5 Recommendations for research

The PDG has made the following recommendations to plug the most important gaps in the evidence.

Recommendation 1

Who should take action?

Research councils, national and local research commissioners and funders, research workers and journal editors.

What action should they take?

  • Include as standard in research reports:

    • a description of what was delivered, over what period, to whom and in what setting

    • information on the impact on health

    • clear definitions of the 'health outcomes' measured

    • a report of differences in access, recruitment, and (where relevant data are available) uptake, according to socio-economic and cultural variables such as social class, education, gender, income or ethnicity

    • a description and rationale of the research methods and forms of interpretation used, and where relevant the reliability and validity of the measures of behaviour change adopted.

  • Ensure research studies on behaviour change always:

    • identify and account for the different components of change among different social groups

    • pay attention to minority ethnic and religious groups

    • include social variables wherever possible (for example, social class or education) in every study

    • consider the impact of age and gender on the effectiveness of interventions and programmes.

  • Promote the inclusion of process as well as outcome data.

  • Encourage those in charge of randomised controlled trials on health-related behaviour change to register with a trial register.

Recommendation 2

Who should take action?

Research commissioners and funders.

What action should they take?

  • Encourage research that takes into account the social and cultural contexts in which people adapt or change their behaviour and the factors that encourage or inhibit change. These include:

    • the role of support networks, neighbourhood resources and community action

    • the relationships that help protect and build people's resilience

    • the way people adapt positively to adverse socio-structural conditions

    • social processes that strengthen the mutual support provided by families and other forms of households

    • the clustering of health behaviours

    • the material circumstances in which people live, including income levels, environmental characteristics of neighbourhoods and work-related factors.

  • Use embedded process evaluations that include the perspectives of recipients.

  • When studying the mechanisms of adaptation and change, use mixed method ethnographic research, longitudinal studies and qualitative approaches, as well as multivariate and interactive statistical models.

  • Support development of new methods for collating and synthesising a range of evidence on effectiveness. These methods should meet the highest scientific standards.

Recommendation 3

Who should take action?

Policy makers, research commissioners and local service providers.

What action should they take?

  • Collect baseline data at the outset of interventions or policy changes and allow for an adequate length of time for evaluation.

  • Develop evaluative approaches which can accommodate the complexities inherent in community and population-level interventions or programmes, including multiple and confounding factors.

  • Develop methods for synthesising and interpreting results across studies conducted in different localities, policy environments and population groups.

  • Formulate rigorous and transparent methods for assessing external validity and for translating evidence into practice.

Recommendation 4

Who should take action?

Policy makers, research funders and health economists.

What action should they take?

As a matter of urgency, commission research on the cost-effectiveness of behaviour change interventions. This should cover:

  • interventions over the mid to long term

  • interventions aimed at specific population groups (for example, low-income groups, men versus women, young people versus older people)

  • primary prevention versus clinical treatment for behaviour-related disease.

More detail on the evidence gaps identified during the development of this guidance is provided in appendix D.