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.行为改变技术（Behavioural Change Technique, BCT）分类体系为系统定义、分类与验证行为改变策略的创新成果提供了关键支撑资源。该分类体系涵盖93种明确界定并分类的独立行为改变策略，可实现复杂行为改变干预中各组成部分的标准化定义与区分。 患者参与实验室（Patient Engagement Lab）旨在测试并对比不同行为改变策略对大型移动健康（mHealth）项目中介结果的影响。相关中介结果包括与他人共享文本消息、阅读WhatsApp消息、响应双向消息提示，以及自我报告的目标健康行为参与度（如门诊就诊情况、避孕或其他治疗方案的依从性）。 为支持在南非国家级移动健康平台上更快速地集成与验证行为改变技术，研究团队开发了《WhatsApp行为改变技术原型测试指南》。不过，在互联网协议消息应用中实施行为改变技术是一项复杂且耗时的工作。 本次提供的原型由经验丰富的南非数字内容设计师与患者参与实验室的南非服务使用者共同开发。团队通过WhatsApp应用程序编程接口（API）集成方案评估了每项行为改变技术的实施可行性；对于可行的行为改变技术，团队开发了展示其实施方式的脚本，并结合服务使用者的反馈进行了修订。 《WhatsApp行为改变技术原型测试指南》中的行为改变技术原型聚焦中低收入国家移动健康工作的两大核心领域：生殖健康/计划生育消息推送与艾滋病病毒（HIV）检测服务。这些原型专为通过WhatsApp应用程序编程接口在南非实施而设计，但多数功能可推广至其他互联网协议消息应用或平台（如Facebook Messenger、Signal或Telegram）。事实上，如今通过WhatsApp实施可能是最具挑战性的，因为WhatsApp已更新其服务条款。 除行为改变技术原型外，《WhatsApp行为改变技术原型测试指南》还将行为改变技术与不同领域的术语进行了关联（如行为经济学试验中测试的“助推”策略），并提供了系统对照表，将行为改变技术与可在WhatsApp（及其他互联网协议）消息平台上观测到的中介结果进行匹配。 这三类数据集协同开发，旨在支持消息平台更高效的测试与优化。我们希望这些资源能够为其他致力于开发并迭代改进其移动健康平台的从业者提供助力。