Designing Behaviour Change Interventions Research Articles

A simulation approach to estimate energy savings potential of occupant behavior measures

Occupant behavior in buildings is a leading factor influencing energy use in buildings. Low-cost behavioral solutions have demonstrated significant potential energy savings. Estimating the behavioral savings potential is important for a more effective design of behavior change interventions, which in turn will support more effective energy-efficiency policies. This study introduces a simulation approach to estimate the energy savings potential of occupant behavior measures. First it defines five typical occupant behavior measures in office buildings, then simulates and analyzes their individual and integrated impact on energy use in buildings. The energy performance of the five behavior measures was evaluated using EnergyPlus simulation for a real office building across four typical U.S. climates and two vintages. The Occupancy Simulator was used to simulate the occupant movement in each zone with inputs from the site survey of the case building. Based on the simulation results, the occupant behavior measures can achieve overall site energy savings as high as 22.9% for individual measures and up to 41.0% for integrated measures. Although energy savings of behavior measures would vary depending upon many factors, the presented simulation approach is robust and can be adopted for other studies aiming to quantify occupant behavior impact on building performance.

Estimating energy savings from behaviours using building performance simulations

ABSTRACTOccupants’ behaviours are a major determinant of energy use in buildings. The related savings potential has been insufficiently exploited. Although research has addressed behavioural savings through real-world interventions and quantitative modelling approaches, it has not yet explored the full variety of household activities. This work proposes an integrative modelling approach of energy behaviours in the residential setting as a tool to estimate the behavioural impact of households on energy consumption. It uses building energy performance simulation (BEPS) tools to exploit the behavioural savings potential associated with usage and investment energy behaviours when using different energy services in daily household activities. Simulations have estimated significant behavioural savings potential associated with energy behaviours, which may be materialized if some forms of behaviour are induced. Investment behaviours have higher savings potential than usage behaviours, and the behavioural savings potential per energy service is proportional to the energy consumption breakdown. BEPS tools enable a quantitative estimate of the behavioural impact on energy consumption, but further improvements to these tools are needed to incorporate the complexity of behavioural dimensions. Estimating the behavioural savings potential is important for a more effective design of behaviour change interventions, which in turn will support more effective energy efficiency policies.

Making the case for change: What researchers need to consider when designing behavior change interventions aimed at improving medication dispensing.

There is a growing emphasis on behavior change in intervention development programmes aimed at improving public health and healthcare professionals' practice. A number of frameworks and methodological tools have been established to assist researchers in developing interventions seeking to change healthcare professionals' behaviors. The key features of behavior change intervention design involve specifying the target group (i.e. healthcare professional or patient cohort), the target behavior and identifying mediators (i.e. barriers and facilitators) of behavior change. Once the target behavior is clearly specified and understood, specific behavior change techniques can then be used as the basis of the intervention to target identified mediators of behavior change. This commentary outlines the challenges for pharmacy practice-based researchers in targeting dispensing as a behavior when developing behavior change interventions aimed at pharmacists and proposes a definition of dispensing to consider in future research.

How behavioural science can improve financial advice services

Evidence from the behavioural sciences, notably economics and psychology, has profoundly changed the way policymakers and practitioners view expert advice to consumers. In this article, we take stock of the behavioural science evidence on financial advice and explore its implications for the profession. We organise the evidence in a comprehensive theoretical framework that also serves a practical purpose: the design of behaviour change interventions. We suggest various ways in which financial advisers can use the insights from behavioural science to improve the take-up and effectiveness of their advice. Finally, we discuss ethical and practical considerations for the financial advisor wishing to put behavioural science knowledge to use.

…design and describe behaviour change interventions

To prevent illness, promote recovery and support optimal delivery of health care services, health psychologists need to design effective behaviour change interventions. This paper describes two recently launched resources available to health psychologists to guide the design of behaviour change interventions and specification of intervention content:(i) The Behaviour Change Wheel: A Guide to Designing Interventions.(ii) Online training in a method for specifying the active content of behaviour change interventions: The Behaviour Change Techniques Taxonomy v1 (BCTTv1).

Identifying determinants of effective complementary feeding behaviour change interventions in developing countries.

As stunting moves to the forefront of the global agenda, there is substantial evidence that behaviour change interventions (BCI) can improve infant feeding practices and growth. However, this evidence has not been translated into improved outcomes on a national level because we do not know enough about what makes these interventions work, for whom, when, why, at what cost and for how long. Our objective was to examine the design and implementation of complementary feeding BCI, from the peer‐reviewed literature, to identify generalisable key determinants. We identified 29 studies that evaluated BCI efficacy or effectiveness, were conducted in developing countries, and reported outcomes on infant and young children aged 6–24 months. Two potential determinants emerged: (1) effective studies used formative research to identify cultural barriers and enablers to optimal feeding practices, to shape the intervention strategy, and to formulate appropriate messages and mediums for delivery; (2) effective studies delineated the programme impact pathway to the target behaviour change and assessed intermediary behaviour changes to learn what worked. We found that BCI that used these developmental and implementation processes could be effective despite heterogeneous approaches and design components. Our analysis was constrained, however, by the limited published data on how design and implementation were carried out, perhaps because of publishing space limits. Information on cost‐effectiveness, sustainability and scalability was also very limited. We suggest a more comprehensive reporting process and a more strategic research agenda to enable generalisable evidence to accumulate.

