The Behaviour Change Wheel: a system for designing effective interventions

Transcription

1 The Behaviour Change Wheel: a system for designing effective interventions Susan Michie Professor of Health Psychology, University College London Chair, Behaviour and Communications group, UK s Scientific Pandemic Influenza Advisory Committee (SPI)

2 Purposes of communication in relation to pandemic flu In terms of public health, the ultimate purpose of communication is to change behaviour Increase knowledge and understanding for its own sake? Purpose: social and political Increase knowledge and understanding in order to change health-related behaviour Purpose: reduce disease transmission and severity

3 Behaviour After vaccines, changing behaviour is the most important factor in reducing harm caused by influenza Vaccines, themselves, depend on behaviour Health professional offer and delivery Attendance at clinic

4 What other behaviours?: WHO, 2010 Keep at least 1 metre distance from people who show symptoms of influenza-like illness reduce the time spent in crowded settings improve airflow in living spaces by opening windows avoid touching mouth, nose and eyes if possible and most importantly, clean hands thoroughly with soap and water, or with an alcohol-based hand rub on a regular basis. What can I do to protect myself from catching pandemic (H1N1) 2009? index.html ( ).

5 Communicating to change behaviour Health Education model Give information About risk and what to do Increase worry X not sufficient Other influences on behaviour Skills and confidence That people can conduct the recommended behaviours That the recommended behaviours will be beneficial Mental models about illness, risk, behaviours Context Social influences and environment

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8 This talk: a system for designing effective interventions 1. Start with the target behaviour Precise description Understanding of its determinants 2. Consider full range of possible interventions and policies 3. Identify specific behaviour change techniques 4. Design communication strategy to support the above

9 Effective communication requires An analysis of the target behaviour Who needs to do what, when and how understanding as to why desired behaviour is not occurring A method for selecting types of intervention and specific behaviour change techniques Modes of delivery of behaviour change techniques Media, messages, images, source

10 An analysis of the target behaviour: Why are desired behaviours not happening? Use theories of behaviour change We have many relevant psychological theories and models of behaviour and behaviour change Not generally used in communications design and delivery Need to integrate and simplify to make useable

11 Behaviour change theories: 3 groups Motivational: explain behaviour of people who have not yet established intention e.g. Theory of Planned Behaviour, Operant Learning Theory Action: explain behaviour of people who have identified a need to change e.g. Control Theory/Self-regulation Theory Organisational: explain institution level change e.g. Diffusion of Innovation

12 Consensus study to integrate and simplify behaviour change theory Participants 18 researchers in health psychology with an interest in theory and implementation research 14 implementation researchers from UK, Netherlands and Canada 33 theories and 128 constructs generated Simplified into 12 domains of theoretical constructs Interview questions associated with each domain Michie et al (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach, Quality and Safety in Health Care, 14, 26-33

13 Results: Theoretical domains 1. Knowledge 2. Skills 3. Professional role and identity 4. Beliefs about capabilities 5. Beliefs about consequences 6. Motivation and goals 7. to do x? Memory, attention and decision processes 8. Environmental context and resources with x? 9. Social influences 10. Emotion 11. Action plans 12. Nature of the behaviour What is the purpose of the guidelines? What do they think about the credibility of the source? Do they think guidelines should determine their behaviour? Is doing x compatible or in conflict with professional standards/identity? How much do they want to do x? How much do they feel they need Are there other things they want to do or achieve that might interfere Does the guideline conflict with others? Are there incentives to do x?

14 Behaviour emerges from interactions between three necessary conditions Capability Motivation Psychological or physical ability to enact the behaviour Behaviour Reflective and automatic mechanisms that activate or inhibit behaviour Opportunity Physical and social environment that enables the behaviour COM-B system

15 Motivation: reflective and automatic Reflective Beliefs about what is good and bad, conscious intentions, decisions and plans Automatic Emotional responses, desires and habits resulting from associative learning and physiological states Reflective-Impulsive Model, Strack & Deutsch, 2004 PRIME Theory of Motivation, West, 2006

