PWP Beh Change BD JH v2 June 2015 · • Physical and Social • Physical opportunity afforded by...

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Behaviour change: theories & techniques

Lucie Byrne-Davis Jo Hart

Hart & Byrne-Davis 2015

Objectives

At the end of this session you will:

• Understand more about behaviours related to health and why people find it hard to change • Understand the components of the COM-B framework • Have knowledge of some strategies that have been shown to be effective and ineffective to support behaviour change • Start to think about how a behavioural approach might influence your own individual practice.


Why behaviour change?

•  Five ways to wellbeing: they involve ACTIONS i.e., behaviours

•  Health threatening behaviours cause disease

•  Health protective behaviours prevent disease

•  Physical health and mental health are inextricably linked

Smoking causes 1 in 10 deaths worldwide

Smoking causes 1 in 10 deaths worldwide

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60-72% UK adults don’t meet exercise recommendations

2012 US Food and Health Survey found: • More people found it hard to work out how to eat healthily (52%) than found it hard to complete their taxes (48%) • Over ½ of US adults had tried or were trying to lose weight


“Let’s just tell everyone to change!”

•  Why do people engage in health threatening behaviours?

•  What psychological changes are needed?

•  What techniques can health professionals use?

•  How can we help health professionals use these techniques?


How behavioural science can help








Are people rational?

Why do people engage in health threatening behaviours?

So does that mean we have no control?

People are not rational in all behaviours – we know that some behaviours are conditioned and learned in other ways

No, we do make up our minds about what we are going to do but these intentions interact with our conditioned and learned behaviours (habits) to result in behaviour.

Models with rational decision making (social cognition models) explain around 50% of behavioural intention and less of actual behaviour

KEY POINT: There is a difference between intention and behaviour that can best be understood in a dual process model

PRIME theory (West, 2006): http://www.primetheory.com

Plans (intentions) Evaluations

(beliefs)

Motives Wants etc.

Impulses (urges)

Responses

Internal environment (percepts, drives, emotional states, arousal ideas, frame of mind)

External environment (stimuli, information)


PRIME theory of motivation: Dual processes


PRIME theory of motivation

“Three central ideas in the theory are: • It is wants and needs at each moment that drive our behaviour. • Our intentions and beliefs about what is good or bad only influence our actions if they create sufficiently strong wants and needs at the relevant moment. • Our image of ourselves and how we feel about that (our identity) is a potentially very strong source of wants and needs which can be enough to overcome ones arising from biological drives such as hunger.”

–  From http://www.primetheory.com

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PRIME theory of motivation

Identity: a closer look “Identity is a potentially important source of motives, it is the ultimate source of self-regulation and it is a major source of stability of behaviour. Major elements of identity are Labels (e.g. non-smoker), Attributes (e.g. health-conscious) and Rules (e.g. I do not smoke). Implementing behaviour change in the face of conflicting wants, needs and urges can be effortful and use up mental resources but ‘deep’ identity change and rules with clear boundaries reduce conflict and effort required.”

–  From http://www.primetheory.com

What behaviours have you encountered?

?

Natasha is 21 years old. She has been at university for over a year and when she started University for the first time she began buying and cooking her own food. She has put on 3 stone in this year.

She spends a lot of money on take away food and eating out with friends. She doesn’t eat much in the day time but drinks a lot of so-called ‘energy drinks’ and snacks from a campus vending machine.


Using PRIME theory to understand risky behaviour

What is the behaviour?

?

Plans: Has Natasha ever thought about eating differently? (previous intention) or does she plan to change her eating habits in the future (intention) and if so, when? (timeline)

Evaluations: What does she think about the healthy food guidelines (beliefs) and would following the guidelines be good or bad and why (evaluation of behaviour)

Motives: Does she want to follow the healthy eating guidelines? How much? What motivates her to eat healthily? How important is that motivation to Natasha?

Impulses: Are there times when Natasha has a strong impulse to eat healthily (positive impulse) What triggers (precedes) this impulse (trigger). How could Natasha use this impulse to help her eat healthily (harnessing impulse). Are there times when Natasha has a strong impulse NOT to eat healthily (negative impulse) What triggers (precedes) this impulse (trigger). How could Natasha avoid this impulse or change it to help her eat healthily (harnessing impulse).

