Restricted accessResearch articleFirst published online 2026
Using the behaviour change intervention ontology to examine the inclusion,delivery and experience of behaviour change techniques in a youth health promotion programme
Adolescents from low socioeconomic backgrounds face disproportionate risks to health and well-being, underscoring the need for targeted, evidence-based interventions. Systematic extraction of active ingredients in interventions can inform the design of more effective interventions. This study aims to (1) identify Behaviour Change Techniques (BCTs) and Mechanisms of Actions (MoAs) used to change behaviour in the ‘11 for Health’ programme, (2) interview programme receivers and deliverers exploring their experiences with BCTs and MoAs. Twenty-four BCTs were coded in the manual with 10 associated MoAs. Thematic analysis of interviews generated 16 codes for adolescents and 17 for teachers, each mapped onto BCTs. Adolescents highlighted, ‘social support’ and ‘agree outcome goal’, while teachers emphasised ‘social support’ and ‘information about health consequences’. Further research is needed to substantiate whether potential refinements to the programme and inclusion of new BCTs, as identified in the interviews, could lead to enhanced effectiveness and long-term impact of the programme.
Trial registration: This is a secondary analysis of a clinical trial, which has been registered at: ClinicalTrials.gov ID: NCT03647007.
Amberscript (2025) Amberscript: Web-based automatic and human transcription and subtitling service. Available at: www.amberscript.com (accessed 9 October 2023).
2.
AnselmaMChinapawMJMKornet-van der AaDA, et al (2020) Effectiveness and promising behavior change techniques of interventions targeting energy balance related behaviors in children from lower socioeconomic environments: A systematic review. PLoS One15(9): e0237969.
3.
BossenDBakMBraamK, et al (2022) Online and offline behavior change techniques to promote a healthy lifestyle: A qualitative study. International Journal of Environmental Research and Public Health19(1): 1.
4.
BraunVClarkeV (2019) Reflecting on reflexive thematic analysis. Qualitative Research in Sport Exercise and Health11(4): 589–597.
5.
BullFCAl-AnsariSSBiddleS, et al (2020) World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine54(24): 1451–1462.
6.
CerinELeslieE (2008) How socio-economic status contributes to participation in leisure-time physical activity. Social Science & Medicine66(12): 2596–2609.
7.
CollinsLM (2018) Conceptual Introduction to the Multiphase Optimization Strategy (MOST). In: CollinsLM (ed.) Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy (MOST). Springer International Publishing, pp.1–34.
8.
ConnV. S.HafdahlA. R.MehrD. R. (2011). Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes. American Journal of Public Health101(4): 751–758. https://doi.org/10.2105/AJPH.2010.194381
9.
CraikeM.WiesnerG.HillandT. A.BengoecheaE. G. (2018). Interventions to improve physical activity among socioeconomically disadvantaged groups: An umbrella review. International Journal of Behavioral Nutrition and Physical Activity15(1): 43.
10.
EcclesDWArsalG (2017) The think aloud method: what is it and how do I use it?Qualitative Research in Sport Exercise and Health9(4): 514–531.
11.
Elizondo-MontemayorL.Moreno-SànchezD.GutierrezN. G.Monsivais-RodriguezF.MartinezU.Lamadrid-ZertucheA. C.Hernandez-TorreM. M. (2014). Individualized tailor-made dietetic intervention program at schools enhances eating behaviors and dietary habits in obese hispanic children of low socioeconomic status. The Scientific World Journal2014(1): 484905.
FullerCWØrntoftCLarsenMN, et al (2017) ‘FIFA 11 for Health’ for Europe. 1: Effect on health knowledge and well-being of 10- to 12-year-old Danish school children. British Journal of Sports Medicine51(20): 1483–1488.
14.
GraySMitchellFWangCKJ, et al (2018) Understanding students’ experiences in a PE, health and well-being context: A self-determination theory perspective. Curriculum Studies in Health and Physical Education9(2): 157–173.
15.
HansonMDChenE (2007) Socioeconomic status and health behaviors in adolescence: A review of the literature. Journal of Behavioral Medicine30(3): 263–285.
16.
