WEEK 2 Flashcards
Behaviour Change: What is it and why is it important?
Goal of Behaviour Change in Exercise Psychology:
Get inactive people to adopt regular exercise habits and keep people exercising regularly
Exercise is good for us, we feel better when we exercise on a regular basis but it is a complex behaviour to change
50:50 likelihood that someone who started will not be adhering at 6 months
Behaviour Change: Relevance of Psychology?
Psychologists try to understand why people behave in the way they do while interacting with the world (context) around them
This complex abundance of information has been reduced and made more manageable through the application of theory
Behaviour change programmes (should) have a theoretical foundation to explain how changes in behaviour occur (antecedents, consequences, and the target behaviour
The choice of which theory based variables to target should be decided based on factors that have been documented to mediate exercise behaviour
Detail Traditional Behaviour change approaches
Informational Approaches
- Knowledge about the benefits of physical activity and how to become more active
- Attitudes toward exercise
Behavioural Approaches
- Behavioural management skills for adopting and maintaining behaviour
Social Approaches
- Social influences and social environments that facilitate exercise
Environmental and policy approaches
- Physical environments that support exercise
- Policies to support exercise
What are Intervention frameworks?
Efficacy is not sufficient in intervention design / evaluation:
MRC: Medical Research Council guidelines
NICE: National Institute for Health & Clinical Excellence
RE-AIM: Reach, Efficacy, Adoption, Implementation, Maintenance
Intervention mapping
Behaviour Change Wheel
Detail the Medical Research Guidelines (MRC)
- Review
- Identify strategies (acceptability)
- Feasibility
- Pilot work
- Encourages mixed-methods
- Full trial
Theoretical approach
Started in 2000 and updated in 2009 as was seen as too rigid/ too scientific and less applicable to real world setting. The updated guidelines were much more iterative to account for the complexity of influences on exercise behaviour.
Detail the NICE: National Institute for Health & Clinical Excellence (UK)
Recommendations on planning, implementation and evaluation of interventions
- Assessment of the target group
(population group we are trying to change) - Work with other organisations and the community
Increase expertise - Build on the skills and knowledge that already exists in the community
- Identify and resolve problems that prevent people changing their behaviour
- Barriers to exercise
- Evidence of what works
- Theoretical approach
- Train staff
- Evaluate
Detail the order of intervention mapping
- Needs assessment (aka PPI - participant/patient/involvement according to MRC, understanding population group’s needs
- Define what changes you want to achieve and their determinants
- Select the most appropriate Theoretical methods and feasible practical strategies
- Plan: How will the
programme look like? - Plan: How will the programme be Adopted, Implemented and sustained?
- Plan: How can the programme be evaluated?
What does RE-AIM stand for?
Reach Effectiveness Adoption Implementation Maintenance
What is RE-AIM?
Iterative RE-AIM Framework is a useful strategy to plan, evaluate, and guide mid-course adaptations for research studies and improvement programs
Detail the reach aspect of RE-AIM
The absolute number, proportion, and representativeness of individuals who are willing to participate in an intervention, or program, and reasons why or why not.
How do I reach the targeted population with the intervention?
Detail the effectiveness aspect of RE-AIM
The impact of an intervention on important individual outcomes, including potential negative effects, and broader and variability across subgroups (generalisability or heterogeneity of effects)
How do I know my intervention is effective?
Detail the adoption aspect of RE-AIM
The absolute number, proportion, and representativeness of settings and intervention agents (people who deliver the program) who are willing to initiate a program, and why.
How do I develop organisational support to deliver my intervention?
Detail the implementation aspect of RE-AIM
At the setting level, implementation refers to the intervention agents’ fidelity to the various elements of an intervention’s key functions or components, including consistency of delivery as intended and the time and cost of the intervention. Importantly, it also includes adaptations made to interventions and implementation strategies.
How do I ensure the intervention is delivered properly?
Detail the maintenance aspect of RE-AIM
At the setting level, the extent to which a program or policy becomes institutionalised or part of the routine organisational practices and policies. At the individual level, maintenance has been defined as the long-term effects of a program on outcomes.
How do I incorporate the intervention so that it is delivered over the long term?
Detail the behaviour change wheel
Understanding the nature of the behaviour to be changed, determination of the broad approach or type of intervention to be adopted, and then working on specifics of intervention components
Behaviour change may need to take place at multiple levels: individual, practitioner/professional and or organisational level
Detail the behaviour change wheel and COM-B
The target behaviour must be understood within the context in which it occurs:
Why are behaviours are as they are and what needs to change for the desired behaviour to occur?
Who needs to do what differently, when, where and how?
COM-B which underpins and forms the centre of the Behaviour Change Wheel
What does COM-B stand for?
Capability - attribute of a person that together with opportunity makes behaviour possible
Opportunity - an attribute of an environmental system that together with capability makes a behaviour possible or facilitates it
Motivation - an aggregate of mental processes that energise and direct behaviour
What is COM-B and why do we use it in practice?
Behavioural diagnosis
Talk to members of the target group with questions framed around the COM-B characteristics;
Note: the questions would not be on how to change but would focus on identifying what needs to change (to be effective)
behaviour will occur only when the person concerned has the capability and opportunity to engage in the behaviour and is more motivated to enact that behaviour than any other behaviours
Outline the COM-B model of behaviour
The COM-B model proposes that there are three components to any behaviour (B): Capability (C), Opportunity (O) and Motivation (M). In order to perform a particular behaviour, one must feel they are both psychologically and physically able to do so (C), have the social and physical opportunity for the behaviour (O), and want or need to carry out the behaviour more than other competing behaviours (M). As each of these components interact, interventions must target one or more of these in order to deliver and maintain effective behaviour change
List the 9 interventions on the COM-B model
- Education - increasing understanding and awareness
- Persuasion - info , emotion
- Incentivisatoin
- Coercion
- Training - improve skills
- Enablement - reduce barriers of capability and
opportunity - Modelling - propose a model to aspire to or imitate
- Environmental restructuring - what is changed as part of environment
- Restrictions - rules
What are the developing intervention functions on the COM-B model?
