Using Data & the Behaviour Change Wheel Tanya Fosdick & Dan Campsall.
The Behaviour Change Wheel - Stockport NHS Foundation Trust · 2012. 3. 22. · Michie et al (2011)...
Transcript of The Behaviour Change Wheel - Stockport NHS Foundation Trust · 2012. 3. 22. · Michie et al (2011)...
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?