Achieving successful Behaviour Change

Carmen Lefevre

Centre for Behaviour Change

University College London

@Carmen_Lefevre@

ucl.ac.uk/behaviour-change

Why talk about behaviour change?

Behaviour

BehaviourHealth Disease

Behaviour change is relevant to the

prevention and reversal of disease, e.g. obesity

Why talk about behaviour change?

• Obesity is one of the main health risk factors in

the developed world

• E.g. in UK 26% of adults and 16% of children

classed as obese

• Cost to the health system ~ £5billion/year

Behaviour change at different levels

INDIVIDUAL: bringing a healthy lunch

rather than buying fast food; menu

planning; shopping lists

ORGANISATIONAL: Food placement in

supermarkets; salad bars in organisation’s

canteens

POLICY: introducing a sugar tax on fizzy

drinks; food labelling rules

We know we can’t all fly

planes or perform open

heart surgery…

We recognise these

tasks require expert

knowledge and skills

WWWWWWeee rrreeccccoooooggggnnnniiiisssseee tttthhhhheeeesssseee

tasks require expert

we all behave and see others

behave ….

So we often have our own

theories about how to change

behaviour …

But, they are often incorrect

But when it comes to changing behaviour……

There is a science of behaviour change

Many interventions designed according to

The ISLAGIATT principle of intervention

design…

It Seemed Like A Good Idea At The Time

Martin Eccles, Emeritus Professor of Clinical Effectiveness , Newcastle University

Behavioural

problemIntervention

Understanding

the behaviour(s)

we are trying to

change

SO, LET’S CHANGE BEHAVIOUR…

• Understand the behaviour you are trying to change

Define precisely who needs to do what, where, when,

how?

• Conduct a ‘behavioural analysis’

Identify barriers and facilitators.

• Use a framework that points to the types of

intervention that are likely to be effective

Consider the full range of options available.

A systematic method

Michie et al. 2011, Implementation Science

What do we mean by ‘behaviour’?

– Anything a person does in response to internal or external events

– Actions may be

• overt (motor or verbal) and directly measurable, or

• covert (activities not viewable but involving voluntary muscles) and indirectly

measurable;

– behaviours are physical events that occur in the body and are controlled by

the brain

Agreed across disciplines of psychology, sociology, anthropology and economics:

Hobbs, Campbell, Hildon, & Michie, 2011Hobbs, Campbell, Hildon, & Michie, 201

An action or set of activities to get individuals to behave

differently from how they would act without such an action

It can change …

how people behave

how often they perform a behaviour

how long they act for

over what time period

What is a ‘behaviour intervention’?

Intervention

Step 1: What do we want the

person / group of people to do?

Specify behaviour

Step 2: What will it take them

to do it? Behavioural analysis

and diagnosis

E.g.

Step 3: How are we

going to get them to do

it? Intervention design

E.g.

Step 4: Did it work?

Intervention evaluation

Intervention

Step 1: What do we want the

person / group of people to do?

Specify behaviour

Designing an intervention

Who needs to do what

differently to achieve the

desired change? When do they need to do it?

Where do they need to do it?

How often do they need to do it?

With whom do

they need to do it?

In what context do they need to do it?

• Being more specific about which

behaviour(s) we are trying to change

allows us to be more focussed when it

comes to understanding these

behaviours….

Example:

Food Choice Intervention

• Improving food choice not precise enough

• who needs to do what differently, where, when,

how?

– Who

– What

– Where

– When

– How

– shoppers

– buy healthier food items

– at the supermarket

– every time at the supermarket

– e.g. by making a list

Intervention

Step 1: What do we want the

person / group of people to do?

Specify behaviour

Step 2: What will it take them

to do it?

-To change behaviour we first

need to understand it

-What needs to shift?

Behavioural analysis and

diagnosis

Step 2: Behavioural Diagnosis

• Effective interventions depend on good diagnosis

– both for treating medical conditions and for changing

behaviour

• Diagnosis requires a systematic method

– Why are behaviours as they are?

– What needs to change for the desired behaviour/s to

occur?

