Informed - Issue 35, Autumn 2009

Effective health behaviour change strategies

Promoting behaviour change would be a cost-effective way to reduce chronic diseases. But how can psychological theories be effectively translated into actual behaviour change on an individual and population level? Which techniques really work?

There is strong evidence that changing people’s health behaviour has the potential to decrease some of the largest causes of mortality and disability, such as heart disease and cancer [1]. WCRF UK estimates that unhealthy behaviours such as having a poor diet, being inactive and being overweight are responsible for about a third of the most common cancers in developed countries [2].

Despite the benefits of empowering people to change their health behaviour, effective interventions are lacking. According to the National Institute for Health and Clinical Excellence (NICE), the limited success of interventions may be due to their failure to take into account theories and principles underlying health behaviours [1]. Presently, no strategic approach to health behaviour change exists in the UK. Various models, methods and theories are being used in unco-ordinated ways [1], and this makes it more difficult for health professionals to focus on evidence-based strategies.

Problems and solutions

Health behaviour is influenced by numerous variables, including physiological, psychological, emotional, socio-economic and environmental factors. This makes targeted research difficult. There also appears to be a disconnection between academics who develop psychological behaviour change theories and health professionals who implement interventions in the community [3]. According to Mark Conner, Professor of Applied Social Psychology at Leeds University, interventions have so far largely been unsuccessful because they involve too many psychological theories and tend to focus on what behaviour to change, rather than how to change it.

At the 2009 ‘Promoting Behaviour Change’ conference organised by the Association for the Study of Obesity (ASO) in Leeds, Professor Conner proposed some possible solutions.

Identifying specific variables related to behaviour change, such as social pressures, emotions, attitudes, norms and self-efficacy (an individual’s belief in their ability to change), and key ‘active ingredients’ of behaviour change interventions, is necessary to understand what works and why [4].

Also, greater emphasis needs to be placed on theories aiming to change determinants of behaviour. Different groups and individuals will respond to different interventions so tailoring strategies is also a vital consideration.

Which techniques really work?

Two recent reviews [4, 5] have looked at the effectiveness of different techniques in promoting healthy behaviours.

Self-monitoring, used in addition to at least one other self-regulatory technique, was most consistently associated with successful outcomes. Self-monitoring relies on patients keeping a record of specified behaviours by, for example, keeping a food diary or filling in a questionnaire. The four most effective self-regulatory techniques were:

• Intention formation: involves the patient setting a general goal or making a behavioural resolution, such as: “I will take more exercise next week”
• Specific goal setting : involves detailed planning of what the patient will do. It should include at least one specific attribute like frequency or duration and one ‘context’ such as where, when or how. For example: “I will run for 20 minutes twice a week after work”
• Review of behavioural goals: involves reconsideration of previously set goals
  or intentions
• Feedback on performance: involves commenting on how well or badly a person has performed an action

More information on these and other techniques is available on www.interventiondesign.co.uk, a website dedicated to improving the design and reporting of behaviour change interventions.

NICE guidance for health professionals

Current NICE behaviour change guidelines [1] are based on evidence of effectiveness, theory, fieldwork data and stakeholders’ feedback. NICE advises to use interventions that motivate and support people to feel positive about the benefit of changing their behaviour. It suggests planning change in terms of easy steps and helping people set, record and share goals to make a personal commitment to change. It also stresses the importance of the social context and suggests planning coping strategies to prevent relapse.

In the absence of policies to reduce detrimental socio-economic influences on health, promoting behaviour change could represent a cost-effective way to reduce chronic diseases. Currently, there is no conclusive evidence that one technique is better than another. However, self-monitoring and goal setting seem to have been most successful so far. Also, motivational and supportive techniques that help individuals adopt positive attitudes toward health behaviour change are recommended.

References
1. NICE public health guidance 6, 2007. Behaviour change at population, community and individual levels
2. WCRF/AICR. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a Global Perspective. Washington DC: AICR, 2009
3. Barker M & Swift JA 2009 Proc Nutr Soc 68:205-209
4. Webb TL & Sheeran P 2008 Br J Soc Psychol 47:373-395
5. Mitchie S et al (In Press) 2008 [online]. Available from: www.interventiondesign.co.uk/wp-content/uploads/2008/09/abraham-et-al-2.pdf

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