The Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy of behavior change techniques builds on initial work on classifying psychological techniques used in intervention to change behavior, with a particular emphasis on physical activity and healthy eating. The taxonomy aims to provide a common language for the organization, identification, and adoption of behavior change techniques in interventions. The taxonomy is a tool for researchers designing effective interventions that work and practitioners wishing to identify the techniques that will be most effective in changing physical activity behavior. The taxonomy is based on Charles Abraham and Susan Michie’s initial taxonomy of behavior change techniques refined to eliminate inconsistencies. The taxonomy provides a reference guide for each technique and the psychological constructs it purports to change. Forty-three techniques are specified in CALO-RE. Each has a specific definition derived from systematic reviews of intervention research independently coded and verified by leading experts. The definitions also specify exclusions and exceptions ensuring that the techniques do not overlap. The CALO-RE taxonomy does not specify the theories from which the techniques are derived; this information was supplied by Abraham and Michie. The taxonomy provides a standardized set of common terms to facilitate understanding of interventions, enable better evaluation of the effectiveness of specific intervention techniques, and provide insight into the psychological mediators that explain the process by which the technique works in changing behavior.
Behavior Change Theory and the Taxonomy
A vast array of psychological factors, such as self efficacy, attitudes, motivation, intentions, and risk perceptions, have been found to be linked to physical activity behavior. Such antecedents are important as it is assumed that such variables can be manipulated or changed through techniques communicated to individuals by various means like one-to-one consultations or via the media. While interventions targeting psychological factors have led to increased physical activity participation, their effectiveness has been shown to be relatively modest. A key reason is that interventions do not adequately identify the intervention techniques that will be successful in changing the psychological constructs known to be correlated with physical activity. This means that the techniques used may not be completely effective in changing behavior as they do not lead to a change in the psychological constructs, known as psychological mediators, associated with physical activity. Another problem in intervention research is that the reporting of the intervention components adopted to change physical activity behavior is inadequate. This limits the extent to which other researchers will be able to replicate the findings and limits the inferences that those aiming to synthesize research can make with regard to the effectiveness of specific techniques in changing the psychological constructs and changing behavior. A final problem is that many interventions adopt multiple behavior change techniques that seek to target multiple psychological mediators. While adoption of multiple techniques can be effective in bringing about behavior change, it limits researchers’ ability to identify which of the techniques was responsible for bringing about the change. Researchers will, therefore, be unable to arrive at a definitive conclusion as to which of the intervention techniques are doing the work in changing behavior.
These issues have led to calls for (1) identifying and classifying the intervention techniques that target specific antecedents of physical activity through a mapping process, (2) improved reporting of behavior change techniques within reports of intervention trials, and (3) improvements in the design of interventions to provide tests of individual techniques identified in the mapping process on physical activity behavior change. Recent developments in the taxonomy of behavior change techniques have led to a direct mapping of specific techniques on to the psychological antecedents of behavior change. This has provided researchers and practitioners with a menu of strategies from which to choose when designing interventions as well as identifying any overlaps and gaps.
Methods and Development
The lists that Abraham and Michie used to develop their taxonomy mixed general theoretical approaches, modes of delivery, and intervention settings. Therefore, a refined taxonomy of 26 clearly defined behavior change techniques was developed so as to overcome these issues and allow reliable coding of interventions. Three systematic reviews were then completed to assess whether the behavior change techniques could be used to identify core components of behavior change interventions. The 26 behavior change technique definitions resulted in 93% agreement between raters, and acceptable interrater reliability levels for most of the definitions.
Since the publication of the original behavior change technique taxonomy, which has been widely adopted and used in reviews, researchers have identified further opportunities to improve the classification. Researchers at Coventry, Aberdeen, and London collaborated to identify limitations, such as lack of clarity or disagreement between raters, with Abraham and Michie’s original taxonomy, and to introduce further classifications. Research teams adopted an iterative process of coding one or two research articles, calculating interrater reliability coefficients, and revising the taxonomy accordingly through group discussion. This process resulted in the CALO-RE taxonomy, which has fewer conceptual problems and less overlap between items and is more comprehensive.