Is Trust in Health Information Related to Better Hand Hygiene Among Military Conscripts?

Respiratory infectious diseases present a major health problem among military conscripts. To examine determinants of hand washing and their relations to trust in authority-provided health information, a social-cognitive model was applied to cross-sectional data from 140 Finnish conscripts aged 18 to 22. The results show that trust in authority-provided health information is associated with higher self-efficacy, higher knowledge, higher perceived effectiveness, and lower perceived risk; that higher self-efficacy and higher disease worry are associated with hand washing; and that trust in authority-provided health information has a direct, independent effect on hand washing. The results give information for designing behavior change interventions.

Development of a theory-based interactive digital intervention to improve condom use in men in sexual health clinics: an application of qualitative methods using the behaviour change wheel

BackgroundEffective interventions for sexually transmitted infections (STIs) are more likely to have made extensive use of behaviour change theory and techniques and to have involved users in intervention design than those that are not effective; however, how to include theory in the design of behaviour change interventions is not clear. Recently, a framework for intervention has been developed that is a synthesis of the theoretical ideas depicted in 19 other frameworks (the behaviour change wheel [BCW]). The BCW defines behaviour change as requiring capability, opportunity, and motivation. These factors form the hub of the BCW around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these factors. We are developing a digital intervention to increase condom use in men in sexual health clinics, drawing on published work on barriers to condom use, behaviour change theory, and the views of men attending clinics to design the content and interactive features of the intervention. We present our experience of use of the BCW to incorporate these three sources of information into the design of a behaviour change intervention. MethodsInformation from three sources was combined: a review of the published work on barriers and facilitators to condom use; workshops with clinical and academic experts in sexual health; and semi-structured interviews with men attending sexual health clinics. This information was combined with use of the BCW framework to identify what theoretical domains needed to be targeted to change behaviour (eg, condom use skills, beliefs about consequences of behaviour) and how these should be targeted (eg, interactive features and behaviour change techniques). FindingsFindings from the review of publications and interviews with men affected the intervention content. Reduced pleasure was the most prominent barrier to condom use. Other barriers included absence of accurate knowledge about risk (eg, believing that one can make judgments about risk), and difficulty using condoms in “the heat of the moment”. The intervention was therefore designed to target these factors. Furthermore, published work suggests that many people make errors when using condoms, and so an activity training people in condom use was included. Men who were interviewed wanted information about STI symptoms and consequences, and so this was also included. Combining information from different sources is essential in designing a complex intervention; however, managing such a wealth of data can prove challenging. BCW helped to provide structure for this process, by sorting the findings into the categories set out by it. It was helpful in perceiving how each intervention target maps onto a theoretical domain and to guide decisions about how to prompt behaviour change. For example, inaccurate beliefs about ability to judge the risk of STIs is a psychological capability that we targeted by developing an interactive activity that depicts scenarios for asymptomatic chlamydia acquisition within a sexual network. This activity draws on the behaviour change techniques, including giving information about health consequences, comparative imagining of future outcomes, and vicarious consequences. InterpretationThe BCW provides a good starting point for intervention development and is a good framework for integration of information. The BCW integrates theoretical principles from multiple models of health behaviour, providing a systematic way of considering several influences on behaviour and planning the ways that an intervention may seek to change behaviour. Getting consensus between experts about which dimensions were most important was sometimes difficult. To overcome this limitation, we used data from the review of published work and the interviews to make informed decisions within the research team. FundingThis research was part of a wider project, which was funded by a NIHR Health Technology Assessment grant.

Exploring the connectedness of rural auxiliary midwives to social networks in Koutiala, Mali

Backgroundrural auxiliary midwives are central to clinical maternal care in Mali. However, little is known about their social role within the villages they serve. Exploring the social connectedness of midwives in their communities can reveal areas in which they need additional support, and ways they could benefit their communities beyond their clinical role. Objectiveto examine rural auxiliary midwives' social connectedness to the communities they serve. Designembedded, mixed methods design combining social network case studies with semi-structured interviews. Participants and settingmidwives were recruited for semi-structured interviews during technical trainings held in Koutiala in southern Mali. Social network analyses were conducted among all adult women in two small villages purposively sampled from the Koutiala region. Methods29 interviews were conducted, transcribed, and coded using NVivo (Version 9) to qualitatively assess social connectedness. In two villages, the complete social networks of women's friendships were analysed using UCINET Version 6 (n=142; 74). Rank-orders of actors according to multiple measures of their centrality within the network were constructed to assess the midwives' position among village women. Findingsboth local and guest midwives reported feeling high levels of social integration, acceptance, and appreciation from the women in their communities. Specific challenges existed for guest or younger midwives, and in midwives' negotiations with men. In the two sociometric analyses, both the local and guest midwives ranked among the most influential social actors in their respective villages. Key conclusions and implications for practicethough they hold a unique position among other rural women, this study suggests that midwives in Koutiala are well connected socially, and may be capable of becoming effective agents of network based-behavioural health interventions. Additional support is warranted to help midwives affirm a credible professional status in a male-dominated society, especially those of local status and younger age. Programme planners and policy-makers should consider the potential of midwives in communication when designing behaviour change interventions for women in similarly underserved areas.

