Effective Behaviour Change Interventions Research Articles

Towards more effective behavioural energy policy: An integrative modelling approach to residential energy consumption in Europe

Energy behaviours represent an important underexploited resource in the context of promoting end-use energy efficiency, namely in the residential sector. However, addressing the multidimensional nature of energy behaviours is a complex task and more effective behaviour change interventions and policies grounded on comprehensive approaches are required. An integrative intervention to explore the influence of usage energy behaviours on energy consumption was developed through an innovative combination of modelling techniques. A real-world case study was utilised to generate contextualised understanding. This intervention supported problem structuring methods as pertinent tools to be utilised in complex human-centred energy research, such as energy behaviours, by enabling the development of tailored methodologies which minimise the human bias. It further confirmed real-world behaviour change interventions should involve the different energy stakeholders and be designed to be flexible and adaptive. Results confirmed variables associated with different dimensions significantly impact energy consumption. In this case study the promotion of residential energy efficiency includes both structural and energy behavioural actions, namely a better insulation of the dwellings and encouraging specific usage energy behaviours. These results support the need to consider an integrative perspective when addressing energy behaviours and designing effective behavioural change interventions and energy efficiency policies.

Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis

Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis

Using the theory of planned behavior to identify key beliefs underlying pro-environmental behavior in high-school students: Implications for educational interventions

This study relied on the theory of planned behavior (TPB) to identify the beliefs that influence young people's pro-environmental behavior. High-school students completed a questionnaire regarding the performance of pro-environmental behaviors early in the school year and reported on their behavior toward the end of the year. In addition to the standard TPB constructs, the initial questionnaire assessed descriptive norms, moral norms, sex, and empathic concern. Results revealed an excellent fit for the standard TPB model; attitudes, descriptive subjective norms, and perceptions of control made independent contributions to the prediction of intentions, and intentions together with perceived control predicted behavior. Behavioral, normative, and control beliefs predicted, respectively, attitudes, subjective norms, and perceived behavioral control. Empathic concern influenced intentions and behavior indirectly by its effects on behavioral, normative, and control beliefs. Examination of the effects of specific beliefs revealed important implications for designing effective behavior-change interventions.

Salt reduction: Moving from consumer awareness to action

Globally, the average daily dietary salt intake is more than double the recommended level. Given the major role that salt plays in the development of cardiovascular disease, it is important to reduce total salt intake. Key sources of salt in the diet include commercially prepared or manufactured food products and discretionary salt added by consumers during cooking and consumption. Therefore a significant lowering in the current salt intake requires a shift in both commercial foods and consumer behaviour. In terms of commercial foods, the challenge is to achieve further reductions in the salt content while maintaining good taste, stability and texture to ensure consumers will like (or even prefer) these reformulated products. However, a change in consumer behaviour is also required to ensure that lower salt products are accepted and that consumers do not add salt back during cooking. Consumer behaviour change in this area remains complex and has received relatively little attention so far. It is hard for consumers to estimate their salt intake and, while most campaigns focus on raising awareness of reducing salt, this awareness may not always lead to action. The development of scalable and effective salt-reduction behaviour change interventions requires a more in-depth understanding of the relevant consumer behaviours and their determinants, as well as the development of practical behaviour change techniques and facilitators (e.g., provision of appealing lower salt products). Moreover, to speed up the salt reduction progress from ‘awareness’ to ‘action’, key stakeholders need to take responsibility and agree on actions for executing product reformulation and creating consumer behaviour change programmes. This review is intended to inform and support the ongoing development of effective action-oriented global strategies for salt reduction.

Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices

Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. To identify behaviours of HCWs that facilitated non-compliance with IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices. Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation.

Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): A randomized controlled trial of a six month pedometer program with financial incentives

Non-communicable diseases (NCDs) are emerging as the predominant global health challenge of this century. Physical inactivity is one of the primary risk factors for NCDs. Therefore, increasing physical activity levels is a public health imperative. The arrival of affordable wearable technologies, such as wireless pedometers, provides one strategy for encouraging walking. However, the effectiveness of these technologies in promoting sustained behavior change has not been established. Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions, including physical activity interventions that rely on wearable technologies. The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives (cash or donations to charity) for reaching weekly physical activity goals. We present here the design and baseline characteristics of participants of this four arm randomized controlled trial. 800 full-time employees (desk-bound office workers) belonging to 15 different worksites (on average, 53 (sd: 37) employees at each worksite) were successfully randomized to one of four study arms. If shown to be effective, wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents.