16 Need a framework for designing interventions with following criteria: 1. Comprehensive coverage 2. Coherence 3. Clear link to a model of behaviour Useable by, and useful to, policy makers, service planners and intervention designers

17 Systematic review of current frameworks Search 3 electronic databases were systematically searched for frameworks of behaviour change interventions 8 experts in behaviour change were consulted 19 frameworks identified covering 16 categories distinction between interventions whose target is behaviour and policies that enable or support those interventions

18 Behaviour at the hub. COM-B Result The Behaviour Change Wheel A system for choosing interventions and policies

19 Behaviour at the hub. COM-B Behaviour at the hub. COM-B Model of Behaviour Physical Reflective Psychological Automatic Social Physical

20 The Behaviour Change Wheel Model of behaviour at the hub of a wheel (COM-B) Around this, 9 intervention functions Interventions: Each include one or more specific behaviour change activities techniques designed to change behaviours Around this, 7 policy categories that could enable or support these interventions to occur

21 Intervention functions Policies: decisions made by authorities concerning interventions

22 Policy categories Communication/ marketing Using print, electronic, telephonic or broadcast media Guidelines Creating documents that recommend or mandate practice Fiscal Using the tax system Regulation Legislation Environmental/ social planning Service provision Establishing rules or principles of behaviour or practice Making or changing laws Designing and/or controlling the physical or social environment Delivering a service

23 Applying this system to designing behaviour change interventions Steps 1. Analyse behaviour using COM-B 2. Link to possible intervention functions 3. Select intervention functions Feasibility, acceptability, cost effectiveness 4. Choose specific behaviour change techniques 5. Select supportive policies

24 Behaviour Change Techniques (BCTs) Active ingredients within the intervention designed to change behaviour. They are observable, replicable and irreducible components of an intervention. Can be used alone or in combination with other BCTs.

25 Guidelines for specifying interventions CONSORT guidelines for reporting RCTs Evaluators should report precise details of interventions [as] actually administered Moher et al, 2001 Which details? Davidson et al, Annals of Beh Med, 2003 the content or elements of the intervention characteristics of those delivering the intervention characteristics of the recipients, characteristics of the setting (e.g., worksite) the mode of delivery (e.g., face-to-face) the intensity (e.g., contact time) the duration (e.g., number sessions over a given period) adherence to delivery protocols

26 To describe content. Need a reliable method distinct BCTs standardised and precise language Examples of taxonomies 40 BCTs identified from interventions to change physical activity and healthy eating Michie et al, Psychology & Health, techniques used in smoking cessation interventions Michie et al, Annals Behavioral Medicine, identified by consulting textbooks for applied psychology training Michie et al, Applied Psychology: An International Review, 2008

27 Behaviour change techniques: reliable taxonomy to change physical activity and healthy eating behaviours Involves detailed planning of what the person will do including, at least, a very specific definition of the behaviour e.g., frequency (such as how many times a 1. General information day/week), intensity 15. (e.g., General speed) encouragement or duration (e.g., for how long for). In addition, 2. Information on consequences 16. Contingent at least one of rewards the following contexts i.e., where, when, how or with whom must be specified. 3. Information about approval This could include 17. identification Teach to of use sub-goals cues or preparatory behaviours and/or 18. specific Follow contexts up prompts in which the behaviour will be performed. 4. Prompt intention formation 5. Specific goal setting 6. Graded tasks 7. Barrier identification 8. Behavioral contract 9. Review goals 10. Provide instruction 11. Model/ demonstrate 12. Prompt practice 13. Prompt monitoring 14. Provide feedback 19. Social comparison 20. Social support/ change 21. Role model 22. Prompt self talk 23. Relapse prevention 24. Stress management The person is asked to keep a record 25. Motivational of specified interviewing behaviour/s. This 26. could Time e.g. management take the form of a diary or completing a questionnaire about their behaviour. Abraham & Michie (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology.

28 Conclusion: a system for designing effective interventions 1. Start with the target behaviour Precise description Understanding of its determinants 2. Consider full range of possible interventions and policies 3. Identify specific behaviour change techniques 4. Design communication strategy to support the above

29 For more information Susan Michie Website: Google Susan Michie