à Facilitators & Barriers

– Answering this is helped by a model of behaviour

à COM-B

COM-B: A simple theory-based model to

understand behaviour

Physical and social environment that

enables the behaviour

Psychological or physical ability to

enact the behaviour

Reflective and automatic mechanisms

that activate or inhibit behaviour

Michie et al. 2011, Implementation Science

• To understand why shoppers don’t buy healthy

food options

– Review the literature

– Conduct surveys or interviews

Example:

Food Choice Intervention

Behavioural Analysis

Physical Opportunity

- The local shop does not offer fresh produce

Psychological Capability

- knowing which foods are healthy

Physical Capability

- Ability to cook healthy meals

Reflective motivation

- Uncertainty about the value of a healthy diet

Automatic motivation

- Wanting to eat unhealthy foods, e.g.

chocolate

Example barriers of healthy food choices

mapped onto COM-B

Intervention

Step 1: What do we want the

person / group of people to do?

Specify behaviour

Step 2: What will it take them

to do it? Behavioural analysis

and diagnosis

E.g.

Step 3: How are we

going to get them to do

it? Intervention design

E.g.

Step 3: Intervention Design

• Following the behavioural analysis we can design

an intervention with the highest likelihood of

success

– Using the existing evidence base of successful

interventions

• We need to ask:

– What needs to shift to change behaviour?

» Capability, Opportunity and/or Motivation

– Which intervention function is most likely going to work?

– Which behaviour change techniques to use?

Michie et al. 2011, Implementation Science

Behaviour Change Wheel

• Synthesis identified 9

intervention functions and 7

policy categories

• COM-B forms the hub of the

wheel

Use rules to reduce the

opportunity to engage in

the behaviourIncrease knowledge or

understanding

Use communication to induce

positive or negative feelings to

stimulate action

Create an expectation of

reward

Create an expectation of

punishment or cost

Impart skills

Increase means

or reduce barriers to increase

capability (beyond education or

training) or opportunity

(beyond environmental

restructuring)

Provide an example for people

to aspire to or emulate

Change the physical or

social context

Intervention functions

Making or changing laws

Designing and/or controlling the

physical or social environmentCreating documents that

recommend or mandate

practice. This includes all

changes to service provision

Using the tax system to reduce

or increase the financial cost

Establishing rules or principles

of behaviour or practice

Delivering a service

Using print, electronic,

telephonic or broadcast

media

Crea

reco

prac

Policies

Behaviour Change Wheel: a framework for

designing interventions

Depending on the

behavioural diagnosis

using COM-B specific

intervention functions

may be most suitable

Intervention functions

Education Persuasion Incentiv-

isation

Coercion Training Restriction Environmental

restructuring

Modelling Enablement

Physical

capability

Psychological

capability

Physical

opportunity

Social

opportunity

Automatic

motivation

Reflective

motivation

Selecting appropriate intervention functions

• Psych. capability – lack of knowledge about healthy

foods

– Education

• Automatic motivation – desiring eating chocolate

– Incentivisation or coercion

• Physical opportunity – lack of available produce

– Environmental restructuring

Example:

Food Choice Intervention

Intervention Development

Intervention

Step 1: What do we want the

person / group of people to do?

Specify behaviour

Step 2: What will it take them

to do it? Behavioural analysis

and diagnosis

E.g.

Step 3: How are we

going to get them to do

it? Intervention design

E.g.

Step 4: Did it work?

Intervention evaluation

• What? à which outcome measure

– e.g. behaviour (food purchase), outcome (weight loss), or

both

• When? à when to measure for outcomes

– e.g. baseline, pre and post, continuous monitoring, long

term follow-up

• Who? à who will measure outcomes

– e.g. supermarket, researcher, self-report; note: may

involve behaviour change!

• How? à how will the outcome be measured

– e.g. compare with existing data (current obesity rate),

observation, self report

How to? Evaluating the intervention effectiveness

Take home points

• We need evidence-based behaviour change

approaches to succeed

• Behaviour change involves all levels of society:

– Individual, organisation, government

• Pin-pointing the behaviour to tackle and

diagnosing the antecedents of this behaviour is

vital but often overlooked

NEW: MSc in Behaviour Change

• Register now for September 2017

• Open to students from diverse academic backgrounds

• Full-time or part-time

• Cross-disciplinary

• Taught by world experts

• Links to placements

Course Directors:

Prof Susan Michie & Dr Paul Chadwick

www.ucl.ac.uk/prospective-students/graduate/taught/degrees/behaviour-change-msc

Achieving successful Behaviour Change

Carmen Lefevre

Centre for Behaviour Change

University College London

@Carmen_Lefevre@

ucl.ac.uk/behaviour-change

c.lefevre@ucl.ac.uk