HowlettNGarcía-IglesiasJBontoftC, et al (2022) A systematic review and behaviour change technique analysis of remotely delivered alcohol and/or substance misuse interventions for adults. Drug and Alcohol Dependence239: 109597.
17.
HuynhTLTNealWNBarstowEA, et al (2025) Preferred behavior change techniques for physical activity interventions among persons newly diagnosed with multiple sclerosis: A qualitative study. Behavioral Medicine51: 106–116.
18.
JohnstonMCareyRNConnell BohlenLE, et al (2021) Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus. Translational Behavioral Medicine11(5): 1049–1065.
19.
LarsenMNElbeA-MMadsenM, et al (2021) An 11-week school-based ‘health education through football programme’ improves health knowledge related to hygiene, nutrition, physical activity and well-being—and it’s fun! A scaled-up, cluster-RCT with over 3000 Danish school children aged 10–12 years old. British Journal of Sports Medicine55(16): 906–911.
20.
LarsenMNTerraccianoAMøllerTK, et al (2023) An 11-week school-based “health education through football” programme improves musculoskeletal variables in 10-12-yr-old Danish school children. Bone Reports18: 101681.
21.
LaukkanenAPesolaAJFinniT, et al (2017) Parental support and objectively measured physical activity in children: A yearlong cluster-randomized controlled efficacy trial. Research Quarterly for Exercise and Sport88(3): 293–306.
22.
MadsenEEKrustrupPMøllerTK, et al (2022) Implementation facilitation of the “11 for Health in Denmark”: A case study in a Danish 5th grade class. Scandinavian Journal of Medicine and Science in Sports32(1): 152–164.
23.
MadsenMElbeAMadsenEE, et al (2020) The “11 for Health in Denmark” intervention in 10- to 12-year-old Danish girls and boys and its effects on well-being—A large-scale cluster RCT. Scandinavian Journal of Medicine and Science in Sports30(9): 1787–1795.
24.
MarquesMMCareyRNNorrisE, et al (2021) Delivering behaviour change interventions: Development of a mode of delivery ontology. Wellcome Open Research5: 125.
25.
MarquesMMWrightAJCorkerE, et al (2024) The behaviour change technique ontology: Transforming the behaviour change technique taxonomy v1. Wellcome Open Research8: 308.
26.
McAuliffeHMc SharryJDunneD, et al (2021) Identifying the active ingredients of cardiac rehabilitation: A behaviour change technique and qualitative analysis. British Journal of Health Psychology26(4): 1194–1218.
27.
McEwanDHardenSMZumboBD, et al (2016) The effectiveness of multi-component goal setting interventions for changing physical activity behaviour: A systematic review and meta-analysis. Health Psychology Review10(1): 67–88.
28.
MergelsebergE (2023) Active ingredients of interventions improving smoking cessation support by Dutch primary care providers: A systematic review - Enrique L. P. Mergelsberg, Dennis de Ruijter, Mathilde R. Crone, Eline S. Smit, Ciska Hoving. Available at: https://journals-sagepub-com.proxy1-bib.sdu.dk/doi/full/10.1177/01632787221099941 (accessed 27 January 2025).
29.
MichieSRichardsonMJohnstonM, et al (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine46(1): 81–95.
30.
MichieSThomasJJohnstonM, et al (2017) The Human Behaviour-Change Project: Harnessing the power of artificial intelligence and machine learning for evidence synthesis and interpretation. Implementation Science12(1): 121.
31.
MichieSWestRFinnertyAN, et al (2021) Representation of behaviour change interventions and their evaluation: Development of the upper level of the behaviour change intervention ontology. Wellcome Open Research5: 123.
32.
MøllerTKKrustrupPBrøndJC, et al (2025) Essential improvements in fat percentage and cardiometabolic fitness after a residential stay for socially vulnerable children—With and without the “11 for Health” concept. Pediatric Exercise Science37: 239–251.
33.
MøllerTKLarsenMNPfefferK, et al (2024) The effects of a combined physical activity and health education program on health knowledge and well-being of socially vulnerable children. Scandinavian Journal of Medicine and Science in Sports34(4): e14606.
34.
NorrisEMarquesMMFinnertyAN, et al (2020) Development of an intervention setting ontology for behaviour change: Specifying where interventions take place. Wellcome Open Research5: 124.
