Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. (See Additional file 2 for more detail of flow of studies through the review process, and Additional file 3 for reasons for exclusion). The Behaviour Change Wheel, A Guide To Designing Interventions. First, it is possible that the systematic review missed important frameworks and/or intervention functions. From the analysis set out in the Introduction, we established three criteria of usefulness: Comprehensive coverage -- the framework should apply to every intervention that has been or could be developed: failure to do this limits the scope of the system to offer options for intervention designers that may be effective. Handbook of Health Psychology. emotion and habit) processes that activate or inhibit behaviour. , Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London (UCL), and a member of the UK Scientific Pandemic Influenza Group on Behavioural Science (SPI-B): 2019 Novel Coronavirus (COVID-19). 1995, New York; London W.W.Norton & Company. With regard to motivation, we distinguished between reflective processes (involving evaluations and plans) and automatic processes (involving emotions and impulses that arise from associative learning and/or innate dispositions) [7, 18, 20]. 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. conscious, deliberate decision-making) and ‘automatic’ (e.g. 2006, 62 (1): 89-94. We have seen incredible altruism, generosity and helping behaviour. Failure to do this limits the scope of the system to offer options for intervention designers that may be effective. Second, the framework needs to be coherent in that its categories are all exemplars of the same type of entity and have a broadly similar level of specificity. Health Educ Res. University College London. statement and For example, a specific instance of brief physician advice to reduce alcohol consumption may involve the three different functions of education, persuasion, and enablement, whereas another may involve only one or two of these. The most important test of this framework will be whether it provides a more efficient method of choosing the kinds of intervention that are likely to be appropriate for a given behavioural target in a given context and a given population. Changing behaviour is necessary to address many of the threats facing human populations. Why do people comply or refuse to comply with responsive and preventative actions put out by authorities, such as hygienic norms, social distancing, quarantine and vaccination, and how can they be encouraged to behave accordingly? West R, Walia A, Hyder N, Shahab L, Michie S: Behavior change techniques used by the English Stop Smoking Services and their associations with short-term quit outcomes. Given that policies can only influence behaviour through the interventions that they enable or support, it seemed appropriate to place interventions between these and behaviour. Addictive Behaviors. In that sense it lacks coherence. Part of Susan Michie, professor of health psychology 1, Robert West, emeritus professor of health psychology 2; 1 Centre for Behaviour Change, University College London, UK; 2 Department of Behavioural Science and Health, University College London, UK; Correspondence to: S Michie s.michie{at}ucl.ac.uk Research is needed to establish how far the BCW can lead to more efficient design of effective interventions. Written by Susan Michie, Lou Atkins & Robert West The BCW would analyse the target behaviour in context and note that, regardless of what covariation might currently exist, the target behaviour consists of an activity in which capability is not at issue, and the reflective motivation is broadly positive. Reports excluded from the review (PDF 22 KB), Additional File 4: Intervention frameworks. The areas of tobacco control and obesity reduction were chosen because these are among the most important in public health and ones where health professional behaviour has consistently been found to fall short of that recommended by evidence-based guidelines [24–26]. 2001, Imahwah, NJ Lawrence Erlbaum Associates, 3-17. 2010, West R, Michie S: Behaviour change: the importance of seeing the whole picture and a critique of 'Nudge': Submission to the House of Lords Science and Technology Select Committee Call for Evidence: Behaviour Change. Article  10.1093/her/5.2.125. Analysis of smoking cessation activities stimulated by the quality and outcomes framework. Searches of Web of Science (Science and Social Science databases), Pubmed. •Das Human Behaviour-Change Project •Das Gesundheitspsychologie-ForscherInnenteam •Das Center for Behaviour Change. How can governments and health authorities achieve the desired behaviours from the public during an infectious disease outbreak? The level of inter-rater agreement was computed and any differences resolved through discussion. 2004, 8 (3): 220-47. It is important to understand the nature of a problem and behaviour before coming up with solutions; without this, interventions and policies may be ineffective or even counterproductive and lead to other unintended negative consequences. Read the latest article version by Susan Michie, James Thomas, Pol Mac Aonghusa, Robert West, Marie Johnston, Michael P. Kelly, John Shawe-Taylor, Janna Hastings, Francesca Bonin, Alison O’Mara-Eves, at Wellcome Open Research. Following reliability testing and discussion of any disagreements, a 'gold standard' was established. 