Medical care. 'Intervention mapping' would suggest that concern be the target for an intervention (as long as a judgement were made that this could be modified using interventions that were realistically applicable). In many countries, despite personal protective behaviours being included in government advice, little guidance, training or support is given to promote adherence – we need guidance not just on what to do, but on how to achieve those changes consistently and for the long term. Susan Michie, FMedSci, FAcSS is Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London (www.ucl.ac.uk/behaviour-change). A systematic approach to behavior change intervention development is advocated by several frameworks, to secure robust development process. Several things became apparent when reviewing the frameworks. resources) and the social (e.g. From the analysis set out in the Introduction, we established three criteria of usefulness: Comprehensive coverage -- the framework should apply to every intervention that has been or could be developed: failure to do this limits the scope of the system to offer options for intervention designers that may be effective. Their coding data were compared with the 'gold standard.'. 2009, 4: 40-10.1186/1748-5908-4-40. Susan Michie. The COM-B system - a framework for understanding behaviour. SM and RW conceived the study, designed the measures, supervised the systematic review, supervised the analyses and drafted the write-up. How existing frameworks map on to intervention and policy categories (PDF 27 KB), Additional file 7: Frameworks analysed by criteria of comprehensive coverage, coherence and link to a model of behaviour. By using this website, you agree to our People belong to social networks, family groups and organisations, through which changes in individual behaviour scale up to the population level. When we take a multi-faceted approach to changing behaviours, they can become embedded in our practices. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. A second example is that raising the financial cost of a behaviour whose incidence one wishes to reduce (an example of coercion) could be enabled and supported by different policies, from fiscal measures (taxation) to legislation (fines). The problem arises because automatic motivational factors are currently working against the behaviour (e.g., lack of emotional reward for giving advice or punishment for not giving it and lack of cues to action). LinkedIn. We are, as a species, highly adaptive. 2010, 12 (7): 742-7. Cite this article. West R, Walia A, Hyder N, Shahab L, Michie S: Behavior change techniques used by the English Stop Smoking Services and their associations with short-term quit outcomes. Cohen DA, Scribner R: An STD/HIV prevention intervention framework. 2010, Institute for Government, the Cabinet Office, Cochrane Effective Practice and Organisation of Care Group: EPOC resources for review authors. Most frameworks include common key tasks to … Article  This will depend not only on the behavioral outcome but also on the ways the BCTs are delivered and the context. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions Ann Behav Med. Evidence of intervention effectiveness serves to guide health providers to implement what is considered to be best practice (for example, Cochrane reviews, NICE guidance). The former identified three factors that were necessary and sufficient prerequisites for the performance of a specified volitional behaviour: the skills necessary to perform the behaviour, a strong intention to perform the behaviour, and no environmental constraints that make it impossible to perform the behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). Susan Michie 1, Maartje M van Stralen 2 & Robert West 3 Implementation Science volume 6, Article number: 42 (2011) Cite this article. Maibach EW, Abroms LC, Marosits M: Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework. These can be found in [7]. Michie S, Churchill S, West R: Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation. The BCW would analyse the target behaviour in context and note that, regardless of what covariation might currently exist, the target behaviour consists of an activity in which capability is not at issue, and the reflective motivation is broadly positive. Pers Soc Psychol Rev. Why do people comply or refuse to comply with responsive and preventative actions put out by authorities, such as hygienic norms, social distancing, quarantine and vaccination, and how can they be encouraged to behave accordingly? Online Summer School. 2004, 82 (10): 724-31. discussion 32, PubMed  Thus, in order to improve intervention design, we need a systematic method that incorporates an understanding of the nature of the behaviour to be changed, and an appropriate system for characterising interventions and their components that can make use of this understanding. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Next, reliability of use by practitioners was assessed by asking two policy experts (the Department of Health Policy Lead for implementation of the 2010 English government tobacco control strategy and a tobacco researcher) to independently classify the 24 components of the strategy (see Additional file 1 for coding materials). Google Scholar, Gilles ME, Strayer LJ, Leischow R, Feng C, Menke JM, Sechrest L: Awareness and implementation of tobacco dependence treatment guidelines in Arizona: Healthcare Systems Survey 2000. The first step to changing behaviour is to understand behaviour in its context, meaning that behavioural science should be at the heart of efforts to reduce disease transmission, and, indeed, all threats to health, the environment and society. Behaviour Change Wheel Coding materials (PDF 6 KB), Additional File 2: Flow of studies through the review process. This simple, comprehensive model of behaviour in its context is called “COM-B” (Capability-Opportunity-Motivation-Behaviour). It starts with a theoretical understanding of behaviour to determine what needs to change in order for the behavioural target to be achieved, and what intervention functions are likely to be effective to bring about that change. It forms the basis for a systematic analysis of how to make the selection of interventions and policies (as in Tables 2 and 3). This led to a framework that met the third criterion of linkage with an overarching model of behaviour change (Tables 2 and 3). This suggested a potentially elegant way of representing the necessary conditions for a volitional behaviour to occur. A third example is the use of the term 'enablement.' Coleman T: Do financial incentives for delivering health promotion counselling work? In light of the above, this paper aims to: Review existing frameworks of behavioural interventions to establish how far each meets the criteria of usefulness, and to identify a comprehensive list of intervention descriptors at a level of generality that is usable by intervention designers and policy makers. Implement Sci. Susan Michie Jobs People Learning Dismiss Dismiss. The framework does not appear to encompass all the important intervention types. Changing behaviours, a scientist’s opinion. To achieve its goal, a framework for characterising interventions should be comprehensive: it should apply to every intervention that has been or could be developed. Google Scholar, DEFRA: A Framework for Pro-Environmental Behaviours: Report. Implementation Science, 6:42. By SF Michie, L Atkins and R West. Sort. There are differences between people’s capability, opportunity and motivation, depending on, for example, their age, gender, employment and living conditions. Coherence, i.e., categories are all exemplars of the same type and specificity of entity. ABC Guides. Also thanks to Marie Johnston, Queen of acronyms, for COM-B. Thus, we identified six components within the behavioural system (Figure 1). First, it is possible that the systematic review missed important frameworks and/or intervention functions. Thus, behaviour change interventions are fundamental to the effective practice of clinical medicine and public health, as indeed they are to many pressing issues facing society. Use this list to construct a framework of behaviour change interventions that meets the usefulness criteria listed above. For example, an intervention that involved incentivising primary care organisations to prioritise public health interventions could be implemented through different policies such as producing guidelines and/or legislation. Am J Prev Med. While this is a model of behaviour, it also provides a basis for designing interventions aimed at behaviour change. People have already made huge sacrifices — some more than others — but they have overwhelmingly adhered to what have been very challenging restrictions. Only a minority of the frameworks could be regarded as coherent or linked to an overarching model of behaviour. The one arrived at here will no doubt be superseded. The International Association of Applied Psychology Handbook of Applied Psychology. MMvS undertook the systematic review, performed the coding and commented on the write-up. BMC public health. Whilst this framework of 12 theoretical domains has proved useful in assessing and intervening with implementation problems [9], the domain of behaviour has remained under-theorised and therefore underused in its application. Privacy Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. 2010, London, National Institute for Health and Clinical Excellence: Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children National Institute for Health and Clinical Excellence. She leads an extensive programme of research developing the science of behaviour change interventions and applying that science to intervention development and evaluation. Just by identifying all the potential intervention functions and policy categories this framework could prevent policy makers and intervention designers from neglecting important options. © 2021 BioMed Central Ltd unless otherwise stated. Geller S, Berry T, Ludwig T, Evans R, Gilmore M, Clarke S: A conceptual framework for developing and evaluating behavior change interventions for injury control. Improving the implementation of evidence-based practice and public health depends on behaviour change. This includes the MRC- funded Articles Cited by Co-authors. will point to nine different intervention types to