Transcript The PRIME Theory of motivation and its application to

Changing healthcare professional
behaviour: the Behaviour Change
Wheel
Robert West
University College London
March 2013
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Aims
• To provide a structured way of thinking about behaviour
change to help develop an optimal intervention strategy
• To prompt a discussion in how to apply this to promote
appropriate prescribing of varenicline
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Changing behaviour: the basics of designing
an intervention strategy
1. Decide exactly what do you want your target group to
do?
2. Perform a ‘behavioural diagnosis’ of ‘what it would take’
to achieve this in terms of improving capability,
opportunity and motivation
3. Identify relevant ‘intervention functions’ and ‘behaviour
change techniques’
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What should health professionals do?
1. Find out if their patients smoke
2. If they smoke,
– advise on the best ways of stopping
– offer help with stopping
– act on the response
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Behavioural diagnosis: the COM-B model
For any behaviour to
occur the individual or
group must
• have the physical and psychological
capability
• have the physical and social opportunity
• be more motivated to do it at the relevant
time than anything else
Michie et al 2011 Implementation Sci
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What does being capable mean?
• We know, understand, accept and remember
– what to do
– why we should do it
– how to do it
• We have the mental and physical skills to act
appropriately when appropriate
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What does having the opportunity mean?
• Physical opportunity
– access to necessary resources
– absence of competing demands on time
– exposure to necessary prompts
• Social opportunity
– social norms
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What being motivated mean?
• At every moment we act in pursuit of what we most want
or need at that moment
• We can only want what we can imagine
• We want things that we feel positive anticipation about
• We need things that promise relief from physical or
mental discomfort
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Behaviour Change Wheel
Michie S, van Stralen M, West R (2011) The
Behaviour Change Wheel: A new method for
characterising and designing behaviour change
interventions. Implementation Science, 6, 42.
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Intervention functions
Education
Increasing knowledge or understanding
Persuasion
Using communication to induce positive or negative feelings
or stimulate action
Incentivisation
Creating expectation of reward
Coercion
Creating expectation of punishment or cost
Training
Imparting skills
Restriction
Using rules that limit engagement in the target behaviour or
competing or supporting behaviour
Environmental
restructuring
Changing the physical or social context
Modelling
Providing an example for people to aspire to or imitate
Enablement
Increasing means/reducing barriers to increase capability or
opportunity
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Health professional interventions
Education
Ensure that HPs know, understand and believe the benefits of
recommending and prescribing varenicline to their patients
where appropriate, and how to do it
Persuasion
Ensure that HPs feel positively about engaging with patients
in this way
Incentivisation
Not appropriate
Coercion
Not appropriate
Training
Ensure that HPs have the clinical and communication skills
needed to engage with patients in this way
Restriction
Not appropriate
Environmental
restructuring
Provide prompts for recommending and prescribing
varenicline
Modelling
Provide models for appropriate prescribing behaviour
Enablement
Not appropriate
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Policy options
Comms/marketing
Using print, electronic, telephonic or broadcast media
Guidelines
Creating documents that recommend or mandate
practice. This includes all changes to service provision
Fiscal
Using the tax system to reduce or increase the financial
cost
Regulation
Establishing rules or principles of behaviour or practice
Legislation
Making or changing laws
Env/Soc Planning
Designing and/or controlling the physical or social
environment
Service provision
Delivering a service
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Policy options to promote appropriate
varenicline prescribing
Comms/marketing
Develop paid and unpaid media, direct communications
campaigns,
Guidelines
Sponsor and help to shape guideline development and
implementation
Fiscal
Not appropriate
Regulation
Contribute to regulatory processes
Legislation
Not appropriate
Env/Soc Planning
Not appropriate
Service provision
Provide accessible, attractive training courses (e.g.
online)
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Discussion
• What is the target behaviour?
• What will it take?
– Capability
– Opportunity
– Motivation
• What intervention functions offer most promise?
• How can these be implemented?
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