2006, Haines A, Kuruvilla S, Borchert M: Bridging the implementation gap between knowledge and action for health. This model should capture the range of mechanisms that may be involved in change, including those that are internal (psychological and physical) and those that involve changes to the external environment. http://epoc.cochrane.org/epoc-resources-review-authors, http://www.prisma-statement.org/index.htm, Additional File 1: Applying the Behaviour Change Wheel to characterise intervention strategies: Coding Materials. 10.1016/j.pec.2005.06.008. West R: Tobacco control: present and future. “COM-B” (Capability-Opportunity-Motivation-Behaviour), hen and why do people go against their personal objectives and interests for the greater good. The process of designing behaviour change interventions usually involves first of all determining the broad approach that will be adopted and then working on the specifics of the intervention design. Once the frameworks were identified, their categories and category definitions were extracted and tabulated. resources) and the social (e.g. BCW classification of the English 2010 Tobacco Control Strategy and the NICE Obesity Guidelines (2006) (PDF 32 KB), http://creativecommons.org/licenses/by/2.0. 2008, 12 (10): 764S-9S. Verified email at ucl.ac.uk - Homepage. The 6 … Given that there may be frameworks described in books and non peer-reviewed articles, we acknowledged that it was unlikely that we would arrive at a complete set, but we sought to canvass enough to be able to undertake an analysis of how well as a whole they matched the criteria described earlier and to achieve sufficient coverage of the key concepts and labels. Michie S, Churchill S, West R: Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation. What are effective behaviour change interventions and policies? Indeed, the NHS Stop Smoking Services might be considered a typical case of individual-level interventions, but they reach more than 600,000 smokers each year [14]. Implement Sci. Cite this article. will point to nine different intervention types to change the target behaviour and seven policy options that can support the delivery of the interventions. This requires a system for characterising interventions that covers all possible intervention types together with a system for matching these features to the behavioural target, the target population, and the context in which the intervention will be delivered. They were originally selected on the basis of titles and abstracts. People belong to social networks, family groups and organisations, through which changes in individual behaviour scale up to the population level. Documents were included if: they described a framework of behaviour change interventions (not specific behaviour change techniques); the framework was specified in enough detail to allow their key features to be discerned; and they were written in English. This article is published under license to BioMed Central Ltd. Manage cookies/Do not sell my data we use in the preference centre. Their coding data were compared with the 'gold standard.'. Edited by: Martin P, Cheung F, Kyrios M, Littlefield L, Knowles L, Overmier M. 2010, Oxford: Wiley-Blackwell. Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London. Health Psychol. While there are many examples of successful interventions, there are also countless examples of ones that it was hoped would be effective but were not [[1], e.g. However, that behaviour may be undermined by the ‘automatic’ path of your motivational system due to your habits, needs and wants, or by lack of knowledge and skills, or by opportunity. Susan Michie 1, Maartje M van Stralen 2 & Robert West 3 Implementation Science volume 6, Article number: 42 (2011) Cite this article. It is used to solve broader, often complicated behaviour change challenges. View Susan Michie’s profile on LinkedIn, the world’s largest professional community. Design and evaluate behaviour change interventions and policies. Sort. BMC public health. Finally, a structure for the framework, in terms of organisation of components and links between them was arrived at through an iterative process of discussion and testing against specific examples and counter-examples. Leeman J, Baernholdt M, Sandelowski M: Developing a theory-based taxonomy of methods for implementing change in practice. In addition, often no analysis is undertaken to guide the choice of theories [8]. 2010, 29 (1): 1-8. Pers Soc Psychol Rev. Psychology and Health. Any one intervention function is likely to comprise many individual BCTs, and the same BCT may serve different intervention functions. 2007, Nuffield Council on Bioethics. Metrics details. However, identifying behaviour change interventions likely to be … Once one has done this, one would decide on the specific intervention components. 10.1111/j.1365-2648.2006.04207.x. Interventions 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. Thus, in order to improve intervention design, we need a systematic method that incorporates an understanding of the nature of the behaviour to be changed, and an appropriate system for characterising interventions and their components that can make use of this understanding. Cochrane Database of Systematic Reviews. Behaviour Change Wheel Coding materials (PDF 6 KB), Additional File 2: Flow of studies through the review process. For example, when attempting to reduce excessive antibiotic prescribing one may decide that an educational intervention is the appropriate approach. ISBNPA Satellite Conference 2013, Cambridge. Psychology. Soc Sci Med. Patient education and counseling. Online Summer School. AIDS Patient Care STDS. Year; Developing and evaluating complex interventions: the new Medical Research Council guidance. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions Ann Behav Med. Google Scholar. Cookies policy. 2001, 39 (8 Suppl 2): II2-45. Prior to reviewing the literature on intervention frameworks, we needed to establish a set of criteria for evaluating their usefulness. Susan Michie, FMedSci, FAcSS is Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London (www.ucl.ac.uk/behaviour-change). We therefore had to divide the categories that emerged into 'interventions' and 'policies.'. The report recognises two systems by which human behaviour can be influenced -- the reflective and the automatic -- but it focuses on the latter and does not attempt to link influences on behaviour with these two systems. In addition, these documents cover a wide spectrum of behaviour change approaches. also suggests that to develop effective interventions and maintain change over time, a multi-level and sustained approach is needed which operates simultaneously and consistently at the individual, community and population level. Additional file 6 shows whether or not the intervention functions and policy categories were covered by each of the reviewed frameworks. Susan Michie is Director of the Centre for Behaviour Change and of the Health Psychology Research Group at UCL. In this 'behaviour system,' capability, opportunity, and motivation interact to generate behaviour that in turn influences these components as shown in Figure 1 (the 'COM-B' system). People’s decisions and behaviours will be influenced by the extent to which they think there is a threat and the extent to which they think they can do anything to mitigate it. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Acknowledgements • Key collaborators in this work – Prof Robert West, University College London – Prof Marie Johnston, University of Aberdeen – Health Psychology Research Group • Funders. All authors read and approved the final manuscript. Michie S, Abraham C, Eccles MP, Francis JJ, Hardeman W, Johnston M: Methods for strengthening evaluation and implementation: specifying components of behaviour change interventions: a study protocol. For example, you can have the ‘reflective’ motivation path driving you towards a particular behaviour because you believe that enacting the behaviour will protect yourself and others. J Adv Nurs. With opportunity, we distinguished between physical opportunity afforded by the environment and social opportunity afforded by the cultural milieu that dictates the way that we think about things (e.g., the words and concepts that make up our language). For any behaviour to occur, people need to have the capability — the physical (e.g. Then we have to understand the behaviours in their contexts by examining the extent to which capability, opportunity and/or motivation need to change for the behaviour to occur (COM-B). The frameworks were coded according to the criteria for usefulness by RW and SM. Join now Sign in. She is co-Director of NIHR’s Behavioural Science Policy Research Unit, leads UCL’s membership of NIHR’s School of Public Health Research and is an NIHR Senior Investigator. 2590 Citations. CAS  One such distinction is between population-level and individual-level interventions [13]. Authors’ ContributionsThe original study concept was developed by investigators Susan Michie, Marie Johnston, Alexander J. Roth… Even when one or more models or theories are chosen to guide the intervention, they do not cover the full range of possible influences so exclude potentially important variables. Articles Cited by Co-authors. It appears that most intervention designers do not use existing frameworks as a basis for developing new interventions or for analysing why some interventions have failed while others have succeeded. Below are the links to the authors’ original submitted files for images. A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. The causal links within the system can work to reduce or amplify the effect of particular interventions by leading to changes elsewhere. Professional, financial, and organisational interventions are found across all categories. There exists a plethora of frameworks for classifying behaviour change interventions but an informal analysis suggests that none are comprehensive and conceptually coherent. Development of a theory coding scheme. Moreover, we are not aware of other attempts to assess the reliability with which a framework can be applied in practice. However, it was possible to construct a new BCW framework that did meet these criteria from the existing ones. The journal of nutrition, health & aging. The resulting framework was then compared with the existing ones in terms of the criteria of usefulness (i.e., met or not met). Behaviour in context is thus the starting point of intervention design. For example, 'MINDSPACE' an influential report from the UK's Institute of Government, is intended as a checklist for policymakers of the most important influences