change the target behaviour and seven policy options that can support the delivery of the interventions. This framework could be reliably applied to classify interventions within two important areas of public health. This is a much broader conceptualisation than appears in many discourses, covering as it does basic drives and 'automatic' processes as well as choice and intention. For any behaviour to occur, people need to have the capability — the physical (e.g. The 6 … The behaviour system also has automatic processing at its heart, broadening the understanding of behaviour beyond the more reflective, systematic cognitive processes that have been the focus of much behavioural research in implementation science and health psychology (for example, social cognition models such as the Theory of Planned Behaviour). The level of inter-rater agreement was computed and any differences resolved through discussion. Year; Developing and evaluating complex interventions: the new Medical Research Council guidance. This model should capture the range of mechanisms that may be involved in change, including those that are internal (psychological and physical) and those that involve changes to the external environment. Additional file 4 shows the frameworks and gives a brief description of each [11, 12, 16, 27–42]. Source: Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. To improve this situation, and to improve the translation of research into practice, we need to develop the science and technology of behaviour change and make this useful to those designing interventions and planning policy. View Susan Michie’s profile on LinkedIn, the world’s largest professional community. A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. Interventions are used to promote uptake and optimal use of effective clinical services, and to promote healthy lifestyles. 1996, 42 (8): 1155-61. Additional file 6 shows whether or not the intervention functions and policy categories were covered by each of the reviewed frameworks. Centre for Behaviour Change Harnessing cross-disciplinary expertise to address social, health and environmental challenges. 2000, 35: 153-67. The primary practical purpose of research into behavior change is the development of interventions that will be effective, subject to other constraints such as affordability [1, 2]. However, it was possible to construct a new BCW framework that did meet these criteria from the existing ones. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions. We do not consider these broad distinctions further in this paper. Reliable taxonomies for BCTs within these intervention functions have yet to be developed. Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. We believe that this is the first attempt to undertake a systematic analysis of behaviour intervention frameworks and apply usefulness criteria to them. Susan Michie, professor of health psychology 1, Robert West, emeritus professor of health psychology 2; 1 Centre for Behaviour Change, University College London, UK; 2 Department of Behavioural Science and Health, University College London, UK; Correspondence to: S Michie s.michie{at}ucl.ac.uk When it comes to theoretical underpinnings, the BCW approach draws from a single unifying theory of motivation in context that predicts what aspects of the motivational system will need to be influenced in what ways to achieve a behavioural target, whereas the 'intervention mapping' approach draws on a range of theoretical approaches each of which independently addresses different aspects of the behaviour in question. Behaviour change techniques and a framework for increasing physical activity Susan Michie Department of Psychology, University College London. This can be illustrated by a study of GP advice to smokers, which found that a single variable -- degree of concern that it would harm the doctor-patient relationship -- accounted for significant variance in the rate of advice-giving [49]. There are a number of limitations to the research described in this paper. 2008, 23 (5): 509-13. Dismiss. (See Additional file 2 for more detail of flow of studies through the review process, and Additional file 3 for reasons for exclusion). Cited by. This categorises interventions to change health professional behaviour into professional, financial, organisational, or regulatory, covering many of the key intervention types. 2010. Other criteria can be used to evaluate its applicability, e.g., reliability, ease of use, ease of communication, ability to explain outcomes, usefulness for generating new interventions, and ability to predict effectiveness of interventions. All authors read and approved the final manuscript. However, the categories are very broad and within each is a mixture of different types of interventions at different conceptual levels. Population Services International: PSI Behaviour Change Framework "Bubbles". The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions Susan Michie Professor of Health Psychology Director of Centre for Behaviour Change University College London KT Canada November 2015 @SusanMichie Implement Sci. