Behavior Change Projects Research Articles

Construction framework process: a qualitative investigation of behaviour change drivers and project outcomes

Purpose Construction framework agreements are identified by the UK Government’s Construction Strategy 2025 as an integrated procurement path to improve construction industry efficiency. However, criticisms from the industry have arisen from the lack of transparency and incorrect application of such frameworks. This paper aims to examine the client and supplier relationships within a framework agreement to discover what behaviour change drivers should be applied in the framework process to achieve the desired project outcomes. Design/methodology/approach A triangulation approach was adopted. An initial literature review on organisational behaviour and job performance theories was conducted followed by a qualitative expert review survey of client construction managers to confirm the project outcomes desired by public-sector clients and the associated behaviour change drivers. This was followed by a qualitative multiple-case study investigation of eight typical framework projects to form a commonality of views to explain the impact of behaviour change drivers on project outcomes. Findings Results from both qualitative studies demonstrated that improvements in project outcomes of time, cost, quality, sustainability and closer relationships can be driven by two sets of behaviour drivers: client organisational behaviour change drivers (setting up incentive and risk-sharing procurement approach, effective communication through development of stronger relationships and performance monitoring using contract key performance indicators) and supplier contextual behaviour change drivers (motivating conscientious behaviour and attitude towards self-improvement and innovations, supporting shared culture of providing services aligning with the client needs, promoting learning and development amongst all suppliers and most importantly providing trust and collaboration to the client). Research limitations/implications The investigation was based on an expert review with eight multiple-case studies conducted within the geographical area of England. Further research should be conducted nationwide so that the findings can become more robust and benefit the entire public sector. Practical implications It is suggested that framework managers should apply the supplier contextual performance drivers as selection criteria in the procurement process, whilst the client organisational performance drivers should be applied in the whole procurement and construction monitoring process to drive project outcomes aligned with the government construction policy objectives. Originality/value This research demonstrates that the project behaviour of clients and suppliers can be shifted within the construction framework environment to yield the desired project outcomes. This can be achieved by applying the client organisational behaviour drivers and the supplier contextual behaviour change drivers in tandem to optimise the framework process.

Linking measures to mechanisms of action in behavior change: A qualitative analysis of expert views

RationaleTesting mechanisms of action (MoAs) hypothesized to underlie behavior change can enhance intervention effectiveness. Rigorous measurement of putative mechanisms is critical to this effort, but measures are rarely validated with respect to target MoAs. ObjectiveThis study aimed to elucidate challenges of linking measures to putative MoAs and to identify priorities for future research. MethodThis study was a systematic exploration of written comments by experts in behavioral intervention research and theories of behavior change (N = 20) capturing their opinions about a task querying whether self-report measures from the Science Of Behavior Change (SOBC) Measures Repository were related to a set of MoAs identified by the Human Behaviour Change Project (HBCP). ResultsSix themes were identified: 1) Study Value, 2) Measure Properties, 3) Mechanism Properties, 4) Miscellaneous Measure Concerns, 5) Conceptual Challenges, and 6) Approaches to Developing Measure-Mechanism Links. Experts noted challenges such as lack of measure validation, poor measure properties (e.g., double-barreled items), overly broad MoA definitions that limited their utility, lack of clarity around the term “related,” and more. Nonetheless, experts expressed the importance of the exercise. Suggestions included developing and refining measures that are validate for assessing MoAs, clarifying and elaborating MoA definitions, and conducting further, more granular research. ConclusionThis systematic examination of expert comments highlights issues that need further investigation to advance behavioral science, specifically pertaining to identifying valid measures of MoAs in behavioral and process research. This study highlights the challenges and opportunities for future research on linking measures and MoA in behavioral science and subsequently enhancing the efficacy of behavioral interventions.

