9 - designing behaviour change interventions Flashcards
(33 cards)
examples of patient behaviours
Screening uptake
Early symptom reporting
Adherence to medical advice
Maintenance of behaviour change
examples of HCP behaviours
Persuasive communication and interaction Appropriate advice and follow up Continuing professional development Implementation of evidence-based practice Adherence to best practice guidelines
why is changing behaviours complex
there are a myriad of influences
Eg. social influences, environmental cues, attitudes and
beliefs, past behaviour, habits and routines,
organisational structures (rules and regulations).
Medical Research Council Guidance for developing and
evaluating complex interventions
a cycle between 4 aspects:
o Development –> identify evidence base, model procedures
o Feasibility/piloting –> testing procedures, what sample size?
o Evaluation –> assess cost-effectiveness
o Implementation –> monitoring, long-term follow-up?
factors that help you develop a complex but effective intervention
Understand the behaviour(s) you are trying to change
Use a framework to help you identify the types of
intervention strategies that are likely to be effective
Take into account the perspectives of the people using the intervention (receiving and delivery)
Target multiple systems to be most effective
examples of frameworks available to guide intervention
development
- Intervention Mapping • Behaviour Change Wheel and COM-B model • Person-based approach • CeHRes Roadmap (ehealth) • 6SQuID
stages in development of an intervention
Identify target behaviour(s)
identify what influences the behaviour (is it modifiable?)
Develop a logic model of the problem
think about all the various levels or systems that influence the behaviour
use the intervention mapping approach
what is intervention mapping
a 6-step protocol to follow for developing theory-based and evidence-based health promotion programs
6 steps in intervention mapping
Needs Assessment –> what is the problem?
logic model of change –> what is the behavioural outcome? (who/what needs to change?)
Program Design –> what are the theory and evidence-based change methods?
Program Production –> draft materials and prototypes
Implementation –> what needs to change to implement the intervention?
Evaluation –> is it effective? does it work through the intended mechanisms?
how do we know what to change when we identify a problem?
look at evidence base
carry out qualitative interviews
stakeholder consultations
stakeholder consultation
identifies the most important things to change to reach the outcome –> prioritisation
examples of self-care for heart failure
- engaging in exercise training
2. taking prescribed medicines
in order to implement change we must first understand..
- why behaviours are as they are
2. what needs to change
what is a logic model
step-by-step diagrams which simply summarise:
- what you are hoping to achieve
- the processes involved to achieve it
think about what you might need in order to achieve a desired behaviour
3 factors influencing behaviours in COM-B model
capability
opportunity
motivation
what is meant by the COM in COM-B model
capability –> psychological/physical ability to enact the behaviour
opportunity –> physical/social environment enabling the behaviour
motivation –> reflective or automatic mechanisms that activate or inhibit behaviour
explain the COM-B model if the target behaviour was engaging in exercise training for heart failure patients
C - start on walking-based program, specific HF activities e.g. hands below head
O - active care-giver involvement, home-based CBE
M - facilitator and care-giver encouragement
what is meant by the reflective-impulsive model
suggests that social cognition and behaviour are the outcome of two systems of information processing, the reflective system and the impulsive system
what is the theory of planned behaviour
links beliefs and behaviour
says that attitudes toward behaviour, subjective norms, and perceived behavioural control, shape an individual’s behavioural intentions and behaviours
Does changing cognition change health related
motivation and behaviour?
yes - if cognitive change is effective, small to medium effect sizes are found for motivation and behaviour
think horizontal bar charts (higher increase in intention for health behaviours than for behaviour)
what does the intention-behaviour gap in the theory of planned behaviour mean?
the size of effect on intention is not fully translated in effect on behaviour
e.g. intent to stop smoking
why does the intention-behaviour gap exist?
due to conscious, reflective, deliberative,
reasoned, and slow processes
e.g. as a result of the reflective-impulsive model…
behaviours deriving from the reflective system of information processing
mindful, conscious awareness and monitoring, top-down
behaviours deriving from the impulsive system of information processing
bottom up, mindless, default
behaviour is often initiated and sustained with little conscious monitoring.