Selecting behaviour change techniques (BCTs) for a hospital deprescribing intervention for older people in Saudi Arabia: a modified nominal group technique consensus study

Abstract Introduction Deprescribing for older adults in Saudi hospitals remains poorly implemented in clinical practice. Developing effective interventions to enhance implementation requires strategies tailored to the Saudi healthcare context. Previous qualitative research has highlighted that these strategies must consider key behavioural determinants, including professional hierarchies, limited interprofessional collaboration, and fragmented care, which influence healthcare professionals’ (HCPs) deprescribing behaviour. This study identified and operationalised behaviour change techniques (BCTs) to guide the development of a deprescribing intervention for integration into Saudi hospitals. Aim To select BCTs for a deprescribing intervention for older adults in Saudi hospital settings based on the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side effects, and Equity) criteria,1 and to explore how these techniques could be operationalised. Methods A modified nominal group technique (NGT) was conducted in two phases to achieve consensus on BCTs from the Behaviour Change Techniques Taxonomy version 1.2 Participants were purposively sampled from the Medication Safety Committee of a hospital in southern Saudi Arabia. Eligible participants were physicians and pharmacists involved in geriatric care, with at least one year of relevant clinical experience. In Phase 1, an online questionnaire facilitated appraisal of 17 BCTs, identified from an initial set of 40 BCTs through qualitative research and appraised by the research team for relevance to hospital-based deprescribing in Saudi Arabia. Each BCT was rated on a five-point Likert scale against six APEASE-aligned statements with a free-text box for comments. BCTs achieving ≥80% agreement across all six criteria were classified as ‘accepted,’ those meeting at least three criteria as reaching ‘partial consensus,’ and those failing to meet more than three criteria as ‘rejected.’ In Phase 2, a face-to-face NGT session reached consensus on BCTs which had achieved partial consensus in Phase 1 and discussed operationalisation of accepted BCTs. Results Seven HCPs (three physicians and four pharmacists) participated. In Phase 1, nine BCTs were rejected, six achieved partial consensus, and two were accepted. In Phase 2, three additional BCTs were accepted. Preferred delivery methods were agreed for the operationalisation of these: ‘Social processes of encouragement, pressure, support’ (empowering pharmacists’ role during ward rounds); ‘Social comparison’ (via regular performance reports); ‘Salience of consequences’ (integrated into digital deprescribing dashboards); ‘Information about others’ approval’ (disseminated through hospital-wide email bulletins); and ‘Information about health consequences’ (presented in hospital-wide grand rounds). Delivery methods were prioritised based on practicality and effective integration into clinical practice. Conclusion This study presents the first theory-informed selection of BCTs for a deprescribing intervention tailored to Saudi hospitals. The modified NGT enabled structured evaluation and consensus building. Although the sample size was small, the high consensus threshold (≥80%) reduced uncertainty and strengthened the validity of the accepted BCTs for practice. However, the single site setting and inclusion of only physicians and pharmacists limit the generalisability of the findings, as input from other HCPs involved in deprescribing was not included. Despite this, the study findings identified BCTs with potential to influence HCP behaviour and provide a foundation for future feasibility testing and refinement to enhance deprescribing practices in Saudi hospitals.