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. If people perceive a serious threat, then they will adapt their behaviour often to considerable degrees as we have seen over the last few weeks. Personal protective behaviours are critical to limiting the virus’ transmission. J Phys Act Health. These requirements constitute three criteria of usefulness that can be used to evaluate the framework: comprehensiveness, coherence, and links to an overarching model of behaviour. Documents were included if: they described a framework of behaviour change interventions (not specific behaviour change techniques); the framework was specified in enough detail to allow their key features to be discerned; and they were written in English. None of the frameworks covered all of these. This paper examines this first part of this process. The frameworks were coded according to the criteria for usefulness by RW and SM. PubMed Central  Goel P, Ross-Degnan D, Berman P, Soumerai S: Retail pharmacies in developing countries: a behavior and intervention framework. The Behaviour Change Wheel, A Guide To Designing Interventions. Background. McEwen A, West R, Preston A: Triggering anti-smoking advice by GPs: mode of action of an intervention stimulating smoking cessation advice by GPs. emotion and habit) processes that activate or inhibit behaviour. Our next step was to consider the minimum number of additional factors needed to account for whether change in the behavioural target would occur, given sufficient motivation. For example, when attempting to reduce excessive antibiotic prescribing one may decide that an educational intervention is the appropriate approach. For example, if wide reach is a feature of population level interventions, routine general practitioner (GP) smoking assessment and advice (given to all patients) should fall into that category; yet it is delivered specifically to individuals and can be tailored to those individuals. University College London. Reports excluded from the review (PDF 22 KB), Additional File 4: Intervention frameworks. We limited the criteria to those we considered to form a basis for judging adequacy. Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions, Implementation Science. For example, in everyday language 'education' can include 'training,' but for our purposes it was necessary to distinguish between 'education' and 'training' with the former focusing on imparting knowledge and developing understanding and the latter focusing on development of skills. Authors’ Statement of Conflict of Interest and Adherence to Ethical StandardsAuthors Rachel N. Carey, Lauren E. Connell, Marie Johnston, Alexander J. Rothman, Marijn de Bruin, and Michael P. Kelly have no conflicts of interest. Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London. Michie S, Prestwich A: Are interventions theory-based? There are others, e.g., parsimony, that are desirable features but do not lend themselves to thresholds. The authors declare that they have no competing interests. the knowledge and skills) to enact the behaviour, both the physical (e.g. 2010, 10: 167-10.1186/1471-2458-10-167. Schuster RJ, Tasosa J, Terwoord NA: Translational research--implementation of NHLBI Obesity Guidelines in a primary care community setting: the Physician Obesity Awareness Project. 2008, Boston Yale University Press. Having selected the intervention function or functions most likely to be effective in changing a particular target behaviour, these can then be linked to more fine-grained specific behaviour change techniques (BCTs). Having established the structure of the new framework, the next step was to link the components of the behaviour system to the intervention functions and to link these to policy categories using the approach described in the Methods section. Indeed, the NHS Stop Smoking Services might be considered a typical case of individual-level interventions, but they reach more than 600,000 smokers each year [14]. 10.1136/qshc.2004.011155. Behaviour Change Wheel Book - Buy the Paperback Book, E-Book or Online Book here. The first step in changing behaviour is to identify precisely what behaviours are involved—who needs to do what, when, where and how. One reason for this may be that these frameworks do not meet their needs. Flow of studies through the review process (PDF 37 KB), Additional File 3: Reports excluded from the review. For example, it has been used in UK parliamentary circles to demonstrate to Members of Parliament that the current UK Government is ignoring important evidence-based interventions to change behaviour in relation to public health [43, 44]. 2007, 58 (2): 191-200. 2005, CD001871-3. In that sense it lacks coherence. There exists a plethora of frameworks for classifying behaviour change interventions but an informal analysis suggests that none are comprehensive and conceptually coherent. In addition, often no analysis is undertaken to guide the choice of theories [8]. Just by identifying all the functions and policy categories could be increased behaviours [ 9 ] PubMed. To what have been widely adopted to be … Fabiana Lorencatto Centre behaviour! Measures, supervised the systematic review, performed the coding and commented on the ways the BCTs are and! 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