Responses: How does she respond to the positive impulses and negative impulses?


Using PRIME theory to understand risky behaviour







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Plans: Implementation intentions, coping planning

Evaluations: beliefs and thoughts about the behaviour(s)

Motives: needs and wants

Impulses: Positive impulses, triggers, negative impulses, harnessing impulses

Responses: to the positive impulses and negative impulses?


What psychological changes are needed? What other things influence health

behaviour?

?

Susan Michie, Maartje M van Stralen and Robert West (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science 6: http://www.implementationscience.com/content/6/1/42

Educa-on Increasing knowledge or

understanding

Providing informa-on to promote healthy

ea-ng

Interven-on Defini-on Example

Persuasion Using communica-on to

induce posi-ve or nega-ve feelings or s-mulate ac-on

Using imagery to mo-vate increases in physical ac-vity

Incen-visa-on Crea-ng expecta-on of

reward

Using prize draws to induce aBempts to stop smoking

Coercion Crea-ng expecta-on of punishment or cost

Raising the financial cost to reduce excessive alcohol consump-on


Training Impar-ng skills Advanced driver

training to increase safe driving

Restric-on

Using rules to reduce the opportunity to engage in the

target behaviour (or to increase the target behaviour by reducing the opportunity to engage in compe-ng

behaviours)

Prohibi-ng sales of solvents to people under 18 to reduce

use for intoxica-on

Environmental restructuring

Changing the physical or social context

Providing on-‐screen prompts for GPs to ask

about smoking behaviour


Modelling Providing an example for people to aspire to

or imitate

Using TV drama scenes involving safe-‐sex prac-ces to increase

condom use

Enablement

Increasing means/reducing barriers to increase capability or

opportunity1

Behavioural support for smoking cessa-on, medica-on for

cogni-ve deficits, surgery to reduce

obesity, prostheses to promote physical ac-vity

1Capability beyond educa-on and training; opportunity beyond environmental restructuring

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Communica-on / marke-ng

Using print, electronic, telephonic or broadcast

media

Conduc-ng mass media campaigns

Policies Defini-on Example

Guidelines

Crea-ng documents that recommend or mandate

prac-ce. This includes all changes to service

provision

Producing and dissemina-ng

treatment protocols

Fiscal Using the tax system to reduce or increase the

financial cost

Increasing duty or increasing an--‐

smuggling ac-vi-es

Regula-on Establishing rules or

principles of behaviour or prac-ce

Establishing voluntary

agreements on adver-sing

Policies Defini-on Example

Legisla-on Making or changing laws Prohibi-ng sale or

use

Environmental/ social planning

Designing and/or controlling the physical or social

environment

Using town planning

Service provision

Delivering a service

Establishing support services in

workplaces, communi-es etc.

COM-B – The Centre of the BCW

•  Individual’s psychological and physical capacity to engage in the activity concerned.

•  It includes having the necessary knowledge and skills.

•  Physical and psychological capability •  Psychological capability being the capacity to

engage in the necessary thought processes - comprehension, reasoning et al.


Capability

•  Factors that lie outside the individual that make the behaviour possible or prompt it.

•  Physical and Social •  Physical opportunity afforded by the environment •  Social opportunity afforded by the cultural milieu

that dictates the way that we think about things e.g., the words and concepts that make up our language


Opportunity

•  Brain processes that energize and direct behaviour, not just goals and conscious decision-making.

•  Includes habitual processes, emotional responding, as well as analytical decision-making.

•  Reflective and automatic •  Reflective processes - involving evaluations and

plans •  Automatic processes - involving emotions and

impulses that arise from associative learning and/or innate dispositions


Motivation

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What explanations are common?

? •  Policies and interventions influence behaviour.

•  However, behaviour is mediated through people and therefore through psychology.

•  As health care professionals you typically intervene at the level of the psychology of the person


What influences behaviour













What techniques have you seen or used?

? Where do they fit on the wheel?

