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PLoS One. 2019 Apr 17;14(4):e0213983. doi: 10.1371/journal.pone.0213983. eCollection 2019.

What do cost-effective health behaviour-change interventions contain? A comparison of six domains.

Author information

Department of Behavioural Science and Health, University College London, London, United Kingdom.
Department of Clinical, Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, United Kingdom.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
National Institute for Health and Care Excellence, NICE, London, United Kingdom.



To help implement behaviour change interventions (BCIs) in practice it is important to be able to characterize their key components. This study compared broad features of cost-effective BCIs that addressed smoking, diet, physical activity, alcohol and sexual health. It also assessed the association of these with the magnitude of the cost-effectiveness estimates.


A content analysis of 79 interventions based on 338 intervention descriptions was conducted, using the Behaviour Change Wheel (BCW) to classify intervention content in terms of intervention functions, and the BCT taxonomy to identify and categorise component Behaviour Change Techniques (BCT). Regression analysis identified the association of these with upper (pessimistic) and lower (optimistic) cost-effectiveness estimates.


The most and least common functions and BCT clusters were education (82.3%) and shaping knowledge (79.7%), and coercion (3.8%) and covert learning (2.5%). Smoking interventions contained the largest ([Formula: see text] = 12) number of BCTs and were most cost-effective. Several other factors were associated with worse (coercionfunction βupper = 36551.24; shaping knowledgeBCT βlower = 2427.78; comparison of outcomesBCT βupper = 9067.32; repetition and substitutionBCT βupper = 7172.47) and better (modellingfunction βlower = -2905.3; environmental restructuringfunction βupper = -8646.28; reward and threatBCT βupper = -5577.59) cost-effectiveness (p<0.05).


Cost-effective BCIs rely heavily on education with smoking interventions exhibiting the most comprehensive range of BCTs. Providing an example to aspire to, restructuring the environment and rewarding positive behaviour may be associated with greater cost-effectiveness.

Conflict of interest statement

EB has received unrestricted funding from Pfizer. RW has undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. LS has received honoraria for talk and travel expenses from manufacturers of medications for smoking cessation to attend meetings and workshops. RW is funded by Cancer Research UK; EB is funded by the NIHR SPHR and CRUK also provide support. RW is funded by Cancer Research UK and NIHR SPHR also provide support. SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. The views expressed are those of the authors(s) and not necessarily those of the NHS, NIHR, or Department of Health. No funders had any involvement in the design of the study, the analysis or interpretation of the data, the writing of the report, or the decision to submit the paper for publication. LO’s salary is funded by NICE. BG and FL have nothing to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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