35.
NorrisEWrightAJHastingsJ, et al (2021) Specifying who delivers behaviour change interventions: Development of an intervention source ontology. Wellcome Open Research6: 77.
36.
NtoumanisN.MollerA. C. (2023). Facilitating health behavior change: A self-determination theory perspective. In: RyanRM (ed.) The Oxford Handbook of Self-Determination Theory (pp. 777–800). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780197600047.013.39
37.
NtoumanisNNgJYYPrestwichA, et al (2021) A meta-analysis of self-determination theory-informed intervention studies in the health domain: Effects on motivation, health behavior, physical, and psychological health. Health Psychology Review15(2): 214–244.
38.
OlanderEKFletcherHWilliamsS, et al (2013) What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity10(1): 29.
39.
OlsenNRBradleyPEspehaugB, et al (2015) Impact of a multifaceted and clinically integrated training program in evidence-based practice on knowledge, skills, beliefs and behaviour among clinical instructors in physiotherapy: A non-randomized controlled study. PLoS One10(4): e0124332.
40.
ØrntoftCFullerCWLarsenMN, et al (2016) ‘FIFA 11 for Health’ for Europe. II: Effect on health markers and physical fitness in Danish schoolchildren aged 10–12 years. British Journal of Sports Medicine50(22): 1394–1399.
41.
PoitrasVJGrayCEBorgheseMM, et al (2016) Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology Nutrition and Metabolism41(6): S197–S239.
42.
ProcterSMutrieNDavisA, et al (2014) Views and experiences of behaviour change techniques to encourage walking to work: A qualitative study. BMC Public Health14(1): 868.
43.
QSR International (2022) NVivo. QSR International.
44.
ReissF (2013) Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine90: 24–31.
45.
RydenstamTFellTBuliBG, et al (2020) Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study. Health & Place65: 102387.
46.
SchenkPMWrightAJWestR, et al (2024) An ontology of mechanisms of action in behaviour change interventions. Wellcome Open Research8: 337.
47.
SeijtsG. H.LathamG. P.WoodwarkM. (2012). Learning goals: A qualitative and quantitative review. In: LockeEALathamGP (eds.) New Developments in Goal Setting and Task Performance (pp. 185–210). Routledge.
48.
ShuvalKBerkovitsENetzerD, et al (2007) Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors’ attitudes, knowledge and clinical behaviour: A controlled trial and before and after study. Journal of Evaluation in Clinical Practice13(4): 581–598.
49.
SluijsE. M. F. vanEkelundU.Crochemore-SilvaI.GutholdR.HaA.LubansD.OyeyemiA. L.DingD.KatzmarzykP. T. (2021). Physical activity behaviours in adolescence: Current evidence and opportunities for intervention. The Lancet398(10298): 429–442.
50.
SmithDMTaylorWLavenderT (2016) Behaviour change techniques to change the postnatal eating and physical activity behaviours of women who are obese: a qualitative study. BJOG123(2): 279–284.
51.
SwannCRosenbaumSLawrenceA, et al (2021) Updating goal-setting theory in physical activity promotion: A critical conceptual review. Health Psychology Review15(1): 34–50.
52.
Van Den BekeromLVan GestelLSchoonesJ, et al (2023) Health behavior interventions among people with lower socio-economic status: A scoping review of behavior change techniques and effectiveness. PsyArXiv. Available at: https://osf.io/3jdc5 (accessed 18 February 2025).
53.
WangGSHoyteC (2018) Common substances of abuse. Pediatrics in Review39(8): 403–414.
54.
WeissmanSEPerinpanayagamRWrightFV, et al (2022) Application of the behaviour change technique taxonomy (BCTTv1) to an inclusive physical literacy-based sport program for children and youth. International Journal of Sports Science & Coaching17(1): 18–36.
55.
WilkPClarkAFMaltbyA, et al (2018) Exploring the effect of parental influence on children’s physical activity: The mediating role of children’s perceptions of parental support. Preventive medicine106: 79–85.
56.
World Health Organisation (2022) Global Status Report on Physical Activity 2022: Country Profiles. World Health Organization.