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Health professionals say it is common and an important part of being a health care professional

BUT they report feeling untrained in this

Opportunities to discuss lifestyle

change with patients are often missed

It can be a frustrating experience

This stops illnesses being prevented or

properly managed


Discussing lifestyle with patients What obstacles might occur for the health

professionals?

?

What doesn’t work?

? Fear influences human behaviour so it seems plausible that ‘fear inducing’ messages would encourage behaviour change

We might expect that telling someone ‘smoking kills’ would result in cessation (health professionals often try this)

BUT we know this doesn’t work…Why?

People tend to try to reduce the sensation of fear and this doesn’t always mean removing the true risk

Thus someone may disengage with fear-inducing conversations about smoking risks or may not attend cessation clinics to reduce the fear they feel, rather than stopping smoking


Why scare tactics don’t work

A patient may be experiencing internal conflict as an argument they are having with themselves. If we take the side of change, the patient is likely to respond with the other side of the argument (i.e. ‘yes but…’) to redress the balance. People can easily end up talking themselves into not changing or digging their heels in against change.

If you continue being so inactive, your weight is going to keep going up and your risk of a heart attack is really quite high. I know you would feel much better in yourself if you did more

and were fitter.

But I’m far too busy to waste time going to the gyms or running in circles round the park. I don’t think exercise has anything to do with my weight anyway. We’ve always been

big in my family.

Taking the side of change

Defending the status quo


What to avoid – ‘Taking the side of change’







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Hart & Byrne-Davis 2015 Hart & Byrne-Davis 2015


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Objectives

At the end of this session you will be able to:

• Understand more about behaviours related to health and why people find it hard to change • Understand the components of the COM-B framework • Have knowledge of some strategies that have been shown to be effective and ineffective to support behaviour change • Start to think about how a behavioural approach might influence your own individual practice.


Thank you

[email protected] [email protected]

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Hart J, Peters S. (2011) Healing talk: Health psychology’s contribution to clinical communication. Psychologist. Chisholm A, Hart J, Lam V, Peters S. (2012) Current challenges of behaviour change talk for medical professionals and trainees. Patient Education & Counseling. 87, 389-394. Chisholm A, Hart J, Mann K, Peters S. (2013) Development of a behaviour change communication tool for medical students: The 'Tent Pegs' booklet. Patient Education and Counseling. Chisholm A, Peters S, Mann K, Hart J. (2015). Investigating the feasibility and acceptability of health psychology informed obesity training for medical students. Psychology, Health & Medicine (in press) Keyworth C, Peters S, Chisholm A, Hart J. (2013) Nursing students’ perceptions of obesity and behaviour change: implications for undergraduate nurse education. Nurse Education Today. 33(5) 481-485. Hart J, Yelland S, Mallinson A, Peters S. (2015). When is it ok to tell patients they are overweight? General public’s views of the role of doctors in weight management Journal of Health Psychology, in press Peters S, Bird L, Ashraf H, Ahmed S, McNamee P, Ng C, Hart J. (2013) Medical undergraduates’ use of behaviour change talk: the example of facilitating weight management. BMC Medical education 16(7) Chisholm A, Hart J, Mann K, Harkness E, Peters S. (2012) Preparing medical students to facilitate lifestyle changes with obese patients: a systematic review of the literature. Academic Medicine. 87(7)1-12. Fillingham A, Chisholm A, Hart J, Peters S. (2013) Early training in tackling patient obesity: a systematic review of nurse education. Nurse Education Today. Chisholm A, Peters S, Mann K, Hart J. (2013) Are medical educators following General Medical Council guidelines on obesity education: if not why not? BMC Medical Education 13(53). Michie, S., et al. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health 26, 1-20. Dixon, D., & Johnston, M. (2010). Health behaviour change competency framework: Competences to deliver interventions to change lifestyle behaviours that affect health. Retrieved from http://www.healthscotland.com/documents/4877.aspx Susan Michie, Maartje M van Stralen and Robert West (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science 6: http://www.implementationscience.com/content/6/1/42 Hart & Byrne-Davis 2015

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PWP Beh Change BD JH v2 June 2015 · • Physical and Social • Physical opportunity afforded by...

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