…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).

Personalising nutritional guidance for more effective behaviour change.

Improving diet and other lifestyle behaviours has considerable potential for reducing the global burden of non-communicable diseases, promoting better health across the life-course and increasing wellbeing. However, realising this potential will require the development, testing and implementation of much more effective behaviour change interventions than are used conventionally. Evidence-based, personalised (or stratified) interventions which incorporate effective behaviour change techniques (BCT) and which are delivered digitally are likely to be an important route to scalable and sustainable interventions. Progress in developing such interventions will depend on the outcomes of research on: (i) the best bases for personalisation of dietary advice; (ii) identification of BCT which are proven to enhance intervention efficacy; (iii) suitable platforms (digital-based tools) for collection of relevant participant characteristics (e.g. socioeconomic information, current diet and lifestyle and dietary preferences) linked with intelligent systems which use those characteristics to offer tailored feedback and advice in a cost-effective and acceptable manner. Future research should focus on such interventions aiming to reduce health inequalities and to improve overall public health.

Design and baseline characteristics of the Food4Me study: a web-based randomised controlled trial of personalised nutrition in seven European countries.

Improving lifestyle behaviours has considerable potential for reducing the global burden of non-communicable diseases, promoting better health across the life-course and increasing well-being. However, realising this potential will require the development, testing and implementation of much more effective behaviour change interventions than are used conventionally. Therefore, the aim of this study was to conduct a multi-centre, web-based, proof-of-principle study of personalised nutrition (PN) to determine whether providing more personalised dietary advice leads to greater improvements in eating patterns and health outcomes compared to conventional population-based advice. A total of 5,562 volunteers were screened across seven European countries; the first 1,607 participants who fulfilled the inclusion criteria were recruited into the trial. Participants were randomly assigned to one of the following intervention groups for a 6-month period: Level 0-control group-receiving conventional, non-PN advice; Level 1-receiving PN advice based on dietary intake data alone; Level 2-receiving PN advice based on dietary intake and phenotypic data; and Level 3-receiving PN advice based on dietary intake, phenotypic and genotypic data. A total of 1,607 participants had a mean age of 39.8years (ranging from 18 to 79years). Of these participants, 60.9% were women and 96.7% were from white-European background. The mean BMI for all randomised participants was 25.5kgm(-2), and 44.8% of the participants had a BMI≥25.0kgm(-2). Food4Me is the first large multi-centre RCT of web-based PN. The main outcomes from the Food4Me study will be submitted for publication during 2015.

Psychosocial mediators of physical activity and fruit and vegetable consumption in the Faith, Activity, and Nutrition programme.

Performing and publishing mediator analyses, whether significant or null, provides insight into where research efforts should focus and will assist in developing effective and powerful behaviour change interventions. The present study examined whether self-efficacy, social support and church support mediated changes in leisure-time physical activity (PA) and fruit and vegetable (F&V) consumption in a faith-based intervention. A 15-month PA and F&V intervention, guided by the structural ecological model, targeted the social, cultural and policy influences within the church. Outcomes and mediators were measured at baseline and follow-up. Data were collected from 2007 to 2011. MacKinnon's product of coefficients tested for mediation. Sixty-eight African Methodist Episcopal churches in South Carolina, USA. Five hundred and eighty-two (PA) and 588 (F&V) church members. Despite the significant increases in PA and F&V consumption, none of the hypothesized mediators were significant mediators of change in PA or F&V consumption. When examining each path of the mediation model, the intervention did not change any of the hypothesized mediators. However, changes in some mediators were associated with changes in outcomes. Although there was no significant mediation, the association between changes in mediators and changes in PA and/or F&V consumption suggest that these variables likely play some role in changing these behaviours. Future studies should consider mediation analyses a priori, putting careful thought into the types of measures used and the timing of those measures, while also being cognizant of participant and staff burden. Finding a balance will be fundamental in successfully understanding how interventions exert their effects.

Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviours? A systematic review and meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis examining the effectiveness of behavioural interventions targeting diet, physical activity or smoking in low-income adults.DesignSystematic review with random effects meta-analyses. Studies before 2006...

Sociodemographic, behavioural and health factors associated with changes in older adults' TV viewing over 2 years.