The 40 behavior change techniques identified in the CALO-RE taxonomy define and differentiate techniques, offering researchers and practitioners a clear guide as to which techniques may be adopted to change physical activity behavior in interventions. There is no guidance on which techniques to adopt or which will be more effective; the purpose is for identification and classification only. An outline of each technique is provided in the next section along with exercise-specific examples of what each technique might look like in an intervention to promote exercise and physical activity.
- Information provision (general). In this technique, general (not specific) information is provided about physical activity and its possible outcomes. (A poster might provide a statement that “physical activity is enjoyable and fun for all.”)
- Information provision (to the individual). In this technique, specific information relevant to the individual about physical activity and its possible outcomes, consequences, benefits, and costs is given. (A physician might inform a patient that “if you participate in regular physical activity, it will help you to get your weight down and help you to feel less stressed at work.”)
- Information provision (others’ approval). In this technique, information is provided about what others’ might think of their physical activity. (An exercise specialist might tell a referred patient: “You will find that your family and friends will be very supportive of your new exercise program; they will see a fitter, healthier you!”)
- Information provision (others’ behavior). In this technique, information concerning what others typically do with respect to exercise is provided. (A leaflet might inform a potential middle-age person thinking of taking up physical activity that “people over 50 years of age often take up exercise having not ever exercised in the past.”)
- Goal setting (behavior). In this technique, encouragement to begin or maintain behavior change is provided. It does not involve precise planning to do the behavior. (A goal may be to “exercise more next week.”)
- Goal setting (outcome). In this technique, the individual is encouraged to set general goals achievable through performance of the behavior, but distinct from the behavior itself. (A consultant might highlight blood pressure reduction and losing weight as achievable goals derived from regular exercise.)
- Action planning. In this technique, detailed plans are made including when (e.g., frequency) and where (e.g., in what situation) to act. It is vital that there is a clear link between plans and behavioral responses to specific situational cues. Such plans are often expressed in if–then formats. (A business executive’s plan might be, “If it is 5 p.m. and everyone is starting to leave the office, then I will collect my gym bag and head for the fitness center.”)
- Identifying barriers and problem resolution. In this technique, after the formation of a clear plan, individuals are tasked with identifying possible barriers to performance and solutions to the possible problems. Barriers may be cognitive, emotional, social, or physical (“I feel too tired to exercise on Fridays—therefore, I will go to sleep earlier on Thursday nights.”)
- Setting graded tasks. In this technique, the target behavior is broken into smaller, more manageable tasks, allowing successful progression in small increments—for instance, writing down a sequence of small steps to accomplish the overall behavior over time.
- Review of behavioral goals. In this technique, individuals are prompted to review the successful accomplishment of previously set goals and contingencies and further plans made for instances in which goals were missed. (An individual may report not being able to exercise 5 times a week due to other commitments, so reschedules allotted times to exercise at more convenient times or fits it into a work schedule by walking to work.)
- Review of outcome goals. In this technique, an individual will review the attainment of previously set outcome goals and be given an opportunity to revise the goals. (At a routine check-up, a physician might encourage an exerciser to revise the blood pressure or weight goal and modify the physical activity regime accordingly to enhance chances for success.)
- Effort or progress contingent rewards. In this technique, the person uses rewards or praise for attempts at achieving the goal. This is not reward for engaging in the behavior itself and is not contingent on actual success. (A trainer might say to an exerciser, “Well done, you have really tried hard to attain your goal of three visits to the gym this week.”)
- Successful behavior-contingent rewards. In this technique, rewards for successful performance of the target behavior are provided. The reward may be material or verbal but must be based explicitly engaging in the behavior itself—for instance, providing a reward or incentive for doing some physical activity, regardless of outcome.
- Shaping. In this technique, graded contingent rewards are provided for movement toward completion of the target behavior. The individual may reward oneself for any increase in physical activity behavior in the first instance (e.g., jogging for 10 minutes as opposed to no activity). The reward schedule becomes progressively more restricted in later weeks (e.g., rewarding only for 20 minutes of jogging).
