- Behaviour change competency frameworks
- Behaviour change interventions
- Behaviour change practitioner
- Behaviour change programme
- Behaviour change techniques
- Brief intervention
- Capability, opportunity and motivation
- Choice architecture interventions
- Community-level interventions
- Extended brief intervention
- Feedback and monitoring
- Goals and planning
- Independent evaluation
- Individual-level behaviour change interventions
- Intervention fidelity
- Logic model
- Person-centred approach
- Population-level interventions
- Proportionate universalism
- Social support
- Very brief intervention
Behaviour change competency frameworks describe the knowledge and skills required to deliver interventions to people to help them change their behaviour (Dixon and Johnston 2010).
Behaviour change interventions involve sets of techniques, used together, which aim to change the health behaviours of individuals, communities or whole populations.
Anyone who delivers behaviour change techniques and interventions can be a behaviour change practitioner, regardless of their professional background, as long as they have received specific training in these techniques. However, not all practitioners can deliver all interventions or techniques.
Behaviour change programmes are a coordinated set of more than one intervention that share common aims and objectives.
The term 'behaviour change technique' is used in this guidance to mean the component of an intervention that has been designed to change behaviour, such as social support. The technique must meet specified criteria so that it can be identified, delivered and reliably replicated. It should also be observable and irreducible (behaviour change techniques are the smallest 'active' component of an intervention.) They can be used alone or in combination with other behaviour change techniques.
A brief intervention involves oral discussion, negotiation or encouragement, with or without written or other support or follow-up. It may also involve a referral for further interventions, directing people to other options, or more intensive support. Brief interventions can be delivered by anyone who is trained in the necessary skills and knowledge. These interventions are often carried out when the opportunity arises, typically taking no more than a few minutes for basic advice.
For any change in behaviour to occur, a person must:
Be physically and psychologically capable of performing the necessary actions.
Have the physical and social opportunity. People may face barriers to change because of their income, ethnicity, social position or other factors. For example, it is more difficult to have a healthy diet in an area with many fast food outlets, no shops selling fresh food and with poor public transport links if you do not have a car.
Be more motivated to adopt the new, rather than the old behaviour, whenever necessary.
This is known as the COM-B model (Michie et al. 2011d).
In this guidance, 'choice architecture intervention' is used to mean changing the context in which someone will make a decision in order to influence how they act. For example, placing healthier snacks closer to a shop checkout and putting sugary and high-fat options out of reach may influence people to make a healthier choice because it is more accessible. Behaviour change approaches based on choice architecture are also referred to as 'nudge' or 'nudging' interventions (Thaler and Sunstein 2008).
A community-level intervention targets a particular community in a specific geographic area, or with a shared identity or interest. For example, it could involve addressing local infrastructure and planning issues that discourage people in a specific geographical area from cycling. This could include ensuring local facilities and services are easily accessible by bicycle and changing the layout of roads to improve safety and reduce traffic speeds.
Co-production means ensuring public services are developed and delivered by professionals, people using the services, their families and their neighbours working together in an equal and reciprocal way to agree what is needed, where and how.
An extended brief intervention is similar in content to a brief intervention but usually lasts more than 30 minutes and consists of an individually-focused discussion. It can involve a single session or multiple brief sessions.
In 'feedback and monitoring' a specific behaviour (for example, alcoholic drinks consumed) or outcome (for example, changes in weight following changes to diet) is recorded. The person trying to change their behaviour is given feedback on the recorded behaviour or outcomes (for example, measurement of weight) or comment on progress towards a set goal. Monitoring can be done by a third party, or by the person themselves ('self-monitoring').
'Goals and planning' refers to a group of behaviour change techniques that help people to set goals for their behaviour or for an outcome of the behaviour (such as weight loss) and plan how these goals will be met. Action plans include a description of what will happen in what situation or at what time: how often it will happen, for how long, and where it will take place. Behaviour goals are reviewed regularly in the light of experience and further plans are made according to past progress towards goals.
Independent evaluations are conducted by someone who is not involved in commissioning or delivering an intervention and does not have a vested interest in the outcome. Evaluations can look at process or outcome and answer such questions as:
Was an intervention delivered according to the plan or service specification?
What changes were there in the behaviour of, or health outcomes for, service users?
Why did the planned intervention lead (or not lead) to changes in behaviour or health outcomes?
In this guidance, 'individual-level behaviour change intervention' is used to mean action that aims to help someone with a specific health condition, or a behaviour that may affect their health. It can be delivered on a one-to-one, group or remote basis, but the focus is on creating measurable change in a specific person. A nutritional intervention offered to anyone with a specific biomarker (for example, a specific body mass index) or health status (for example, obesity) is an example. However, a nutritional intervention offered to everyone in the country, or a particular city, is not. Although delivered to an individual, the intervention may affect a whole group or population.
The interventions referred to throughout the guidance include one or more behaviour change technique.
Logic models are narrative or visual depictions of real-life processes leading to a desired result. Using a logic model as a planning tool allows precise communication about the purposes of a project or intervention, its components and the sequence of activities needed to achieve a given goal. It also helps to set out the evaluation priorities right from the beginning of the process.
Motivation is the process that starts, guides and maintains goal-related behaviour, for example making changes to diet and exercise to lose weight. It involves biological, emotional, social and cognitive forces.
Outcomes are the impact that a test, treatment, policy, programme or other intervention has on a person, group or population. Outcomes from interventions to improve the public's health could include changes in their knowledge and behaviour leading to a change in their health and wellbeing.
Using a 'person-centred' approach, services work in collaboration with service users as equal partners to decide on the design and delivery of services. This approach takes into account people's needs and builds relationships with family members. It also takes into account their social, cultural and economic context, motivation and skills, including any potential barriers they face to achieving and maintaining behaviour change. Person-centred care involves compassion, dignity and respect.
Population-level interventions are national policies or campaigns that address the underlying social, economic and environmental conditions of a population to improve everyone's health. This type of intervention could include, for example, distributing leaflets to the whole population highlighting the importance of being physically active, adopting a healthy diet and being a healthy weight.
In a proportionate universalist approach, interventions are delivered to the whole population, with the intensity adjusted according to the needs of specific groups (for example, some groups may need more frequent help and advice). This type of approach can help to reduce the social gradient and benefit everybody.
Social support involves friends, relatives, or colleagues providing support for people who want to change their behaviour (for example, to quit smoking). It can take the form of:
Practical help (for example, helping someone to free up the time they need to get to a service or use a facility, or helping them to get there).
Emotional support (for example, a partner or friend could go walking or cycling with the person on a regular basis if they want to get physically fit).
Praise or reward for trying to change, whatever the result. (For example, a partner or friend could make sure they congratulate the person for attempting to lose weight or stop smoking.)
A taxonomy is a system of naming, describing and classifying techniques, items or objects. For example, a website taxonomy includes all the elements of a website and divides them into mutually exclusive groups and subgroups. An example of a behaviour-change technique taxonomy that can be applied across behaviours is described in Michie et al. 2013.
A very brief intervention can take from 30 seconds to a couple of minutes. It is mainly about giving people information, or directing them where to go for further help. It may also include other activities such as raising awareness of risks, or providing encouragement and support for change. It follows an 'ask, advise, assist' structure. For example, very brief advice on smoking would involve recording the person's smoking status and advising them that stop smoking services offer effective help to quit. Then, depending on the person's response, they may be directed to these services for additional support.