Using the disequilibrium theory in behavior change projects on homework and social media usage

AbstractThe disequilibrium theory suggests restricting a behavior below baseline levels will induce response deficit and make that behavior a more impactful reinforcer. This reinforcement principle was incorporated into a behavior change project for eight students, where the instrumental behavior was homework, and the contingent behavior was social media (SM) access. Students self‐selected their level of SM access deficit and completed both a baseline and treatment phase during the first 8 weeks of an undergraduate learning and behavior course. Most students increased daily homework rates during treatment relative to baseline, although the average increase was not statistically significant. Daily SM rates were significantly decreased during treatment relative to baseline, which was evidence of response deficit. Students rated the behavior change project high on most social validity measures. These results indicate that behavior change projects based on the disequilibrium theory are a viable way to induce changes in socially significant behaviors.

Using Project Based Learning to Teach Applied Behavior Analysis Knowledge and Skills to Pre-Service Teachers

Classroom management is a leading challenge for teachers. Applied Behavior Analysis (ABA) strategies can improve classroom management, however, there is a lack of research on teaching ABA skills. One approach to teaching new skills is Project Based Learning (PBL). Using a PBL format, this study implemented a Behavior Change Project where participants completed a project that incorporated ABA strategies. Pre- and post-assessments showed positive increases, indicating participants gained a better knowledge about ABA and classroom management strategies. Results indicate participants felt more comfortable implementing ABA strategies and designing data collection procedures. In addition, this project helped participants increase professional skills.

A reflection on motivating community action to protect an endangered species using marketing

PurposeThis paper aims to describe a case that has worked with community aiming to prevent koala deaths and injuries across known causes including dogs.Design/methodology/approachOver a 6½-year period, a project team has applied the Co-create–Build–Engage (CBETM) process initially delivering a proof-of-concept pilot programme for one threat faced by koalas, which was later scaled to citywide delivery. This approach is now being extended across 12 local government areas, and the author’s team is now working across all preventable threats faced by koalas’ regionwide. Leave It is now nested as one behaviour change project in a wider project delivered across Southeast Queensland, in partnership with Queensland Government, 12 local government areas, community groups and other organisations.FindingsUnderpinned by the pathway to impact and CBETM processes, this paper describes how the 3½-year Leave It project reduced koala deaths from dog attacks by 40% in the Redland City Council area. A reduction in koala deaths will contribute to a measurable increase in the local koala population across successive generations delivering lasting impact.Research limitations/implicationsThis paper provides an overview of links between inputs, activities, outputs and outcomes to impact. Robust koala population data is needed to precisely measure impact over time.Practical implicationsOne female koala joey saved equates to seven new koalas in the next generation and prevention of koala deaths can be achieved when people can be motivated to take action.Originality/valueThis paper reflects on 6½ years of experience applying marketing to deliver changes in people’s behaviour that protect koalas. A high-level overview of the strategic and operational marketing efforts that have been and continue to be applied is described.

Behaviour change techniques taxonomy v1: Feedback to inform the development of an ontology

Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety of behaviours. The BCTTv1 was intentionally named version 1 to allow for further revisions to the taxonomy. This study aimed to gather data to inform the development of BCTTv1 into a more elaborated knowledge structure, an ontology. Methods: Feedback from users of BCTTv1 about limitations and proposed improvements was collected through the BCT website, a user survey, researchers and experts involved in the Human Behaviour Change Project, and a consultation. In addition, relevant published research reports and other classification systems of BCTs were analysed. These data were synthesised to produce recommendations to inform the development of an ontology of BCTs. Results: A total of 282 comments from six sources were reviewed and synthesised into four categories of suggestions: additional BCTs, amendments to labels and definitions of specific BCTs, amendments to the groupings, and general improvements. Feedback suggested some lack of clarity regarding understanding and identifying techniques from labels, definitions, and examples; distinctions and relations between BCTs; and knowing what they would look like in practice. Three recommendations resulted from this analysis: to review the label and definition of each BCT, the 16 groupings of BCTs, and the examples illustrating BCTs. Conclusions: This review of feedback about BCTTv1 identified the need to improve the precision and knowledge structure of the current taxonomy. A BCT ontology would enable the specification of relationships between BCTs, more precise definitions, and allow better interoperability with other ontologies. This ontology will be developed as part of the Human Behaviour Change Project.