- Activities designed to change behaviours
- Broad approach for the intervention
Who proposed each intervention function is associated with 1 or more Behavioural change theory
Michie et al., (2011)
How is COM-B used?
9 functions can be mapped to the needs identified from the COM-B analysis
E.g., if psychological capability needed to be targeted, then education, training and enablement would be appropriate functions to include in an intervention
E.g., physical opportunities needed to be addressed, then restriction, environmental restructuring and enablement would be appropriate
E.g., If automatic motivation (involving less conscious processing) were a target of the intervention, then coercion, environmental restructuring, modelling and enablement might be appropriate functions
What are some of the advantages of the COM-B model?
An intervention might target one or more conditions
Doesn’t prioritise individual over the group or the environment
Systematic analysis of how to choose what to do
Can be used to structure an analysis into the barriers to and enablers for behaviour change in a given context, thereby ensuring that intervention developers set realistic behaviour change targets
Incorporates context in understanding behaviour and developing behaviour change interventions, while providing a systematic method for analysing the behaviour and characterising interventions based on the behavioural diagnosis
Looks beyond the conscious processing models to include automatic processing, such as habit (new, novel theory)
Detail the importance of theory in behaviour change
Theory is emphasised in all the intervention development frameworks and guidance
Systematic Literature Reviews show that interventions are generally more effective when underpinned by theory compared to those that are not (Greaves, C. J. et al, 2011)
Michie and Prestwich (2010) say this is because
- Theory identifies constructs that are hypothesised to
lead to behaviour change and are therefore targets within interventions
- Examining behaviour change within a theoretical
framework aids the synthesis of evidence across
contexts, population and behaviours
- The use of theory provides a mechanism for
understanding why an intervention was effective or not,
and as result leads to refinement of theory (and
intervention)
What are implementation intentions (Prestwich et al, 2003)
An implementation intention is a self-regulatory strategy in the form of an “if-then plan” that can lead to better goal attainment, as well as help in habit and behaviour modification. It is subordinate to goal intentions as it specifies the when, where and how portions of goal-directed behaviour.
Implementation intentions usually take the form of, “If situation A occurs, then I will do X behaviour.” The situation then becomes a trigger for the behaviour when it comes up in real life. Take this one, for example: “If there are stairs, then I will take them.” Seeing a staircase becomes a trigger for walking up them.
Do interventions based on behavioural theory work in the real world? (Hagger & Weed, 2019)
Theories are useful but we need more money and research to truly understand the implications of the theory. It was argued that the focus should be on social pressures and social influences on society to target change rather than the individual psychological theory. Counter argument with COM-B model that also emphasises individual psychology.
What are some of the challenges of using a single theory?
Frameworks for behaviour change intervention emphasise importance of theory but not how to select a theory
- Lead interventionists to draw on multiple theories to develop comprehensive strategies
Choosing theoretical perspectives (e.g., Theory of Planned Behaviour, Health Belief Model, Self-determination theory etc), that can be employed in an attempt to change exercise behaviour is difficult
- Choosing one theoretical perspective may make the design of an intervention easier but runs the risk of limiting effectiveness as key constructs from other theories are ignored
- As an example, SDT is all about individual motivation within the social context ignoring social norms and physical environment
Multiple theories makes it important that links between theory and behaviour change techniques are clearly articulated
For an intervention to be truly theory based, it is essential that explicit links are made, and reported, between the theoretical constructs (e.g., social norms and attitudes) and the techniques employed to change them
What are the behaviour change techniques (Michie et al, 2011) ?
BCTs are active ingredients designed to change the target behaviour
Taxonomy of behaviour change techniques
Original behaviour change taxonomy (Abraham & Michie, 2008) that has been added to after investigation and systematic literature reviews (currently at 93 techniques)
SLR led to 26 BCT’s have been progressed through Michie’s (2011) work to create: CALO-RE Taxonomy
40 behaviour change techniques
- Standardised terminology and definitions (remove
overlap)
- Includes construct it is hypothesised to change
- Accurate descriptions
- Mapping of BCT’s to behavioural theory
What are some of the advantages of taxonomy of behaviour change techniques?
Standardised BCTs facilitates identification of the BCTs that actually contribute to intervention effectiveness
Provides a common language to accurately describe an intervention, thereby facilitating the ability for intervention evidence to be replicated and synthesised
Standardisation improves the mapping of BCTs to constructs identified in behavioural theory and is likely to aid the development and refinement of behaviour change theory
Standardised BCT definitions helps in the effective implementation of interventions, thereby maximising the chance that BCTs are delivered as intended across different contexts
What is the theory behind BCTs (mechanisms of action)?
MoAs are conceptualised as a range of theoretical constructs that represent the processes through which a BCT affects behaviour.
MoAs are constructs specified in theories of behaviour and behaviour change that can be seen to “mediate” intervention effects, such as “beliefs about capabilities,” “knowledge,” and “behavioural regulation.”
They can be characteristics of the individual (i.e., intrapersonal psychological processes) and characteristics of the social and physical environment (e.g., social support).
Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions.
Detail the Theoretical Domains Framework
A review led by multi-disciplinary team
- 83 theories of behaviour
- 1700 theoretical constructs (mostly overlapping with each other)
TDF was developed to address challenge of overlapping theories and to help guide interventions on which to choose
14 theoretical domains
