Behaviour plays an important role in people's health for example, smoking, poor diet, lack of exercise and sexual risk taking can cause a large number of diseases. In addition, the evidence shows that different patterns of behaviour are deeply embedded in people's social and material circumstances, and their cultural context.
Interventions to change behaviour have enormous potential to alter current patterns of disease. A genetic predisposition to disease is difficult to alter. Social circumstances can also be difficult to change, at least on the short to medium term. By comparison, people's behaviour – as individuals and collectively – may be easier to change.
Identifying effective approaches and strategies that benefit the population as a whole will enable public health practitioners, volunteers and researchers to operate more effectively, and achieve more health benefits with the available resources.
Behaviour Change Techniques
A brief intervention involves oral discussion, negotiation or encouragement, with or without written or other support or follow-up. It may also involve a referral for further interventions, directing people to other options, or more intensive support. Brief interventions can be delivered by anyone who is trained in the necessary skills and knowledge. These interventions are often carried out when the opportunity arises, typically taking no more than a few minutes for basic advice.
Choice architecture interventions ("Nudge")
'Choice architecture intervention' is used to mean changing the context in which someone will make a decision in order to influence how they act. For example, placing healthier snacks closer to a shop checkout and putting sugary and high-fat options out of reach may influence people to make a healthier choice because it is more accessible. Behaviour change approaches based on choice architecture are also referred to as 'nudge' or 'nudging' interventions (Thaler and Sunstein 2008).
Extended brief intervention
An extended brief intervention is similar in content to a brief intervention but usually lasts more than 30 minutes and consists of an individually-focused discussion. It can involve a single session or multiple brief sessions.
Feedback and monitoring
In 'feedback and monitoring' a specific behaviour (for example, alcoholic drinks consumed) or outcome (for example, changes in weight following changes to diet) is recorded. The person trying to change their behaviour is given feedback on the recorded behaviour or outcomes (for example, measurement of weight) or comment on progress towards a set goal. Monitoring can be done by a third party, or by the person themselves ('self-monitoring').
Goals and planning
'Goals and planning' refers to a group of behaviour change techniques that help people to set goals for their behaviour or for an outcome of the behaviour (such as weight loss) and plan how these goals will be met. Action plans include a description of what will happen in what situation or at what time: how often it will happen, for how long, and where it will take place. Behaviour goals are reviewed regularly in the light of experience and further plans are made according to past progress towards goals.
Using a 'person-centred' approach, services work in collaboration with service users as equal partners to decide on the design and delivery of services. This approach takes into account people's needs and builds relationships with family members. It also takes into account their social, cultural and economic context, motivation and skills, including any potential barriers they face to achieving and maintaining behaviour change. Person-centred care involves compassion, dignity and respect.
Very brief intervention
A very brief intervention can take from 30 seconds to a couple of minutes. It is mainly about giving people information, or directing them where to go for further help. It may also include other activities such as raising awareness of risks, or providing encouragement and support for change. It follows an 'ask, advise, assist' structure. For example, very brief advice on smoking would involve recording the person's smoking status and advising them that stop smoking services offer effective help to quit. Then, depending on the person's response, they may be directed to these services for additional support.
Source: NICE Behaviour Change: Individual Approaches, 2014.
Health promotion forms part of many primary care consultations, be it advice about exercise, weight loss, smoking or alcohol. These consultations are often fraught with difficulty, as many patients are resistant to being told what to do or what is good for them. Moving from this direct style of consultation to a more guiding style that encourages patient motivation is thought to increase the success of health promotion.
Motivational interviewing was originally developed in the field of addiction counselling, but has also been used to promote behaviour change in a wide range of healthcare settings, such as smoking cessation, weight loss and promoting increased physical activity.
There is increasing evidence of its effectiveness, with 80% of 72 studies finding that motivational interviewing outperformed traditional advice-giving. It is associated with a more respectful and less combative consultation - this feels professionally better and is certainly more enjoyable for both doctors and their patients.
Health Behaviour in School-aged Children (HBSC)
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