- Generalization of target behavior. In this technique, the person is encouraged to find opportunities to try it in other situations, to ensure the behavior does not become situation specific. (After following a walking program for 2 weeks, a personal trainer will ask the client to try swimming for the same amount of time at the local swimming pool.)
- Self-monitoring of behavior. In this technique, the person is asked to keep a detailed record of activity and use it as a means to change or modify behavior. This could take the form of a questionnaire or diary focusing on duration, time, and situation in which the physical activity was attempted or completed.
- Self-monitoring of behavioral outcome. This technique is similar to point 16, but focus is on measurable outcomes of the behavior (e.g., blood pressure or weight reduction).
- Focus on past success. In this technique, individuals reflect on successful past experience with physical activity as a means to increase motivation to be active in the future. (A person is encouraged to list or write down past successful experiences with physical activity.)
- Provide feedback on performance. In this technique, individuals receive feedback regarding a recent physical activity success with the aim of increasing motivation to be more active in future. This may take the form of an exercise trainer commenting on, supporting, or critiquing a client’s physical activity goals.
- Informing when and where to perform the behavior. In this technique, individuals are offered advice and ideas on when and where physical activity could be performed (e.g., providing suggestions on local exercise classes or gyms, local recreation parks, or even to and from the workplace).
- Instruction on how to perform the behavior. In this technique, a person is instructed on exactly how to effectively perform a behavior (e.g., advice on technique in the gym or instruction on correct frequency or duration of cycling to work).
- Demonstrate behavior. In this technique, the person is shown how to perform an activity. (A gym instructor might give a customer a demonstration of a particular exercise or piece of equipment.)
- Training to use prompts. In this technique, individuals are given instruction on use of cues as a reminder to perform a behavior. (Encouraging exercisers to use frequently occurring everyday events like a particular time of day or mobile phone alerts, reminds them of the need to initiate their physical activity routine.)
- Environmental restructuring. In this technique, the individuals are prompted to make changes to their environment in order to facilitate changes in behavior (e.g., informing friends so that they may help prompt physical activity or removing tempting snacks or treats to help maintain weight loss).
- Agreement of behavioral contract. In this technique, a written agreement between the individual and the practitioner with respect to behavior change is established. (A trainer and client may sign a contract explicitly stating the agreed activities or exercises so there is an explicit record and a sense of commitment on the part of the practitioner and client.)
- Prompt practice. In this technique, the person is reminded to rehearse and repeat the behavior, or situations that lead to the behavior, helping make the behavior more automated or habitual (e.g., providing people with means to rehearse when they are going to do their exercise routine).
- Use of follow-up prompts. In this technique, a set of reminders is delivered to a person that has started a behavior change routine in order to help remind them to continue. Over time, as the person becomes better at performing the behavior, reminders and prompts are reduced. These could include providing people with a personal alarm, e-mail, text message, or other reminder to help them recall their physical activity regimen or goal.
- Facilitate social comparison. In this technique, individuals are encouraged to draw comparisons with others’ behavior to increase motivation through modeling. (A person is encouraged to observe other regular exercisers to provide a positive example of technique or commitment.)
- Plan social support. In this technique, the person is prompted to elicit social support from other people and close relations in order to facilitate successful completion of the behavior. This may take the form of joining clubs or groups involved in physical activity.
- Prompt identification as role model. In this technique, the person is encouraged to view oneself as an example or role model to others for the behavior. This includes opportunities for the person to persuade others to adopt the behavior because of the benefits inherent in it (e.g., urging friends and family to engage in more physical activity).
- Prompt anticipated regret. In this technique, expectations of shame, regret, or guilt for failure to accomplish the goal are induced. (The exercise specialist might encourage an exerciser to think about how guilty one would feel if one missed the next gym session.)
- Fear arousal. In this technique, fear-inducing information aimed at motivating change is provided. (If weight loss is a goal, practitioners might highlight the health risks of being overweight or obese.)
- Prompt self-talk. In this technique, the person is encouraged to use self-talk before and during activity to provide verbal encouragement and support. (An exercise practitioner might encourage individuals to use mantras or motivational words when they are finding their exercise routine difficult.)