Mindfulness for smoking cessation.

Mindfulness for smoking cessation.

A Constructional Approach to the Use of Behavior Change Projects in Undergraduate Behavior Analysis Courses.

One of the key challenges facing instructors of undergraduate introduction to behavior analysis courses is helping students learn to identify the environmental variables that control behavior. Goldiamond frequently employed exploratory and targeted logs to help his clients understand the environmental controlling variables that supported their behavior. We describe a preliminary analysis of the use of adaptations of Goldiamond's exploratory logs in the context of a behavior change project incorporated in several undergraduate introductory behavior analysis courses across three semesters. Three "levels" of exploratory logs were created in which students were asked to record an increasing number of the components of the three-term contingency. Students were also asked to answer the question, "why did this behavior occur" for each behavior reported. In the first semester, students received feedback on their exploratory logs through an online course management system and in the subsequent two semesters students received feedback on their exploratory logs during class periods. Each level of the students' exploratory logs was scored according to the type of explanation (e.g., explanatory fiction, behavioral) students provided for the behavior. The results show that the combination of the behavior change project and in-class feedback promoted more behavioral explanations for the behaviors recorded than the combination of the behavior change project and feedback provided through the online, course management system.

5 Quality Improvement Project (QIP): A Teamwork Approach to Optimise Fluid Intake in Older Inpatients #ButFirstADrink

Abstract The shortfalls of hydration management have been widely exposed since the Frances report in 2013. Age-related changes create challenges for people to drink adequate fluid amounts (Nazarko, 2018), making dehydration prevention in older people an ongoing public health priority (NICE, 2016). Hydration needs of older people are complex and may not be fully understood. A proactive MDT approach to facilitate regular drinking opportunities seems an achievable solution to increase hydration awareness, knowledge and daily fluid intake in older inpatients. A QI methodology was used, including stakeholder engagement and PDSA learning cycles to influence, engage and educate staff on hydration management. Outcome measures: Fluid intake (ml/day), number of drinks/days based on fluid balance chart recordings. Interventions: Sharing the #ButFirstADrink social media hydration movement, which includes educational posters, flyers and a YouTube video. Face to face drop-in education sessions were implemented using local hydration education resources from Age UK Salford and GM nutrition and hydration programme as teaching tools. SPC charts were used to show a time-series data. In 15 weeks, 461/525 fluid charts were reviewed from 169 patients. Mean age was 84 years and 68% females. Average daily fluid intake increased by 25% (exceeding aim) indicating 176mls more fluid was offered on average/day. Mean number of drinks/days increased from 4.6 to 6 post interventions. Knowledge and attitude improved in some areas; however fluid output is not routinely recorded. Post intervention, 89% of staff felt that offering a drink at first contact is a suitable hydration promotion campaign. The project scored 58% using the NHS sustainability model (ACT Academy, 2018) suggesting reason for optimism. As it is a behaviour change project, further engagement and momentum is dependent on ongoing enthusiasm to drive the #ButFirstADrink approach. This intervention is free, simple and innovative and stimulates behaviour change, raises drinking awareness and increases hydration.

Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study

Background Many global health challenges may be targeted by changing people’s behaviour. Behaviours including cigarette smoking, physical inactivity and alcohol misuse, as well as certain dietary behaviours, contribute to deaths and disability by increasing the risk of cancers, cardiovascular diseases and diabetes. Interventions have been designed to change these health behaviours with a view to reducing these health risks. However, the effectiveness of these interventions has been quite variable and further information is needed to enhance their success. More information is needed about the specific processes that underlie the effectiveness of intervention strategies. Aim Researchers have developed a taxonomy of 93 behaviour change techniques (i.e. the active components of an intervention that bring about behavioural change), but little is known regarding their potential mechanisms of action (i.e. the processes through which a behaviour change technique affects behaviour). We therefore aimed to examine links between behaviour change techniques and mechanisms of action. Method First, we conducted a literature synthesis study of 277 behaviour change intervention studies, from which we extracted information on links, described by authors, between behaviour change techniques and mechanisms of action, and identified an average of 10 links per intervention report. Second, behaviour change experts (n = 105) were engaged in a three-round consensus study in which they discussed and rated their confidence in the presence/absence of ‘links’ and ‘non-links’ between commonly used behaviour change techniques (n = 61) and a set of mechanisms of action (n = 26). Ninety links and 460 ‘non-links’ reached the pre-set threshold of 80% agreement. To enhance the validity of these results, a third study was conducted that triangulated the findings of the first two studies. Discrepancies and uncertainties between the studies were included in a reconciliation consensus study with a new group of experts (n = 25). The final results identified 92 definite behaviour change technique–mechanism of action links and 465 definite non-links. In a fourth study, we examined whether or not groups of behaviour change techniques used together frequently across interventions revealed shared theoretical underpinnings. We found that experts agreed on the underlying theory for three groups of behaviour change techniques. Results Our results are potentially useful to policy-makers and practitioners in selecting behaviour change techniques to include in behaviour change interventions. However, our data do not demonstrate that the behaviour change techniques are effective in targeting the mechanism of action; rather, the links identified may be the ‘best bets’ for interventions that are effective in changing mechanisms of action, and the non-links are unlikely to be effective. Researchers examining effectiveness of interventions in either primary studies or evidence syntheses may consider these links for further investigation. Conclusion To make our results usable by researchers, practitioners and policy-makers, they are available in an online interactive tool, which enables discussion and collaboration (https://theoryandtechniquetool.humanbehaviourchange.org/); accessed 1 March 2020. This work, building on previous work to develop the behaviour change technique taxonomy, is part of an ongoing programme of work: the Human Behaviour Change Project (www.humanbehaviourchange.org/; accessed 1 March 2020). Funding This project was funded by the Medical Research Council via its Methodology Panel: ‘Developing methodology for designing and evaluating theory-based complex interventions: an ontology for linking behaviour change techniques to theory’ (reference MR/L011115/1).

An online Paper Authoring Tool (PAT) to improve reporting of, and synthesis of evidence from, trials in behavioral sciences.

The Science of Behavior Change project represents a major advance in the way we approach the study of behavior and behavior change; the protocols in this special issue reflect the innovative approach to intervention development. Digital technology is transforming the way we conduct science and can greatly assist with developing protocols, reporting studies, and evidence synthesis. The journal Addiction has developed an online Paper Authoring Tool (PAT) for reporting full-scale randomized controlled trials that could also be used for reporting protocols and early phase trials. PAT aims to help authors ensure that they include all the required information and present it in a way that is clear and consistent in terms of language and phrasing. It also generates a computer-readable record that should greatly facilitate automation of evidence synthesis. PAT is intended to represent the first step in creation of a supportive ecosystem for the conduct of science, linking grant applications, study protocols, study reports, measures, reviews and study data in a coordinated online knowledge base. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

‘Without the Right Support Network I'd Probably Be Either Dead or in the Prison System’: The Role of Support in Helping Offenders on their Journey to Desistance

AbstractReforms designed to enhance the delivery of flexible and holistic support to offenders were introduced in 2013, with a clear focus on addressing ‘broader life management issues’ to enable behaviour change. Data are drawn from total of 117 semi‐structured interviews undertaken with 57 offenders as part of the Welfare Conditionality: Sanctions support and behaviour change project. The article specifically highlights the significance of long‐term support in successfully helping offenders to change their behaviour. It emphasises the importance of long‐term engagement, together with strengths‐based approaches in helping offenders to progress personal development and create a new prosocial identity whereby they can become invested in society.