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

BackgroundImproving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.MethodsA systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity.ResultsNineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity.ConclusionsInterventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

Evidence‐based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour

Many theories of behaviour are potentially relevant to predictive and intervention studies but most studies investigate a narrow range of theories. Michie et al. (2005) agreed 12 'theoretical domains' from 33 theories that explain behaviour change. They developed a 'Theoretical Domains Interview' (TDI) for identifying relevant domains for specific clinical behaviours, but the framework has not been used for selecting theories for predictive studies. It was used here to investigate clinicians' transfusion behaviour in intensive care units (ICU). Evidence suggests that red blood cells transfusion could be reduced for some patients without reducing quality of care. (1) To identify the domains relevant to transfusion practice in ICUs and neonatal intensive care units (NICUs), using the TDI. (2) To use the identified domains to select appropriate theories for a study predicting transfusion behaviour. An adapted TDI about managing a patient with borderline haemoglobin by watching and waiting instead of transfusing red blood cells was used to conduct semi-structured, one-to-one interviews with 18 intensive care consultants and neonatologists across the UK. Relevant theoretical domains were: knowledge, beliefs about capabilities, beliefs about consequences, social influences, behavioural regulation. Further analysis at the construct level resulted in selection of seven theoretical approaches relevant to this context: Knowledge-Attitude-Behaviour Model, Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Control Theory, Normative Model of Work Team Effectiveness and Action Planning Approaches. This study illustrated, the use of the TDI to identify relevant domains in a complex area of inpatient care. This approach is potentially valuable for selecting theories relevant to predictive studies and resulted in greater breadth of potential explanations than would be achieved if a single theoretical model had been adopted.

Young people's understanding of HIV: A qualitative study among school students in Mankweng, South Africa

This article describes young people's interpretation of HIV, AIDS and sexually transmitted illness in a rural South African community in Mankweng, Limpopo Province. The study was based on 19 focus group discussions with adolescents aged 12-14 years. Our participants had limited knowledge about HIV from a biomedical perspective. Their understanding and interpretations of HIV and other sexually transmitted diseases were largely informed by traditional and religious belief systems that explain how and why people contract an illness via sexual intercourse. Based on these interpretations, they also expressed distrust towards the medical health system, and where to go for care, support and treatment. Local traditional healers were often mentioned as the only people who could cure several of the sexually transmitted diseases described by our informants. The ways of understanding HIV, AIDS and other sexually transmitted illnesses may weaken efforts of health education interventions based solely on a medical and modern notion of disease. The authors emphasise the importance of exploring traditional and religious belief systems and taking these into account when planning and designing behaviour change interventions.

Understanding eating behaviours in Spanish women enrolled in a weight‐loss treatment

To identify the beliefs and attitudes of a sample of obese and overweight Spanish women undertaking a weight-loss treatment. Obesity is a global epidemic. Weight-loss treatments focus on changing eating behaviours; however, many patients fail to adhere to the diet. This suggests that more effective behaviour-change interventions are required to help people change their eating behaviours. According to the theory of planned behaviour (TPB) human behaviour is influenced by beliefs. Identification of people's beliefs is an essential step in the design of behaviour-change interventions. A qualitative approach was employed using semi-structured interviews to interview participants. Seventeen obese and overweight Spanish women enrolled in a weight-loss treatment were recruited using a criterion sample strategy. Participants' reported beliefs referring to the benefits of losing weight and the emotions related to dieting. The more positive these beliefs were the more positive their attitude towards the diet seemed to be. Findings highlight the importance of follow-ups in creating a subjective norm to maintain a diet. Perceived behavioural control to diet seemed to be related to beliefs about social support; whereas beliefs about lack of willpower to overcome temptations seemed to decrease perceived control over eating behaviours. Participants reported several beliefs and attitudes that offer plausible explanations of their eating behaviours. Data from this study seemed to fit the propositions of the TPB and could be used in further research to develop effective eating behaviour-change interventions. Nurses could use the TPB to assess individuals' attitudes, beliefs and expectations when following a diet. That assessment would provide insight into what aspects are relevant for individual patients when dieting, which could lead to more effective diet behaviour-change interventions being designed.