Behaviour Change

Behaviour change is increasingly recognised as central to human well-being, social cohesion and sustainability. From what we eat, how much we move, modes of transport we take, how much energy we use, the list goes on...

The Centre for Behaviour Change is a unique initiative, harnessing the breadth and depth of academic expertise in behaviour change at University College London (UCL) to address key challenges facing society and to bring that to the widest possible audience across the public, commercial and charity sectors. Through our cross-disciplinary events, consultancy, training, teaching and research programmes we aim to make the science of behaviour change as useful and usable as possible.

Changing behaviour is a challenging and complex process, requiring theories, methods and evidence from many disciplines. We are all a bundle of associations between past events, thoughts, emotions and behaviours that can drive our behaviour in opposition to our goals, intentions and plans. We are creatures of habit, of routines, of desires, urges and impulses. Put simply, changing behaviour is hard! So how can we help people develop methods for overcoming these when they get in the way of what they want to achieve, for example, healthy behaviours, relationships, work goals and relaxation outside work?

Arguably every occupation contains an element of behaviour change. Whether it’s GPs getting their patients to adhere to their medication, teachers getting their students to do their homework or salespeople getting their customers to buy their products. While we acknowledge most occupations require training to acquire the necessary knowledge and skills, it’s not always the case with behaviour change. Somehow, we are expected to be able to do this in the absence of formal instruction.

We spend a lot of time trying to change behaviour but how successful are we? Looking at scientific literature, the majority of interventions to change health behaviours fail or have very minimal effects. Why is this? One reason could be that we have been limited in what we can learn from existing interventions. It’s not always clear how interventions have been designed in terms of: what is understood about the behaviours targeted for change; the functions interventions are intended to serve; the active ingredients in interventions to bring about change or the rationale for selecting these ingredients. A second reason is that a range of terms are used to describe the content of interventions, making it hard to draw conclusions about what has been done and what has worked. Different terms are used to describe the same concept, for example, one intervention might contain the component of a ‘daily diary’, another intervention might contain a ‘pedometer’. At face value these may seem different but when expressed in terms of the technique to change behaviour they both represent - self-monitoring of behaviour - it highlights similarities in terms of how these interventions might achieve change. The opposite is also true, with examples of the same term being defined differently in different interventions.

So what could help?

Firstly, a greater understanding of the behaviours we‘re trying to change so we can target these influences in interventions. Secondly, a systematic approach to developing interventions where all options are considered and there is an explicit rationale for selecting intervention content. Thirdly, a standardised language to describe intervention content.

The right tools for the job

There are three tools, developed in behavioural science in the last few years, led by Professor Susan Michie, Director of the Centre for Behaviour Change, that could move us forward in meeting these needs.

1. COM-B (Capability Opportunity Motivation - Behaviour): a model for understanding behaviour

This model is a simple starting point for understanding barriers and facilitators to behaviour. According to this model, for any behaviour to be performed, people need to have the capability, opportunity and motivation. The first task in designing an intervention is to identify which aspects of these need to change for the desired behaviour to be performed.

2. The Behaviour Change Wheel: A framework for designing interventions

The Behaviour Change Wheel (BCW) was developed from 19 frameworks of behaviour change (Figure 1). As none of these frameworks were comprehensive and few were conceptually coherent or linked to a model of behaviour change, the BCW is a synthesis of the common features of these frameworks. The BCW consists of three layers. At the ‘hub’ of the wheel is the COM-B model. Surrounding this is a layer of nine intervention functions (education, persuasion, incentivisation, coercion, modelling, restrictions, enablement, environmental restructuring and training). These functions are the purpose(s) an intervention should serve depending on what is understood about the behaviour targeted for change. The outer layer, the rim of the wheel, identifies seven types of policy categories that could be used to deliver the intervention (communication/marketing, legislation, regulation, fiscal measures, service provision, environmental/social planning and guidelines). Explicit links between COM-B and intervention functions and between intervention functions and policy categories guide designers in being comprehensive in considering options for the purpose interventions should serve and be delivered and systematic in terms of a rationale for selecting from these options.

3. The Behaviour Change Techniques Taxonomy: A standard language of behaviour change

There have been calls in the last decade for improved reporting of the content of interventions. To address this, researchers have begun to specify the active ingredients of interventions in terms of their component behaviour change techniques (BCTs). BCTs are defined as the observable, replicable components of behaviour change interventions. The Behaviour Change Techniques (BCT) Taxonomy (v1) is a structured list of 93 techniques to change behaviour which have been linked to the functions of the BCW in the book ‘The Behaviour Change Wheel: A Guide to Designing Interventions’ (http://www.behaviourchangewheel.com), a step-by-step guide to intervention design.

Where is this approach being used?

BCW has been cited in over 400 peer-review publications and has been used to design interventions in public, private and charity sectors. Its application has mainly been in health behaviour change but has also been used in transport, finance and the built environment.

A final thought

When we are prescribed a pill for any ailment, we take for granted that it’s known what’s in it, how it works, how well it works and how much of it to take. We take this for granted because we assume it has undergone scientific development and evaluation. We wouldn’t expect less. Can we say the same of interventions to change behaviour? With 50% of premature deaths linked to behaviour, the tools described above can move us closer to achieving that same level of scientific rigour in the development and evaluation of interventions to change health behaviours.

Article by
Dr Lou Atkins

is senior teaching fellow and Australasian hub lead at UCL Centre for Behaviour Change, University College London

5th April 2017