Service evaluation of a health behaviour change intervention for patients with peripheral arterial disease

This report describes a pilot health behaviour change (HBC) project established by NHS Grampian vascular service. Results are presented in the form of case studies and data. The intervention aimed to support patients with peripheral arterial disease (PAD) to change health behaviour/improve self-management. PAD is a common condition among people aged over 55 years, with significant health implications if not well managed. PAD is caused by narrowing of the arteries, leading to poor blood flow causing pain and cramp mainly in the calf (intermittent claudication). Without proper blood flow, patients with PAD are at high risk of developing serious health problems, including heart attack, stroke, and amputation. Costs associated with PAD are substantial and largely avoidable with effective behaviour change. Smoking is the principle risk factor in the development of PAD. Other modifiable risk factors include obesity and sedentary lifestyle. Service evaluation data was collected at Aberdeen Royal Infirmary with 30 patients attending the vascular outpatient clinic. Patients received a tailored HBC intervention. Post-intervention, fewer participants smoked (67 per cent at baseline, 30 per cent follow-up); average daily step count increased by 1677 steps; average 5kg weight reduction at six month follow-up. Qualitative feedback highlighted increased self-esteem and improved strategies to help cope with PAD.

Hand washing behavior change effect of community-based hygiene and sanitation intervention in low resource setting.

Lack of hygiene and sanitation causes significant disease, disability and death. Majority of diarrheal diseases are related to hygiene and drinking water. Hand washing with soap after toilet use and before eating reduces these risks significantly. This report is based on a behavior change project in the rural community setting (union council Nahqi), Peshawar, Pakistan aimed to improve hygiene- and sanitation-related behavior. A pre-intervention survey was conducted at household level (n=958), followed by a structured behavior change communication program with motivational and educational material and key health messages for three months. Lastly, an end-line survey was conducted measuring change in practice domains. All the domains of hygiene and sanitation showed statistically significant improvement (11-59% P<0.001), including handwashing before meals (28.2%), before cooking (54.1%), before child feeding (21.2%), after defecation (30.6%); tooth brushing twice daily (7.3%); nail clipping at least weekly (16.3%); bathing daily (11.3%); change of clothing twice weekly (24.7%); covering the water containers (59.3%) and house orderliness (30.6%). The findings conclude that a behavior change communication program that is in accord with community needs, level of their understanding, beliefs and sociocultural norms is well received for positive behavior change.

Exploring the Effectiveness of an Energy Efficiency Behaviour Change Project on Well-Being Outcomes for Indigenous Households in Australia

The Koorie Energy Efficiency Project (KEEP) was a Victoria-based, Australian social marketing initiative designed to provide support to Indigenous households so they could better manage their energy bills by reducing or controlling their energy use. The program was delivered by trained, Indigenous project employees who visited Indigenous households in metropolitan and regional parts of the state. During the home visit, they provided an energy efficiency audit, as well as specific energy efficiency tips and advocacy support. Minor draft-proofing products were also supplied to each household. As part of this project, dwelling and householder information was gathered during each home visit, as well as measures of energy efficiency knowledge, behaviours, and well-being of the main householder before and after a home visit. The results indicate that home visits to support the energy efficiency of indigenous households are effective in terms of encouraging new energy efficiency knowledge, behaviours, and broader elements of well-being. Furthermore, the home visit was found to be effective across all home types, but was significantly more effective in reducing energy related stress and discomfort in traditional houses and traditional apartments. These households were also often small and densely occupied. This suggests that when social marketing programs use methods that are culturally suitable and respectful, such as those used in KEEP, they become a powerful tool to help drive social change in Indigenous communities. The authors conclude that such programs in future will be hindered in their effectiveness unless property owners, such as those of social housing, do not urgently address the maintenance of their properties and ensure they provide fit living conditions for the tenants.

INGO Behavior Change Projects: Culturalism and Teenage Pregnancies in Malawi

ABSTRACTAdolescent girls are at the center of many health development interventions. Based on ethnographic research in rural Malawi, I analyze the design, implementation, and reception of an international non-government organization’s project aiming to reduce teenage pregnancies by keeping girls in school. Drawing on Fassin’s theorization of culturalism as ideology, I analyze how a tendency to overemphasize culture is inherent to the project’s behavior change approach, but is reinforced locally by class-shaped notions of development, and plays out through reinforcing ethnic stereotypes. I argue that culturalism builds upon previous health development initiatives that dichotomized modernity and tradition, and is strengthened by short-term donor funding.