BackgroundOf all age groups, older adults spend the most time watching TV, which is one of the most common sedentary behaviours. Such sedentary activity in older adulthood is thought to risk deterioration of physical and mental functioning, health and wellbeing. Identifying the characteristics of older adults whose TV viewing increases over time may help to target sedentary behaviour reduction interventions to those in most urgent need. Yet, studies of the factors associated with TV viewing have predominantly been cross-sectional. This study used a prospective design to describe changes in TV viewing over a two-year follow-up period, and to model socio-demographic, behavioural and health factors associated with observed changes in viewing time.MethodsA two-year follow-up of 6,090 male and female older adults (mean age 64.9 ± 8.9 years) was conducted in the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. TV viewing time was self-reported at baseline and at follow-up. The sample was categorised according to baseline TV viewing duration (<2 hrs/d, 2 < 4 hrs/d, 4 < 6 hrs/d, ≥6 hrs/d), and the observed direction and extent of changes in viewing duration were described for each category. Socio-demographic, behavioural and health variables (socioeconomic status, depressive symptoms, disability, chronic illness, body mass index, physical activity, smoking), as measured at baseline, were entered into regression models as predictors of changes in TV viewing time between baseline and follow-up.ResultsMean self-reported TV viewing time increased from 5.32 ± 4.08 hrs/d at baseline to 5.53 ± 4.19 hrs/d at follow-up (p < 0.001). Forty-nine per cent of participants increased their TV viewing (23% of all participants by 60 minutes or more), 41% decreased their viewing, and 10% reported no change in viewing duration. Increases in TV viewing at follow-up were associated with lower socioeconomic status, presence of depressive symptoms, higher BMI, physical inactivity, and being a smoker at baseline.ConclusionsFindings call for the development of effective behaviour change interventions to counter increases in inactive TV viewing among older adults, and point to subgroups who may need to be prioritised for such interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0102-3) contains supplementary material, which is available to authorized users.

The development of effective behaviour change interventions to support the use of malaria rapid diagnostic tests by Tanzanian clinicians.

BackgroundParasitological confirmation is now recommended for all cases of suspected malaria. The roll-out of rapid diagnostic tests (RDTs) is hoped to enable this goal in low resource settings through point of care testing. However, simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians, with malaria continuing to be overdiagnosed in many settings. We undertook to design an evidence-based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania, to be evaluated through the Targeting Artemisinin Combination Therapy (TACT) cluster randomised controlled trial.MethodsWe describe five steps in our intervention design: formative research, review of existing evidence and theory, a workshop to define the intervention approach and content and results of formative research, engagement with behaviour change theory and literature, detailed design of intervention materials and piloting and pretesting of intervention materials. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania.ResultsThe formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction, but that health workers used various techniques to resolve this, including provision of antimalarial drugs for RDT-negative patients. Our reviews showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice. Our design process is presented, drawing from this collective evidence. We describe the final TACT intervention package (including interactive small group workshops, feedback text messages, motivational text messages and patient information leaflets and posters) in terms of its programme theory and implementation theory.ConclusionsOur study suggests that evidence-based design of complex interventions is possible. The use of formative research to understand malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test materials and methods prior to implementation. The TACT interventions may be appropriate for other settings where clinicians face similar challenges with malaria diagnostics.Trial registrationNCT01292707.

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.

Behaviour change interventions to promote prescribing of generic drugs: a rapid evidence synthesis and systematic review

ObjectiveTo summarise evidence on the effectiveness of behaviour change interventions to encourage prescribing of generic forms of prescription drugs where clinically appropriate in the UK National Health Service (NHS) and...

Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies.

Several theories construe risk appraisals as key determinants of decisions and actions, and this idea has been supported in correlational studies. However, correlational data cannot answer the question, "Does heightening risk appraisals change people's intentions and behavior?" The present review meta-analyzed experimental evidence in order to address this issue. We identified 4 elements of risk appraisal-risk perception, anticipatory emotion, anticipated emotion, and perceived severity-and located experiments that (a) engendered a statistically significant increase in risk appraisal among treatment compared to control participants and (b) measured subsequent intention or behavior. Heightening risk appraisals had effects of d+ = .31 (k = 217) and d+ = .23 (k = 93) on intention and behavior, respectively. There was evidence that the elements of risk appraisal combined to influence outcomes. For instance, heightening risk perceptions had larger effects on outcomes when anticipatory emotions or perceived severity was also increased. Crucially, risk appraisal effects were augmented by coping appraisals: Risk appraisals had larger effects on outcomes when response efficacy and self-efficacy were enhanced or when response costs were reduced. The largest effect sizes were observed when risk appraisals, response efficacy, and self-efficacy were simultaneously heightened (d+ = .98 and .45, for intention and behavior, respectively). These findings indicate that heightening risk appraisals changes intentions and behavior. However, the direct effects of risk appraisals were generally small. Exploiting synergies among the elements of risk appraisal, and between risk appraisals and coping appraisals, should make for more effective behavior change interventions.

