The Behaviour Change Wheel

Susan Michie

Professor of Health Psychology, University College London

Building Bridges, Manchester, March 2012

The Problem

• “Lifestyle” behaviours: major cause of illness and premature death 48% avoidable deaths in US in 2000 from– smoking– alcohol use– poor diet– physical activity– unsafe sex– driving habits– violence Mokdad et al, 2004

75%

Changing Behaviour: main messages

• It is not easy• There is evidence of “what works”• Interventions and policies are insufficiently

evidence-based (House of Lords report, 2011)

• Make our interventions evidence-based, including “every contact counts”

This talk

• What works?– NICE’s Behaviour Change guidance (2007)

• The Behaviour Change Wheel– Understand the behaviour – Consider all the options

• Two examples of applying the evidence– NHS Health Trainers– Giving brief advice (example of smoking)

Some effective principles of individual behaviour change

• Strengthen motivation to engage in the desiredbehaviour

• Reduce motivation to continue with the undesired behaviour

• Maximise “self-regulatory” capacity

• Maximise supportive activities

NICE Guidance for Behaviour Change (2007)

A comprehensive approach

• Start with understanding the target behaviour in context

• Consider the range of possible evidence-based interventions and policies

• Build research into – service delivery and – improvement mechanisms – to ensure we build solid evidence about “what works”

The COM-B system: Behaviour occurs as an interaction between ...

Psychological or physical ability to enact the behaviour

Reflective and automatic mechanisms that activate or inhibit

behaviour

Physical and social environment that enables the behaviour

The Behaviour Change Wheel

• A comprehensive framework for behaviour change interventions

• Based on systematic review of 19 frameworks

• Has COM-B model of behaviour at its hub

Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions, Implementation Science.

COM-B system

Interventions: activities

designed to change

behaviours

Policies: decisions made by authorities concerning interventions

Interventions are made up of specific behaviour change techniques (BCTs)(Abraham & Michie, 2008)

1. General information 2. Information on consequences3. Information about approval4. Prompt intention formation 5. Specific goal setting 6. Graded tasks7. Barrier identification8. Behavioral contract9. Review goals10. Provide instruction11. Model/ demonstrate 12. Prompt practice13. Prompt monitoring

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Further development

• Smoking cessation: 53 BCTs Michie et al, Annals Behavioral Medicine, 2010

• Physical activity & healthy eating: 40 BCTsMichie et al, Psychology & Health, 2011

• Reducing excessive alcohol use: 42 BCTsMichie et al, Addiction, in press

• General behaviour change: 137 BCTsMichie et al, Applied Psychology: An International Review, 2008

• Current MRC funded study: 86 BCTswww.ucl.ac.uk/health-psychology/BCTtaxonomy

Smoking: evidence based techniques

Advise on stop-smoking

medication

Advise on changing routine

Seek commitment

Facilitate relapse prevention and

coping

Under the counter

Smoking ban

and policies

Intervention functions

Advise on stop-smoking

medication

Facilitate relapse prevention and

coping

Advise on changing routine Seek commitment

Smoking ban

Under the counter

Evidence-based behaviour change interventions

• NHS Health Trainers

• NHS Centre for Smoking Cessation and Training– Directors McEwen, West, Michie (UCL)

www.ncsct.co.ukWebsite: ncsct.co.uk

The NHS Health Trainer Service

• From the local community– with knowledge of the locality and its disadvantaged

groups

• Trained in behaviour change techniques– to motivate, support and teach self-regulation skills– to work with client in setting personalised health goals &

action plans

• 1200+ HTs serving clients in England and Wales

2008/9 national audit

• 632 Health Trainers– 27,762 clients

• 47% from most deprived population quintile

Main results

• 93% set goals & made action plans– 51% achieved goals, 31% part-achieved

• Behaviour change– More fruit & veg, less fried snacks, more physical

activity sessions– Reduced smoking, alcohol use– Reduced BMI, where diet or activity PHPs– Increased self-efficacy, perceived health & wellbeing

• Change similar across deprivation groups

For those making action plans:Diet improved

Outcome N Pre-HTS mean

Post-HTS mean

Cohen’s d p

Daily fruit & veg

(portions)

2376 3.08 5.23 0.97 <.001

No. of daily fried

snacks

1145 1.99 0.79 -0.85 <.001

BMI 3164 34.33 32.45 -0.30 <.001

(Cohen’s d: Small = .20, Medium = .50, Large = .80)

Physical Activity increased

Outcome N Pre-HTS mean

Post-HTS mean

Cohen’s d p

Weekly moderate sessions

921 3.06 4.77 0.42 <.001

Weekly intensive sessions

637 0.63 1.71 0.46 <.001

BMI 595 32.46 31.24 -0.18 <.001

NHS Stop-Smoking Services

• The NHS Stop-Smoking Services treat >700,000 smokers each year and have maintained success rates as numbers treated have grown

• However success rates are variable and could be improved

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NHS Centre for Smoking Cessation and Training: From evidence to practice …

• Evidence of effective interventions from “gold standard” trials (Cochrane reviews)– Identify specific behaviour change techniques within

effective interventions

• Establish professional competences– required to deliver these techniques

• Provide training to deliver these techniques

Website: ncsct.co.uk

Make every contact count …

• “Very Brief Advice”: a minute or two• Too short to change behaviour• Long enough to

– Motivate– Signpost to specialist– “Make your contact count”

Very Brief Advice: a minute or two

• What the evidence says– Ask – if they are smoking– Advise – on how best to stop smoking– Act – make a referral or offer a prescription

• Apply these principles to– all behaviours, and – the hospital setting

Extract from the VBA online course

www.ncsct.co.uk/vba

• To change behaviour– Understand the behaviour– Use evidence-based techniques

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• Your questions?• How can you apply Very Brief Advice to your

setting?