Acyclic behavior change diagrams: a tool to report and analyze interventions

Background: Behavior change interventions have a vital role in enhancing human health and well-being. Nevertheless, concerns have been raised about suboptimal reporting of behavior change interventions, making analyses, replications, and intervention re-use hard or impossible to conduct. Objective: This paper introduces acyclic behavior change diagrams (ABCDs) to achieve more transparent development, evaluation, and reporting of behavior change interventions. ABCDs are a visual representation of the assumptions regarding causal-structural chains that underlie putative active ingredients of behavior change interventions. These causal-structural chains link the behavior change principles that are applied in an intervention to the (determinants of) behavior targeted in that intervention. Conclusions: ABCDs are helpful in making implicit assumptions explicit and help communicate assumptions with team members and other stakeholders. Moreover, we believe they make evaluation easier, and their machine-readability allows for ABCDs to be imported directly into (systematic review) databases with negligible costs while disclosing complete and accurate data. Finally, the ABCD approach fits well with other initiatives to gain a deeper understanding and synthesis of the literature on active intervention elements.