Putting behaviour change in context

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The handout for a CPD session on behaviour change to accompany the slide presentation on behaviour change

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  • 1. Locating Behaviour Change in Public Health Practice : The Hertfordshire Propositions Jim McManus, CPsychol, CSci, AFBPsS, FCIEH, FFPH Director of Public Health for Hertfordshire Jim.mcmanus@hertfordshire.gov.ukFebruary 2014 I: Policymakers and commissioners need a clear Context within which Behaviour Change is used 1. The epidemiology of the UK is such that behavioural sciences can make a significant contribution to primary prevention of non-communicable disease, secondary prevention especially self-management and resilience and tertiary prevention (e.g. coping skills for breathlessness in heart failure.) Behaviour change needs to be seen within this context. 2. This contribution is alongside not instead of policy and population measures (like regulation of tobacco etc). Behaviour change is not the answer to our public health challenges. It is a part of the answer 3. A balanced public health strategy will have interventions at policy, environmental, social, sub-population and individual levels (eg the 6 levels of public health action in the Hertfordshire Public Health Strategy taken from Dettels et al,2009 http://slidesha.re/1e4CVzY ) Another way of looking at this is the Health Impact Pyramid https://www.idph.state.ia.us/adper/common/pdf/healthy_iowans/health_pyrami d.pdfLevels Social changing social norms about health, e.g. acceptability of binge drinking, acceptability of taking smoking breaksExample of how they can be applied Tobacco Behavioural economics, social marketing Young peopleBiological immunisation, vaccinations, treatmentsNicotine replacement therapy and cognitive tools for cravingsEnvironmental encouraging green transport, reducing pollution, changing the public realmEnvironmental cues, display legislation Smokefree playgroundsIndividual Behavioural helping individuals to stop smoking Legislative the smoking ban, legislation on alcohol salesIndividual and group behavioural change and support The ban on smoking Legislation on displaysStructural policy changes such as workplace health, school health policiesWorkplace policies Tobacco control partnerships1

2. Locating Behaviour Change in Public Health Practice : The Hertfordshire Propositions II: Policymakers need Clarity of the aims and uses for Behaviour Change 4. Behaviour change can be used at population or individual or sub-population levels. Different theories, approaches and methods work for different settings. Policymakers should be aware of this. 5. Including behavioural science skills (e.g. health psychologists) in your service is essential to get it right . They need links with the academics to keep track of the field. Weve recognised the need for links between public health practice and academic public health starting with our training and running all through our careers. Its time behaviour sciences had this parity of esteem. 6. Behaviour change can target automatic cognitive/emotive processes (e.g. choice architecture and also eye position tracking on cigarette package warnings) or conscious deliberative ones (e.g. behavioural skills to negotiate safer sex.) You need to be clear which you are using for what, and why III: Policymakers need Clarity of methods, settings and audiences for Behaviour Change 7. The experts in the field need to work with policymakers to create a framework or architecture within which local areas can understand and roll out behaviour change strategies and methods. A preliminary attempt at this is below IV: A first step at a ready reckoner for behaviour change tools and methods A ready reckoner for behaviour change tools and methods Population Level Group Level Individual Levels Automatic Conscious Automatic Conscious Automatic Conscious processes processes processes processes processes processes Choice Advertising Nudge Groupwork for Choice Health Architecture e.g. change4 behaviour Architecture Trainers life Targeted social marketing We still have gaps and weaknesses in science and tools across all of these (i.e. the science is still developing)2