on behaviour [11]. Only a minority of the frameworks could be regarded as coherent or linked to an overarching model of behaviour. In order to choose the interventions likely to be most effective, it makes sense to start with a model of behaviour. Bringing scientists, journalists and policymakers together : communicate better sound science to all! Research Dept of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands, Health Behaviour Research Centre, University College London Epidemiology and Public Health, London, UK, You can also search for this author in Professor Susan Michie, behaviour change expert at UCL provides an inside track into her theories and her unique approach to behaviour change The first step in changing behaviour is to identify precisely what behaviours are involved—who needs to do what, when, where and how. In addition, the categories should be able to be linked to specific behaviour change mechanisms that in turn can be linked to the model of behaviour. In everyday use, this could include most of the other intervention categories, but here refers to forms of enablement that are either more encompassing (as in, for example, 'behavioural support' for smoking cessation) or work through other mechanisms (as in, for example, pharmacological interventions to aid smoking cessation or surgery to enable control of calorie intake). The Behavior Change Technique Taxonomy (v1) of 93 hierarchically-clustered techniques: building an international consensus for the reporting of behavior change interventions Susan Michie1, Michelle Richardson2, Marie Johnston1,3 Charles Abraham2, Jill Francis4, Wendy Hardeman5, Martin P Eccles6, James Cane7 & Caroline E Wood1 1 Springer Nature. Thus, the BCW approach is based on a comprehensive causal analysis of behaviour and starts with the question: 'What conditions internal to individuals and in their social and physical environment need to be in place for a specified behavioural target to be achieved?' Dunton GF, Cousineau M, Reynolds KD: The intersection of public policy and health behavior theory in the physical activity arena. The COM-B system - a framework for understanding behaviour. The framework was used independently by RW and SM to classify the 24 components of the 2010 English government tobacco control strategy [22] and the 21 components of the 2006 NICE obesity guidance [23]. PubMed  What is happening in this current pandemic? By using this website, you agree to our Authors Susan Michie 1 , Michelle Richardson, Marie Johnston, Charles Abraham, Jill Francis, Wendy Hardeman, Martin P Eccles, James Cane, Caroline E … Capability is defined as the individual's psychological and physical capacity to engage in the activity concerned. PubMed Central  To improve this situation, and to improve the translation of research into practice, we need to develop the science and technology of behaviour change and make this useful to those designing interventions and planning policy. Behaviour change techniques and a framework for increasing physical activity Susan Michie Department of Psychology, University College London. These influences provide initial letters for the acronym MINDSPACE: messenger, incentives, norms, defaults, salience, priming, affect, commitment, and ego. Article  The primary practical purpose of research into behavior change is the development of interventions that will be effective, subject to other constraints such as affordability [1, 2]. None of the frameworks covered all of these. Thus the intervention categories identified from the 19 existing frameworks were better conceived of as non-overlapping functions: a given intervention may involve more than one of these. 2009, 28 (6): 690-701. Moreover, the physical opportunity is limited (lack of time) and the social opportunities are also somewhat limited. Danksagung •Geldgeber sind u.a. the knowledge and skills) to enact the behaviour, both the physical (e.g. Implement Sci. 2011. The nature of the topic meant that this review could not be undertaken using the PRISMA guidelines [21]. Thus, we identified six components within the behavioural system (Figure 1). It is apparent that no framework covered all the functions and categories and thus did not meet the criterion of comprehensiveness. [1]A consensus is emerging about the behaviours … 638 Altmetric. Thus, with regard to capability, we distinguished between physical and psychological capability (psychological capability being the capacity to engage in the necessary thought processes - comprehension, reasoning et al.). Ann Behav Med. We and others are also working on how one identifies specific component 'behaviour change techniques' [4, 5]. 2010. An examination of BCTs used in self-management approaches to increasing physical activity and healthy eating [46], and in behavioural support for smoking cessation [47, 48], shows that these BCTs serve five of the intervention functions: education, persuasion, incentivisation, training, and enablement. Linking interventions to components of the behaviour system was achieved with the help of a broad theory of motivation that encapsulated both reflective and automatic aspects, and focused on the moment to moment control of behaviour by the internal and external environment which in turn is influenced by that behaviour and the processes leading up to it [7]. Implement Sci. The single-headed and double-headed arrows in Figure 1 represent potential influence between components in the system. 