Identifying Behaviour Change Techniques in Cancer Nutrition Interventions and Their Implementation Contexts: A Systematic Review

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Abstract
Background/Objectives: Effective nutritional care is a critical component of oncology treatment. Behaviour change techniques (BCTs) are key elements that drive individual behaviour change and are commonly identified within clinical interventions and implementation strategies. Despite their relevance, the application of BCTs in oncology nutrition has not been systematically examined. This systematic review aimed to identify and synthesise the use of BCTs in nutrition interventions and their implementation strategies within adult oncology care. Methods: A search across 10 electronic databases was conducted from inception up to December 2024. Data extraction focused on intervention characteristics, plus implementation barriers, strategies, and outcomes, which were coded using relevant established taxonomies, i.e., Theoretical Domains Framework, Behaviour Change Techniques, and Proctor’s outcomes framework. Study quality was assessed using the QuADS tool. Results: After screening 4055 abstracts and 165 full texts, 38 articles representing 31 unique studies were included. Nutrition interventions (n = 31) spanned across risk screening/assessment, care planning/pathways, nutritional monitoring, and support guidelines. Among the 19 interventions that incorporated BCTs targeting patients and/or healthcare professionals (HCPs), 20 unique BCTs were identified across 97 instances. Separately, implementation strategies reported in 25 of the 38 articles included 96 BCT instances (18 unique) targeting HCPs. BCTs were frequently observed alongside positive outcomes across patient, service, and implementation levels. Conclusions: Application of BCTs in oncology nutrition practice remains implicit and inconsistent. For clinical practice, more explicit specifications of BCTs may support better integration of nutrition care in routine oncology settings. Future research is warranted to test the effectiveness of specific BCTs and their combinations. This can be supported by standardised reporting of intervention content and implementation strategies which can enable identification of patterns of success and optimise replicability.

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