast, effectiveness, side effects/safety, equity would be more applicable to the intervention evaluation phase following a full-scale trial.

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