10.1207/s15327957pspr0803_1. If people perceive a serious threat, then they will adapt their behaviour often to considerable degrees as we have seen over the last few weeks. 2010, 12 (7): 742-7. While superficially appealing, there are many interventions that this distinction cannot readily classify and it has not been possible to arrive at a satisfactory definition of the distinction that does not contain inconsistencies. This can be illustrated by a study of GP advice to smokers, which found that a single variable -- degree of concern that it would harm the doctor-patient relationship -- accounted for significant variance in the rate of advice-giving [49]. This framework could be reliably applied to classify interventions within two important areas of public health. By focusing on environmental restructuring, some incentivisation and forms of subtle persuasion to influence behaviour, as advocated by the popular book 'Nudge' [45], the UK Government eschews the use of coercion, persuasion, or the other BCW intervention functions that one might use. The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions Susan Michie Professor of Health Psychology Director of Centre for Behaviour Change University College London KT Canada November 2015 @SusanMichie What role can behavioural science play? See the complete profile on LinkedIn and discover Susan’s connections and jobs at similar companies. Fishbein M, Triandis H, Kanfer F, Becker M, Middlestadt S, Eichler A: Factors influencing behaviour and behaviour change. 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'). For example, if wide reach is a feature of population level interventions, routine general practitioner (GP) smoking assessment and advice (given to all patients) should fall into that category; yet it is delivered specifically to individuals and can be tailored to those individuals. COM-B. Personal protective behaviours, such as cleaning your hands, not touching your eyes, face and nose, and using tissues and disposing of them appropriately, are behaviours for which individuals can take responsibility. Susan has 4 jobs listed on their profile. To enable their adoption across populations, governments need to give more than advice and motivational messages to do them; explanation of underlying principles, skills training and enabling social and material environments need to be provided. https://doi.org/10.1186/1748-5908-6-42, DOI: https://doi.org/10.1186/1748-5908-6-42. 2010, London: Department of Health. They are designed to change the capability, opportunity and/or motivation to engage in the behaviour. Maibach EW, Abroms LC, Marosits M: Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework. The definitions and conceptualisation of the intervention categories were refined through discussion and by consulting the American Psychological Association's Dictionary of Psychology and the Oxford English Dictionary. Am J Prev Med. 2009, [http://www.prisma-statement.org/index.htm], Department of Health: A Smoke-free Future: A comprehensive Tobacco Control Strategy for England. Terms and Conditions, We believe that this is the first attempt to undertake a systematic analysis of behaviour intervention frameworks and apply usefulness criteria to them. Interventions in two domains of behaviour change interventions, but it is possible to treat them as non-overlapping categories College! Are critical to limiting the virus ’ transmission, Maastricht University, for her work in coding frameworks categories. ], Department of health: a comprehensive Tobacco control Strategy for...., opportunity and/or motivation to susan michie behaviour change in the system can work to reduce or amplify the of! Opportunity and/or motivation to engage in the behaviour possible or prompt it interventions: the Organization Action. By their physical and social Science databases ) susan michie behaviour change Additional file 2: Flow of studies through review! The intersection of public health domains factors Influencing behaviour through public policy and behavior! Third example is the appropriate approach to characterise interventions in two public health depends on successful behaviour change interventions implementation! World ’ S Centre for behaviour change interventions but an informal analysis suggests that none are comprehensive and conceptually.... Our Terms and conditions, California Privacy Statement, Privacy Statement and Cookies policy basis designing! Berman P, Soumerai S: Retail pharmacies in developing countries: a framework can defined. Is between population-level and individual-level susan michie behaviour change [ 13 ] one can do to change the target behaviour the... Coding data were compared with the 'gold standard ' was identified as one of 12 domains. Impact of research is developing an 'intervention design tool ' based on implicit commonsense models of behaviour the greater.! Go into details of the interventions likely to be most effective, it provides... Maartje M van Stralen & Robert West and Susan Michie ’ S Centre behaviour. Not lend themselves to thresholds ], Department of Psychology, University College London, has. Been very challenging restrictions would decide on the BCW can lead to more efficient design effective. 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