- Prompt use of imagery. In this technique, the person is provided with instruction on how to use visualization techniques and imagery to facilitate successful completion of the behavior (e.g., imagining completing a given walking distance or lifting heavier weights).
- Relapse prevention. In this technique, the person is prompted to focus on situations or occasions in which one may relapse, and then develop methods to increase chances of success. (A person following a jogging routine may highlight bad weather as a possible barrier to maintaining the exercise; encouragement to use a treadmill in the gym on cold or rainy days would be a solution.)
- Stress management. In this technique, the person is encouraged to focus on reducing related stress and improving emotional control in order to reduce these as a barrier and promote health. (A counselor or helper may provide therapy to an individual attempting to increase activity levels in order to reduce the effect of negative emotions on their behavior.)
- Motivational interviewing. In this technique, specific interviewing techniques to prompt changes by minimizing resistance and resolving ambivalence to change are used. (A therapist may need to express empathy and provide opportunities for the client to express personal reasons to take up exercise.)
- Time management. In this technique, the person is assisted in managing time efficiently to be able to engage in the desired activity (e.g., using a diary or organizer to plan time).
- Communication skills training. In this technique, individuals are directed toward improving communication skills and improving interactions with others concerning the behavior. This often involves group work and focuses on listening skills and assertive oration. (An exercise specialist may encourage clients to engage in brief role play, encouraging an exercise partner to come to the gym or go to the local swimming pool with them.)
- Stimulate anticipation of future rewards. In this technique, individuals are encouraged to consider future rewards associated with the outcome(s), without necessarily reinforcing behavior change (e.g., getting people to consider the possible gains of exercise, including extrinsic rewards like money and intrinsic rewards like satisfaction).
Implications of CALO-RE
The CALO-RE taxonomy provides a comprehensive and standardized protocol for the identification, reporting, and appraisal of behavior-change interventions for health behaviors, including physical activity. The taxonomy provides a common language for the scientific communication of theoretical-based interventions, which not only helps researchers effectively describe, interpret, and code behavioral-change strategies in interventions that directly link to theoretical constructs, but also establishes a basis for practitioners to accurately evaluate and apply behavior change techniques derived from previous research. The taxonomy assists in the systematic accumulation of knowledge of behavior change techniques from previous research trials and improves the precision for the implementation of multiple theoretical frameworks applied for the promotion of physical activity.
The development of the taxonomy offers a number of avenues for future research and applied practice in behavior-change interventions for physical activity. First, CALO-RE provides a rigorous and systematic procedure that helps correctly map theoretical constructs into behavioral change techniques, so it becomes more realistic to test the effectiveness of individual theoretical components within an intervention. Second, interventions can be optimized by identifying and eliminating overlapping or redundant elements of the behavioral change techniques driven by multiple theoretical components or frameworks. Third, the enhanced connection between theoretical knowledge and behavioral change techniques may enable researchers to reveal the underlying mechanisms of the intention and behaviors of physical activity.
- Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. walls around a closed chamber to generate sufficient pressure to propel blood from the left ventricle, Health Psychology, 27(3), 379–387.
- Bartholomew, L. K., & Mullen, P. D. (2011). Five rolesfor using theory and evidence in the design and testing of behavior change interventions. Journal of Public Health Dentistry, 71(Suppl. 1), S20–S33.
- Dombrowski, S. U., Sniehotta, F. F., Avenell, A., Johnston, M., MacLennan, G., & Araújo-Soares, A. (2011). Identifying active ingredients in complex behavioural interventions for obese adults with additional risk factors: A systematic review. Health Psychology Review, 6(1), 7–32.
- Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health, 26(11), 1479–1498.
- Schaalma, H., & Kok, G. (2009). Decoding health education interventions: The times are a-changin’. Psychology & Health, 24(1), 5–9.
- Webb, T. L., Sniehotta, F. F., & Michie, S. (2010). Using theories of behaviour change to inform interventions for addictive behaviours. Addiction, 105(11), 1879–1892.