Implementing the mobile continuing medical education (mCME) project in Vietnam: making it work and sharing lessons learned.

Mobile technology is a novel approach for delivering continuing medical education (CME), with numerous advantages including lower costs and the ability to reach larger numbers than traditional in-person CME workshops. From May 2015 to May 2017, we conducted two randomized controlled trials in a phased approach to evaluate the effectiveness of a mobile CME (mCME) approach for two cadres of health professionals in Vietnam. The first randomized controlled trial (RCT) tested the use of an SMS-based educational intervention among Community-Based Physician's Assistants; while feasible and acceptable, this intervention failed to improve medical knowledge among participants. Given the failure of the first RCT, and drawing on qualitative work conducted with participants at the conclusion of the trial, various modifications were employed in the second RCT conducted among HIV specialist physicians in Vietnam. Version 2.0 of the mCME intervention did lead to significant improvement in medical knowledge among intervention participants. Here, we discuss in detail the development of an mCME platform and the experiential "lessons learned" during two phases of implementation. Numerous lessons were learned during implementation, including the importance of: (I) mixed methods approaches; (II) an underlying theoretical framework for behavior change projects; (III) expertise in software programming; (IV) aligning educational content to a well-defined participant population; and (V) engaging and motivating adult learners. We also discuss the critical importance of projects with local ownership and investment that are relevant to local problems. mHealth approaches for continued healthcare training and education is increasingly relevant in many low-resource settings, the lessons learned here will be valuable to other organizations looking to scale-up similar mHealth-type educational programmes.

Facilitating Positive Spillover Effects: New Insights From a Mixed-Methods Approach Exploring Factors Enabling People to Live More Sustainable Lifestyles.

Positive spillover occurs when changes in one behavior influence changes in subsequent behaviors. Evidence for such spillover and an understanding of when and how it may occur are still limited. This paper presents findings of a 1-year longitudinal behavior change project led by a commercial retailer in the United Kingdom and Ireland to examine behavior change and potential spillover of pro-environmental behavior, and how this may be associated with changes in environmental identity and perceptions of ease and affordability as well as perceptions of how participation in the project has helped support behavior change. We draw on both quantitative and qualitative data. Study 1 examines quantitative data from the experimental and a matched control group. Study 2 reports qualitative findings from a follow up interview study with participants of the experimental group. As expected, we found significant changes in reported pro-environmental behavior and identity in the experimental group as well as some indications of behavioral spillover. These changes were not significantly associated with changes in environmental identity. The interviews suggested that group dynamics played an important role in facilitating a sense of efficacy and promoting sustained behavior change and spillover. Moreover, the support by a trusted entity was deemed to be of crucial importance.

Using Rigorous Methods to Advance Behaviour Change Science.

The field of behaviour change suffers from significant fragmentation and poor reporting. Here, we describe two large-scale initiatives — the Human Behaviour Change Project and Science of Behavior Change programme — that aim to introduce complementary systematic and rigorous methods to advance the science of behaviour change.

Evaluation of a Behavioral Self-Care Intervention for Public Health Students

ABSTRACTBackground: Postgraduate education is recognized as a time of intense stress. Rates of anxiety and depression are elevated among graduate students, and longitudinal studies have documented increases in clinical symptoms over the course of training. Purpose: The current study was to evaluate whether an academically sponsored self-care intervention would increase engagement in health promotion activities. The primary goal was to determine whether self-care behaviors completed in the midst of a challenging academic program would prevent the worsening of student mental health. Methods: The self-care intervention included behavior change projects designed to increase health-promoting behaviors within 4 domains (nutrition, physical activity, mental health, social support). Students received incentives in the way of bonus points for maintaining health behaviors for the duration of the 12-week semester. Results: Results revealed significant increases in health-promoting behaviors. Importantly, mental health symptoms did not worsen over the course of the semester. Discussion: The study provides preliminary support for the utility of a brief self-care intervention for students in the health sciences. Translation to Health Education Practice: Future studies should examine the applicability of this intervention to students in other fields of study and through online education formats.