9 - designing behaviour change interventions

Question 1

examples of patient behaviours

Answer 1

Screening uptake
Early symptom reporting
Adherence to medical advice
Maintenance of behaviour change

Question 2

examples of HCP behaviours

Answer 2

Persuasive communication and interaction
Appropriate advice and follow up
Continuing professional development
Implementation of evidence-based practice
Adherence to best practice guidelines

Question 3

why is changing behaviours complex

Answer 3

there are a myriad of influences
Eg. social influences, environmental cues, attitudes and
beliefs, past behaviour, habits and routines,
organisational structures (rules and regulations).

Question 4

Medical Research Council Guidance for developing and

evaluating complex interventions

Answer 4

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?

Question 5

factors that help you develop a complex but effective intervention

Answer 5

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

Question 6

examples of frameworks available to guide intervention

development

Answer 6

- Intervention Mapping
• Behaviour Change Wheel and COM-B model
• Person-based approach
• CeHRes Roadmap (ehealth)
• 6SQuID

Question 7

stages in development of an intervention

Answer 7

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

Question 8

what is intervention mapping

Answer 8

a 6-step protocol to follow for developing theory-based and evidence-based health promotion programs

Question 9

6 steps in intervention mapping

Answer 9

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?

Question 10

how do we know what to change when we identify a problem?

Answer 10

look at evidence base
carry out qualitative interviews
stakeholder consultations

Question 11

stakeholder consultation

Answer 11

identifies the most important things to change to reach the outcome –> prioritisation

Question 12

examples of self-care for heart failure

Answer 12

1. engaging in exercise training

2. taking prescribed medicines

Question 13

in order to implement change we must first understand..

Answer 13

1. why behaviours are as they are

2. what needs to change

Question 14

what is a logic model

Answer 14

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

Question 15

3 factors influencing behaviours in COM-B model

Answer 15

capability
opportunity
motivation

Question 16

what is meant by the COM in COM-B model

Answer 16

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

Question 17

explain the COM-B model if the target behaviour was engaging in exercise training for heart failure patients

Answer 17

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

Question 18

what is meant by the reflective-impulsive model

Answer 18

suggests that social cognition and behaviour are the outcome of two systems of information processing, the reflective system and the impulsive system

Question 19

what is the theory of planned behaviour

Answer 19

links beliefs and behaviour

says that attitudes toward behaviour, subjective norms, and perceived behavioural control, shape an individual’s behavioural intentions and behaviours

Question 20

Does changing cognition change health related

motivation and behaviour?

Answer 20

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)

Question 21

what does the intention-behaviour gap in the theory of planned behaviour mean?

Answer 21

the size of effect on intention is not fully translated in effect on behaviour
e.g. intent to stop smoking

Question 22

why does the intention-behaviour gap exist?

Answer 22

due to conscious, reflective, deliberative,
reasoned, and slow processes

e.g. as a result of the reflective-impulsive model…

Question 23

behaviours deriving from the reflective system of information processing

Answer 23

mindful, conscious awareness and monitoring, top-down

Question 24

behaviours deriving from the impulsive system of information processing

Answer 24

bottom up, mindless, default

behaviour is often initiated and sustained with little conscious monitoring.

Question 25

what behaviours results when the reflective and impulsive systems are in conflict

Answer 25

temptation

Question 26

how does conditioning over time develop into addictions and habits

Answer 26

Repeated associations between (1) cue and behaviour (2) behaviour and reward (physiological and emotional) • results in automatic impulsive responses (“conditioning”)

Question 27

why are cues (stimuli) important

Answer 27

prompt automatic responses & behaviour without decisions– so behaviour may conflict with and override what we had intended.

Question 28

how can psychological theories be limited in the regulatory mechanisms they specify?

Answer 28

interventions based on single theories may omit some important regulatory processes or overlook variances between individuals

Question 29

technology to reduce impulsivity

Answer 29

ImpulsePal --> van Beurden (2018) an app that engages reflective system to support dietary change set objective e.g. reduce snacking frequency contextual cues that trigger craving have to be overridden by doing another activity to take mind off craving aims to prevent initiation of impulse devalues reward (snack) - Initiate automatic activation of alternative action - stimulates inhibitory control - Devaluation of control

Question 30

what are change techniques

Answer 30

observable, replicable components of the intervention designed to change causal processes that regulate behaviour.

Question 31

examples of early reliable taxonomy to change frequently used behaviours (taxonomy of change techniques)

Answer 31

``` General information/encouragement Information on consequences Specific goal setting Review goals Provide instruction Prompt practice and self monitoring Provide feedback Contingent rewards Teach to use cues Social support/ change Role model Relapse prevention Stress management Time management ```

Question 32

Behavioural change technique (BCT) taxonomy V1

Answer 32

Michie et al (2013) classification of 124 BCTs from 6 different publications made 6 categories of BCT e.g. goals and planning

Question 33

3 factors to consider when evaluating interventions

Answer 33

outcome evaluation --> does it work? - effectiveness in real world and clinical relevance process evaluation --> how does it work? - mechanisms and techniques - for whom does it work and in what settings economic evalutation - how much does it cost? - is it cost effective?