Transcript The Behaviour Change Wheel - Prime Theory Of Motivation

How to change behaviour: from
education to enablement
Robert West
Susan Michie
University College London
18 May 2011
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Topics
• What are ‘behaviour change interventions’ and why is it
important to study them?
• Understanding behaviour
• Developing a behaviour change strategy
• A worked example
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What is a behaviour change intervention (BCI)?
In theory
• An action or activity that aims to get an individual or
population to behave differently from how s/he or they
would have acted without such an action
1. change the incidence/rate/duration of occurrence of a given
type of behaviour from what it would otherwise have been
2. change the way that a given behaviour is performed
In practice
• A coordinated set of behaviour change techniques
(BCTs) applied to a group or population to change the
prevalence or rate of a given behaviour pattern
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The ‘behavioural target’
• A specification of what is intended
• E.g.
– reduce smoking prevalence to 15%
– increase the prevalence of people who eat 5+
portions of fruit and vegetables each day
– reduce the prevalence of drivers who regularly
exceed 30mph in a built up areas
– increase the rate of condom use
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Importance of studying BCIs
• Maladaptive/anti-social behaviours are common
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smoking
sedentary lifestyle
reckless driving
domestic violence
etc.
• Commonsense approaches are frequently ineffective or
counter-productive
• Studying BCIs can produce better understanding of
mechanisms and lead to more effective interventions
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Designing interventions
1. Describe the behavioural target (BT), the current situation
and the prevailing context
2. Analyse what is needed for the BT to be attained
3. Choose an appropriate mix of broad intervention options
based on that analysis, and policies needed to implement
these
4. Construct specific behaviour change techniques (BCTs)
that make up the interventions
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Common terms for methods for inducing behaviour
change
Educate
Train
Help
Expose to
Inform
Discuss
Suggest
Encourage
Incentivise
Ask
Order
Plead
Coerce
Force
Provide
Prompt
Constrain
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COM-B system for analysing behaviour in
context
1. Capability, motivation and opportunity all
need to be present for a behaviour to occur
2. They all interact as part of a system
3. Motivation must be stronger for the target
behaviour than competing behaviours
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Common terms for methods for inducing behaviour
change
Capability
Educate
Train
Help
Motivation
Expose to
Inform
Discuss
Suggest
Encourage
Incentivise
Ask
Order
Plead
Coerce
Force
Opportunity
Provide
Prompt
Constrain
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Understanding motivation
• Brain processes that energise and direct
behaviour
• Not limited to choice and goal pursuit
• Needs to include
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drive
habit
desire
instinct
self-regulation
etc.
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Motivation: reflective and automatic
Reflective
Beliefs about what is good and bad,
conscious intentions, decisions and
plans
Automatic
Emotional responses, desires and
habits resulting from associative
learning and physiological states
Reflective-Impulsive Model, Strack & Deutsch, 2004
PRIME Theory of Motivation, West, 2006
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PRIME Theory: the structure of human motivation
www.primetheory.com
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PRIME Theory: reflective and automatic processes
www.primetheory.com
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PRIME Theory: Elementary change processes
Automatic
1. Perception: acquiring information from the senses
2. Associative learning: operant and classical conditioning
3. Maturation: changes associated with growing older
4. Habituation: decrease in response with exposure
5. Sensitisation: increase in response with exposure
6. Imitation: direct copying
7. Identification: forming one’s own identity from perceptions of others
8. Consistency disposition: generation of motives, ideas from similar ones
9. Dissonance avoidance: negating or blocking uncomfortable beliefs
10. Objectification: generating evaluations from likes and dislikes
11. Chemical ‘insult’: pharmacological responses
12. Physical ‘insult’: brain lesions
Reflective
1. Assimilation: acquiring information via communication
2. Inference: induction and deduction
3. Analysis: formal and informal calculation
www.primetheory.com
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PRIME Theory: Self-control, identity and behaviour
change
• We are self-aware and form mental representations of
ourselves to which are attached emotions (identity)
• These include labels and rules
• Deliberate behaviour change involves adopting a new
personal rule
• To the extent that this is based on evaluations it requires
effortful self-control
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PRIME Theory: key propositions
1.
At every moment we act in pursuit of what we most desire (want or need)
at that moment.
2.
Wants and needs involved imagined futures and feelings of anticipated
pleasure/satisfaction (wants) or relief from mental or physical discomfort
(needs)
3.
Beliefs about what is good or bad can only influence our actions if they
generate desires that are strong enough to overwhelm those arising from
other sources (e.g. drives and emotional responses) or impulses arising
automatically out of habit or instinct. They will do this to the extent that they
generate clear imagery that can trigger necessary emotional associations.
4.
Identity (our mental representations of ourselves and the emotions
attached to these) is an important source of desires and provides a degree
of stability to our behaviour by virtue of the labels we apply (e.g. nonsmoker) and the rules that govern our behaviour (e.g. not smoking).
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PRIME Theory: key propositions
5.
Identity change is the starting point for deliberate behaviour change (in
terms of a new label and a new set of rules governing our behaviour) and
can be regarded as an ‘act’ that occurs when the desire to make the
change is momentarily greater than the desire not to.
6.
Deliberate behaviour change is sustained when the desires arising from
the new identity are stronger at each relevant moment than the desires
arising from other sources to revert to the previous behaviour pattern, or
are able to overwhelm habitual or instinctive impulses.
