3 Context

Introduction

Practitioners use a range of interventions when working with someone to improve their health. Each intervention will usually involve one or more behaviour change techniques. However, there is a lack of practical advice on which techniques should be used to tackle specific behaviours (for example, in relation to diet, smoking and alcohol) and with people from specific populations or with particular risk factors.

For an individual to improve their health in the medium and long term, behaviour change must be sustained. Maintaining changes to behaviour can involve both helping people to deal with relapses, and ensuring that new behaviours become habitual.

Sustained behaviour change is most likely to occur when a combination of individual, community and population-level interventions are used. In addition, there is a reasonable evidence base relating to motivation to change (Lai et al. 2010; Ruger et al. 2008).

In 2011, the House of Lords Science and Technology Select Committee reviewed a range of factors that impact on behaviour change. In its final report, the Committee recommended that NICE should update its guidance on the topic; in particular it wanted, 'more explicit advice on how behaviour change techniques could be applied to reduce obesity, alcohol abuse and smoking' (House of Lords 2011).

Classifying behaviour-change techniques

Considerable research has been undertaken to specify behaviour change interventions in terms of their component parts. This has led to a definition of behaviour change techniques relevant for a range of health behaviours (Michie et al. 2013) and for specific behaviours:

  • to improve their diet or encourage physical activity (Abraham and Michie 2008; Conn et al. 2002; Inoue et al. 2003; Michie et al. 2011a)

  • to prevent weight gain (Hardeman et al. 2000)

  • to stop smoking (Michie et al. 2011b)

  • to reduce alcohol intake (Michie et al. 2012)

  • to prevent HIV (Albarracin et al. 2005).

Work is currently underway to explore the extent to which techniques may be applicable across different behaviours. The classification system has been shown to be reliable. Its validity is now being assessed (Michie et al. 2013).

Theoretical frameworks

The importance of having a theoretical basis for the design and evaluation of interventions is well established (Medical Research Council 2008; Craig et al. 2008). For example, it can help ensure better outcomes (Albarracin et al. 2005) as well as providing a means of understanding why an intervention is effective or not.

Work has been done to establish theoretical frameworks for behaviour change (Abraham and Michie 2008; Michie et al. 2011a; West 2009) and evidence continues to emerge about these theories (Tuah et al. 2011; Williams and French 2011).

  • National Institute for Health and Care Excellence (NICE)