Currently submitted to: Journal of Medical Internet Research
Date Submitted: Mar 30, 2026
Open Peer Review Period: Apr 6, 2026 - Jun 1, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
BeProGuide: A Behavior Design Guide to De-Implement Low-Value Clinical Practices
ABSTRACT
Background:
Although concern about low-value care (LVC) practices has grown in recent years, interventions relying solely on informational or educational strategies have not proven effective in reducing them. This suggests a need to involve professionals and/or patients in collaborative decision-making processes and change strategy design. This study builds on this premise using the Fogg Behavior Model, which posits that a behavior can only occur when motivation, ability, and a prompt converge at the same time.
Objective:
he aim of this study is to develop a guide to designing, implementing and evaluating interventions that reduce LVC practices. We present a specific case study involving the deprescribing of benzodiazepines in primary care and use it as an example of the process to be followed to reduce other practices of this kind.
Methods:
This study was conducted in two primary care centers in Catalonia, Spain. A total of 31 professionals (physicians and nurses) took part in focus groups employing three techniques from the Fogg Behavior Model: Swarm of Behaviors, Focus Mapping, and Golden Behaviors. Through these techniques, we worked with participants to compile a set of actions for implementation. These actions were tailored to the conditions and capacities of their health centers and were assessed by the participants as feasible and effective in reducing benzodiazepine prescribing.
Results:
Based on this practical experience, we developed our ten-step BeProGuide, which outlines a series of tasks that we recommend completing in any project aimed at reducing LVC practices. This is presented as a detailed checklist to support informed decision-making.
Conclusions:
Our research operationalizes the Fogg Behavior Model by setting out a concrete, replicable procedure for reducing LVC clinical practices. In doing so, it transforms this conceptual framework into an actionable methodological tool, BeProGuide, which takes the form of a step-by-step guide and detailed checklist. This guide is not only applicable in health and medicine, but can be used in other fields such as education, work and organizations, and environmental protection.
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Copyright
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