A mixed method evaluation of behaviour change techniques in iSelf-help: A co-designed online group pain management programme in Aotearoa New Zealand

Access to group-based multidisciplinary pain management programmes is limited in Aotearoa New Zealand. To address this, a 12-week online pain management programme - iSelf-help, was co-designed with people living with persistent pain including cultural considerations for Māori - the Indigenous population of Aotearoa New Zealand. A non-inferiority randomised controlled trial demonstrated clinical and cost-effectiveness of iSelf-help compared to the in-person programme. The Behaviour Change Technique (BCT) Taxonomy (v1) contains 93 distinct BCTs in 16 clusters and is one way of describing the active components of iSelf-help. Using mixed-methods, this study aimed to: (1) map content of 13 iSelf-help modules using the BCT Taxonomy, and (2) identify and code participant experiences, mapping these to the taxonomy. Three reviewers independently mapped 130 resources across the modules to distinct BCTs, calculating frequencies by consensus. Of the 36 participants randomised to the iSelf-help arm of the non-inferiority trial, 15 took part in process evaluation interviews. A qualitative deductive analysis identified participant quotes corresponding to the distinct BCTs. Findings from the content analysis and qualitative mapping were then integrated using a mixed methods approach. 46 BCTs were identified in iSelf-help content. From seven BCT clusters, (#5) Natural consequences and (#8) Repetition and substitution were most frequent. Alignment between content and qualitative mapping was found in (#1) Goals and planning, (#4) Shaping knowledge, (#8) Repetition and substitution, (#9) Comparison of outcomes, and (#13) Identity. As group-based pain management programmes improve long-term outcomes, the identified BCT clusters could be key targets for future online group-based pain management programmes. PERSPECTIVE: iSelf-help is a co-designed, online group pain management programme with cultural considerations for Māori - the Indigenous population of New Zealand. The mapping of iSelf-help contents and iSelf-help participants using Behaviour Change Technique (BCT) Taxonomy (v1) has identified key behaviour change techniques. The identified BCTs could be candidates to include in online group pain management programmes.