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Interventions to change health-related behaviour patterns

Q: Health promotion interventions need to...

... consider changes at individual , organisational , community , national and international levels and to focus on people's control of their everyday lives, their access to resources as well as vested interests that work against adoption of health-promoting lifestyles. Also people's interests are important to focus on.

Q: Intervention mapping: stage 4 - translating theory into practical plan

This involves reviewing materials and methods to implement the selected change techniques in the target setting with target recipients. It is important to consult with potential recipients about materials and to pre-test materials . Be creative: 'dumb ways to die- be safe around trains'

14 important questions on Interventions to change health-related behaviour patterns

Food deserts (social environment)

In many places throughout the US, it is more difficult to buy an apple than French fries if you live in a food desert. Low-income area where a substantial number of residents has low access to supermarket or large grocery store.

Lack of access to quality, affordable healthy food associated with:
- poor dietary habits
- higher risk for obesity
- other health-related problems

Health promotion interventions need to...

... consider changes at individual, organisational, community, national and international levels and to focus on people's control of their everyday lives, their access to resources as well as vested interests that work against adoption of health-promoting lifestyles. Also people's interests are important to focus on.

How to plan a behaviour change intervention? Intervention Mapping (IM)

IM is a sophisticated blue-print for intervention planning from initial design. Six key planning stages for development / implementation of effective behaviour change interventions

1. needs assessment
2. setting change objectives
3. identifying change processes and effective change techniques
4. practical plan
5. adoption and implementation
6. evaluation

As an example 'Breezer culture'

Intervention mapping: stage 1 - needs assessment

- Ascertain whether, and how, target group needs to change
- Specify target behaviour(s) that need to be changed
If this process is not completed then unneeded interventions or interventions that do not adequately target key behaviours may be wastefully developed and implemented.

Key behaviour: alcohol overconsumption among young girls
(discourage drinking? promote moderation? linked to community-based or peer norms? role of education? accessibility of alcohol? who needs to change? All teenagers? Subgroup?)

(!) Intervention mapping: stage 2 - setting change objectives

- specify behaviour changes induced by intervention
- identify (potentially) modifiable determinants such as key beliefs

Change norms in relation to drinking
(key determinant of behaviour = perceived norms)

(!) Intervention mapping: stage 3 - identifying change processes and effective change techniques

Linking determinants and change mechanisms to a set of change techniques most likely to effectively change the target behaviour. Critical aspect of intervention design.

Change norms in relation to drinking at social events
(results from research about peers' views/behaviours. Create role models, use opinion leaders)

Intervention mapping: stage 4 - translating theory into practical plan

This involves reviewing materials and methods to implement the selected change techniques in the target setting with target recipients. It is important to consult with potential recipients about materials and to pre-test materials.

Be creative: 'dumb ways to die- be safe around trains'

Intervention mapping: stage 5 - adoption and implementation

Identifying those who will adopt and use the intervention, negotiating its use with them and producing the intervention in a manner that facilitates accurate implementation. It is crucial that those responsible for adoption of the intervention are persuaded at this stage. Consequently, it is prudent to involve respected opinion-leading representatives of this group in intervention development from stage 3 onwards.

Intervention mapping: stage 6 - evaluation

Involves conducting research to discover whether the intervention worked, how well it worked and how it worked. This in turn may lead back to needs assessment to consider how the intervention can be developed or added to further meet the needs of the target group.

How can we promote change? Stage 2 and 3 in mapping approach

Health promoters needs to understand the determinants and causal processes which prompt and regulate the behaviours and behaviour change they hope to promote.

A useful starting point for intervention design:
Information-Motivation-Behavioural Skilss Model (IMB)

Information-motivation-behavioural skills model (IMB)

IMB proposed that, having identified key behaviours that they wish to promote among a specified target group, health promoters should initially ask themselves, 'What is missing in the target population that explains why these behaviours are not already being performed'?

Established whether the (precisely defined) target group lacks behaviour-relevent information, whether the key determinants of motivation are in place and whether the target group lacks any skills required to translate motivation into behaviour often necessitates preliminary research referred to as 'elicitation research'.

Information \   -------------------------------------
▲                  \                                                                     \
   |                    ▼--▲---------Behavioural skills ----▲-▼-----►Behaviour
▼                          /                                                        /
Motivation ----- / ------------------------------

Fear appeals (motivation enhancing)

A popular approach to enhancing motivation is to use fear appeals. However, perceived threat and fear responses often do not prompt behaviour change. E.g. if people are not persuaded that the threat is personally relevant this may undermine intervention. In addition, if people have low self-efficacy in relation to the recommended action they may protect themselves psychologically through defensive cognitive responses. When this happens, recipients of fear appeals may dismiss the message all together, receiving the message as untrustworthy.

Selecting behaviour change techniques (BCT)

Intervention designers need to select techniques likely to be effective in promoting target behaviour with target population.

A wide reange of BCTs are available and a crucial element of stage 3 planning is to review the relevant literature in relation to the target behaviour. A few elements on the list of 26 BCTs are:
- enhancing information
- changing aspects of motivation
- enhancing self-regulatory skills
- stress management
- motivational interviewing
- time management

Choice of BCT can make a substantial difference to interventions' based on identification of missing behavioural determinants.

Designing useful and sustainable interventions

Interventions are adopted by inteded users of the intervention when they are perceived to be useful, easy to implement, sustainable and affordable in the setting in which they have been tested. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework discusses how to assess these intervention features.

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Interventions to change health-related behaviour patterns

14 important questions on Interventions to change health-related behaviour patterns

Food deserts (social environment)

Health promotion interventions need to...

How to plan a behaviour change intervention? Intervention Mapping (IM)

Intervention mapping: stage 1 - needs assessment

(!) Intervention mapping: stage 2 - setting change objectives

(!) Intervention mapping: stage 3 - identifying change processes and effective change techniques

Intervention mapping: stage 4 - translating theory into practical plan

Intervention mapping: stage 5 - adoption and implementation

Intervention mapping: stage 6 - evaluation

How can we promote change? Stage 2 and 3 in mapping approach

Information-motivation-behavioural skills model (IMB)

Fear appeals (motivation enhancing)

Selecting behaviour change techniques (BCT)

Designing useful and sustainable interventions

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