Supporting effective lifestyle behaviour change interventions

Improving the health of the population, and morbidity and mortality associated with non-communicable diseases, is a national priority. Health education and promotion should focus on avoiding harmful behaviours such as excessive alcohol intake, smoking and poor diet. It is argued that each patient contact should involve health promotion and that healthcare professionals should be encouraged to discuss and support effective lifestyle behaviour change interventions.

The potential for energy reduction in UK commercial offices through effective management and behaviour change

General office equipment can be responsible for a significant proportion of overall electrical energy consumption in UK offices and this is predicted to rise significantly over the coming years [Webber, C. A., Roberson, J. A., Brown, R. E., Payne, C. T., Nordman, B., & Koomey, J. G. (2001). Field surveys of office equipment operating patterns. Berkley: CA: Lawrence Berkley National Laboratory]. As a significant contributor to overall energy use, this equipment has a corresponding cost and carbon impact. The legally binding requirements of the climate change act [Department of Energy and Climate Change. (2008). The climate change act. London: The Ministry of Justice] present a need to address the impact of office equipment, especially within the less-efficient existing building stock. In this study the range of energy consumption patterns observed across workstations in two typical UK, air-conditioned office spaces covering 90 desks and the potential effect of using feedback to encourage energy reduction through behaviour change are explored. The project monitored energy consumption over a four-month baseline period. Taking into account technical, behavioural and environmental influences this baseline established that a significant variation in consumption patterns exists between workstations providing the same function, in comparable locations and over the same period of time. Following the establishment of the baseline data further monitoring took place to assess the effect of behaviour change interventions through the provision of comparative feedback. The core driver behind the variation in consumption identified was found to be occupant behaviour over technical and environmental considerations. The study establishes that it is possible to reduce energy use, carbon emissions and cost associated with desk-level electricity consumption by up to 20% through behaviour change in typical UK office spaces. Further savings are possible through energy management and procurement policy, but behaviour change offers significant initial reductions for limited investment.

Behavior change in a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention content

BackgroundDespite the favorable effects of behavior change interventions on diabetes risk, lifestyle modification is a complicated process. In this study we therefore investigated opportunities for refining a lifestyle intervention for type 2 diabetes prevention, based on participant perceptions of behavior change progress.MethodsA 30 month intervention was performed in Dutch primary care among high-risk individuals (FINDRISC-score ≥ 13) and was compared to usual care. Participant perceptions of behavior change progress for losing weight, dietary modification, and increasing physical activity were assessed after18 months with questionnaires. Based on the response, participants were categorized as ‘planners’, ‘initiators’ or ‘achievers’ and frequencies were evaluated in both study groups. Furthermore, participants reported on barriers for lifestyle change.ResultsIn both groups, around 80% of all participants (intervention: N = 370; usual care: N = 322) planned change. Except for reducing fat intake (p = 0.08), the number of initiators was significantly higher in the intervention group than in usual care. The percentage of achievers was high for the dietary and exercise objectives (intervention: 81–95%; usual care: 83–93%), but was lower for losing weight (intervention: 67%; usual care: 62%). Important motivational barriers were ‘I already meet the standards’ and ‘I’m satisfied with my current behavior’. Temptation to snack, product taste and lack of time were important volitional barriers.ConclusionsThe results suggest that the intervention supports participants to bridge the gap between motivation and action. Several opportunities for intervention refinement are however revealed, including more stringent criteria for participant inclusion, tools for (self)-monitoring of health, emphasis on the ‘small-step-approach’, and more attention for stimulus control.Trial registrationNetherlands Trial Register: NTR1082

Changing eating behaviour: What can we learn from behavioural science?

SummaryDesigning effective behaviour change interventions is key to promoting healthy eating. This paper takes a theoretical perspective to consider why people do not behave in ways that promote health and summarises evidence‐based principles and strategies for behaviour change. We present a theoretically driven, comprehensive method for intervention design using several tools recently developed in behavioural science.