7.
When identity change results from self-conscious beliefs about what is
good and bad, maintaining behaviour change requires ‘self-control’: the
effortful generation of desire to adhere to a rule that is sufficiently powerful
to overcome desires arising from other sources.
8.
Personal rules that have clear boundaries and a strong connection with
components of identity that involve strong emotional attachments will
generate more powerful desires when required and better suppress
countervailing desires and so have a stronger lasting impact on behaviour.
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Formal analysis of behaviour change interventions
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1. Epicure taxonomy West (2006) Taxonomy of approaches designed to
influence behaviour patterns
2. Culture capital framework Knott et al. (2008) Framework of knowledge
about culture change, offering practical tools for policymaking
3. EPOC taxonomy of interventions Cochrane Effective Practice and
Organisation of Care Review Group (EPOC) (2010) Checklist to guide
systematic literature reviewers about the types of information to extract from
primary studies
4. RURU: Intervention implementation taxonomy Walter et al. (2003)
Taxonomy covering a wide range of policy, practice and organisational
targets aimed at increasing impact of research
5. MINDSPACE Institute for Government and Cabinet Office (2010)
Checklist for policy-makers aimed at changing or shaping behaviour
6. Taxonomy of behaviour change techniques Abraham et al. (2010)
Taxonomy of behaviour change techniques grouped by change targets
7. Intervention mapping Bartholomew et al. (2011) Protocol for a
systematic development of theory- and evidence-based interventions
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Formal analysis of behaviour change interventions
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8. People and places framework Maibach et al. (2007) Framework that
explains how communication and marketing can be used to advance public
health
9. Public health: ethical issues Nuffield Council on Bioethics (2007)
Ladder of interventions by government, industry, organisations and
individuals to promote public health.
10. Injury control framework Geller et al. (1990) Heuristic framework for
categorising and evaluating behaviour change strategies aimed at
controlling injuries
11. Implement-ation taxonomy Leeman et al. (2007) Theory-based
taxonomy of methods for implementing change in practice
12. Legal framework Perdue et al. (2005) Conceptual framework for
identifying possible legal strategies used for preventing cardiovascular
diseases
13. PETeR White (in prep.) Comprehensive and universally applicable
model or taxonomy of health
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Formal analysis of behaviour change interventions
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14. DEFRA’s 4E model DEFRA (2008) Process model for policy makers
aimed at promoting pro-environmental behaviours in accordance with social
marketing principles
15. STD/ HIV framework Cohen and Scribner (2000) Taxonomy to expand
the scope of interventions that can be used to prevent STD and HIV
transmission
16. Framework on public policy in physical activity Dunton et al. (2010)
Taxonomy aimed at understanding how and why policies successfully
impact on behaviour change
17. Interven-tion framework for retail pharmacies Goel et al. (1996)
Framework that presents factors that may affect retail pharmacy describing
and strategies for behaviour change to improve appropriateness of
prescribing
18. Environ-mental policy framework Vlek (2000) A taxonomy of major
environmental problems, their different levels and global spheres of impact,
and conceptual modelling of environmental problem- solving
19. Population Services International (PSI) framework PSI (2004) A
conceptual framework to guide and help conduct research on social
marketing interventions
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A derived list of 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 to reduce the opportunity to engage in the
target behaviour (or to increase the target behaviour by reducing the
opportunity to engage in competing behaviours)
• 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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A derived list of policy categories
• Communication/ 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
• Environmental/ social planning Designing and/or controlling the
physical or social environment
• Service provision Delivering a service
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The Behaviour Change Wheel: hub
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The behaviour Change Wheel: inner ring
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Behaviour Change Wheel: complete
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Where this leaves us
• Still at the level of broad intervention functions
• Construction of specific BCTs is still required
• Michie et al have constructed a taxonomy of
BCTs and this is being developed further
• West, Michie et al have constructed specific
BCTs used in behavioural support for smoking
cessation
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Worked example: getting GPs to deliver
brief smoking cessation interventions
• Behavioural target
– increase the rate at which GPs offer cessation
support to smokers from 25% to 50%
• COM-B analysis
– C: uncertainty about how to do it without
embarrassment in the time available; ignorance of
available options for support
– O: limited time; lack of salient cues; limited access to
high quality support
– M: belief that it is a good thing but limited desire
because not rewarded and often mildly punished
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Worked example: getting GPs to deliver
brief smoking cessation interventions
• Intervention options
– Education: on the best methods of brief advice and the benefits
– Training: how to deliver advice quickly without embarrassment
– Incentivisation: change QOF payments to link them with
objective evidence of offer of support (e.g. referral to stopsmoking services)
– Coercion: use professional and social disapproval for failure to
achieve minimum intervention rate
– Modelling: show examples that GPs can identify with
– Environmental restructuring: provide salient prompts e.g.
desktop post-it pads
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Conclusions
• Benefits of a comprehensive approach
– prompts consideration of the full range of options
– provides a basis for analysing behaviour in context to
select an appropriate mix of options
– takes account of environmental as well as intraindividual changes that may be needed
• Only a first step
The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Susan Michie, Maartje M van
Stralen, Robert West Implementation Science 2011, 6:42 (23 April 2011)
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