Abstract
BACKGROUND: Behavioral and implementation science frameworks should be employed in the design of interventions to change behavior, including those delivered in organizational settings, to enhance their effectiveness, replicability, and transparency. However, this is often not done well in health services research. This deficiency also impacts interventions to address unprofessional behaviors (UBs) among healthcare staff. UBs include rudeness and bullying, which harm patient safety and staff wellbeing. This study builds on an earlier realist review of these UB interventions to retroactively identify their active components. METHODS: A systematic search was updated to July 2024 using MEDLINE, Embase, CINAHL, and Google Scholar. Intervention descriptions were extracted from study reports and independently coded using directed content analysis against the May 2024 version of the behavior change technique (BCT) Ontology, which contained 284 BCTs. RESULTS: The search identified 262 titles and abstracts, yielding five new reports. Combined with 42 papers from the prior review, 47 reports of 44 interventions were included. Interventions were categorized as single-session (n = 15), multisession (n = 12), combined session (n = 6), professional accountability (n = 7), and structured culture change (n = 4). Complex interventions used more BCTs: session-based interventions focused on awareness-raising and roleplay, professional accountability on consequences, and structured culture change on goal-oriented techniques. Few interventions reported negative outcomes, limiting the understanding of which BCTs drive effectiveness. CONCLUSIONS: The BCT ontology is broadly applicable to organizational behavior change in healthcare. Complex interventions employ consequence-based and goal-oriented BCTs, but the effectiveness of specific BCTs remains unclear due to poor evaluations. Future interventions should use the BCT Ontology to improve intervention reporting and effectiveness.