TABLE 3
Examples of the application of BCTs that can used in isolation or in combination to address beliefs
BCT BCT definition 7 Examples of application
Beliefs about lack of necessity ( e . g ., these medicines don ’ t protect me from becoming worse ; my health , at present , doesn ’ t depend on these medicines ( adapted from 19 )
5.1 Information about health consequences
Provide information ( for example , written , verbal , visual ) about health consequences of performing the behaviour
Highlight the negative consequences of not taking the medication
9.2 Pros and cons Advise the person to identify and compare reasons for wanting ( pros ) and not wanting to ( cons ) change the behaviour ( includes ‘ Decisional balance ’)
2.6 Biofeedback Provide feedback about the body ( for example , physiological or biochemical state ) using an external monitoring device as part of a behaviour change strategy
Advise the person to list and compare the reasons for taking and not taking the medication
Assess and inform the person about physiological and / or biochemical states related to not taking the medication , such as glycated haemoglobin , blood pressure or cholesterol
Concerns about medication ( for example , these medicines give me unpleasant side effects 20 )
5.1 Information about health consequences
5.3 Information about social and environmental consequences
Provide information ( for example , written , verbal , visual ) about health consequences of performing the behaviour
Provide information ( for example , written , verbal , visual ) about social and environmental consequences of performing the behaviour
Highlight the positive consequences of taking the medication
Highlight the consequences of not taking medication to the family environment ( e . g ., not being able to do family routine activities )
9.2 Pros and cons Advise the person to identify and compare reasons for wanting ( pros ) and not wanting to ( cons ) change the behaviour ( includes ‘ Decisional balance ’)
Advise the person to list and compare the reasons for taking and not taking the medication
KEY POINTS
• The Train4Health competency framework and the accompanying set of standardised BCTs is a resource to health and other professionals across Europe to set standards and guide training .
• Using BCTs facilitates tailored medication adherence interventions by hospital pharmacists , whilst fostering comprehensiveness and consistency .
• Resorting to BCTs renders hospital pharmacists ’ interventions in medication adherence more explicit .
• Hospital pharmacists may strenghen their ability to use a set of standardised BCTs through simulation in the webapplication developed by the Train4Health project . as a unique person should be considered when selecting a BCT addressing a medication barrier . For example , social support may not be suitable for a person living alone and having a restricted social network . Operationalising a selected BCT also requires considering the patient as a unique person ; for instance , advising a person to set reminders in a mobile phone to take the medication ( prompts / cues ( 7.1 )) might not be appropriate for older persons unfamiliar with these devices . In such case , helpful alternatives may include using a post-it on the fridge door .
Another important consideration is about the combined use of BCTs . Table 4 presents examples of BCTs bundles to enhance medication adherence . If used in a bundle , different BCTs are usually applied in more than one occasion . This is exemplified by the BCT Feedback on the outcome ( s ) of the behaviour ( 2.7 ), which might be more effective if the person firstly monitors and records the outcome ( s ) of the behaviour ( Self-monitoring of outcome ( s ) of behaviour ( 2.4 )).
Conclusions The Train4Health competency framework is a resource for pharmacists and other professionals to set standards and guide training on behaviour change support in chronic disease , including medication adherence . A next step for using this resource is deciding on the best approach to assess competencies in practice , to ensure that professionals fulfil their role ; being cognisant of their own competencies through self-assessment is also important for improvement . Training focused on standardised BCTs is emerging as a trend ; the
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