Behavioural Change Technique (BCT) WhatsApp Implementations: Prototypes Testing Guide

The Behavioural Change Technique (BCT) Taxonomy provides a vital resource for systematically defining, categorising and testing innovations in behaviour change strategy. The BCTs are 93 distinct strategies that are clearly defined and categorised. BCTs enable consistent definition and distinction for component parts in complex behaviour change interventions. The Patient Engagement Lab sought to test and compare the effects of alternative BCTs on mediating outcomes in large-scale mhealth programmes. Relevant mediating outcomes include sharing text messages with others, reading WhatsApp messages, responding to two-way message prompts and self-reported engagement in desired health behaviours (such as clinic attendance and adherence to contraceptive or other treatment regimens). The WhatsApp BCT Prototype Testing Guide was developed to support more rapid integration and testing of BCTs on a national mHealth platform in South Africa. Implementing BCTs on internet protocol messaging programmes can, however, be a complex and time consuming task. The prototypes offered here were developed by an experienced South African digital content designer and a South African service user from the Patient Engagement Lab. The team assessed the feasibility of implementing each BCT using WhatsAPP API integration and where BCTs were found to be feasible, scripts were developed showing how they could be implemented and then revised with service user input. The BCT prototypes provided in the WhatsApp BCT Prototype Testing Guide focus on two key focus areas in mhealth work in low- and middle-income countries: reproductive health / family planning messaging and HIV testing. They are designed to be implemented using WhatsApp API integration specifically in South Africa; most features are, however, generalisable to other Internet Protocol messaging applications or platforms (such as Facebook Messenger, Signal or Telegram). Indeed, implementation via WhatsApp may now be the most challenging because WhatsApp since changed their Terms and Conditions. Alongside the BCT prototypes, the WhatsApp BCT Prototype Testing Guide links BCTs to terminology used in different fields (e.g. ‘nudges’ tested in behavioural economics trials); and offers a table systematically matching BCTs to mediating outcomes that are observable on WhatsApp (and other internet protocol) messaging platforms. These three datasets were developed together to support more efficient testing and optimisation of our messaging platforms. We hope these resources can be of use to others seeking to develop and iteratively improve their mhealth platforms.