Diese Präsentation wurde erfolgreich gemeldet.
Die SlideShare-Präsentation wird heruntergeladen. ×

The application of behavioural science to public health adhp webinar fin...

Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Wird geladen in …3
×

Hier ansehen

1 von 44 Anzeige

The application of behavioural science to public health adhp webinar fin...

This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).

This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).

Anzeige
Anzeige

Weitere Verwandte Inhalte

Diashows für Sie (20)

Ähnlich wie The application of behavioural science to public health adhp webinar fin... (20)

Anzeige

Weitere von Professor Jim McManus AFBPsS,FFPH,CSci, FRSB, CPsychol (20)

Aktuellste (20)

Anzeige

The application of behavioural science to public health adhp webinar fin...

  1. 1. The Application of Behavioural Science to Public Health ADPH Webinar Prof Jim McManus Hertfordshire County Council Dr Angel Chater University of Bedfordshire Dr Tim Chadborn PHE Behavioural Insights Team Dr Amanda Bunten PHE Behavioural Insights Team Michelle Constable Hertfordshire County Council
  2. 2. Objectives Gain an overview of behavioural science. Understand relevance and applicability of behavioural science in public health. Gain awareness of the Behavioural Science Strategy development and relevance to ADsPH. 2
  3. 3. Timings Time Description Presenter 11.00 Introductions and welcome Prof Jim McManus 11.05 Setting the scene Dr Tim Chadborn 11.10 Current directions in behaviour change theory Dr Angel Chater 11.20 Examples of the application of behavioural science Dr Amanda Bunten 11.30 Embedding behavioural science in Public Health Michelle Constable 11.40 Overview of the Behavioural and Social Science Strategy Dr Tim Chadborn 11.45 Respond to questions submitted All 12.00 Close Prof Jim McManus 3
  4. 4. What are the facilitators and barriers to the uptake of weight management services? How can we design the built/ lived environment to influence health-related behaviours? Typical questions from policy teams What are the drivers of the provision of brief advice to patients by healthcare professionals? 4
  5. 5.  Draws on insights from psychological research; primarily behavioural economics and health psychology  Can be applied at the individual, professional, community or population level  Used upstream and downstream in prevention and treatment  Central role of robust evaluation to demonstrate effectiveness  Small changes can have widespread impact  Previous behaviour is best predictor of future behaviour – not intentions or beliefs Behavioural Science 5
  6. 6. 6 Behavioural ‘Definitions’ Behaviour is anything a person does in response to internal or external events. (Hobbs, Campbell, Hildon & Michie, 2011) Behaviour should be differentiated from its determinants (self-efficacy, emotion) and its outcomes (quality of life, cholesterol level).
  7. 7. Traditional Theories of Behaviour • The Health Belief Model – Becker (1974) Importance of beliefs, perceived benefits & barriers to action, self-efficacy, stimulus/ cue to action. Limitations: focused on conscious decision making and ignores habits. • Social Learning Theory, Social Cognitive Theory – Bandura (1977) Importance of social environment, modelling and self efficacy Limitations: emphasis on conscious decision making and reflective processes • Theory of Reasoned Action / Theory of Planned Behaviour – Ajzen (1985) Limitation: assume people act in a rational way at all times, not all behaviour is planned. • Stages of Change Model / Transtheoretical Model – Prochaska and DiClemente (1997) Limitation: assumes behaviour change occurs in a linear fashion, progression through a series of stages. Limitations: • Effectiveness of predicting behaviour change • Intention-behaviour gap • Not addressing automatic motivation, habits and impulsive behaviour. Public Health England - Behavioural Insights MasterclassPublic Health England - Behavioural Insights Masterclass7
  8. 8. “..this review suggests that intentional control of behaviour is a great deal more limited than previous meta- analyses of correlational studies have indicated” Changing Behaviours: The limitations of changing minds “Changing behaviour by changing minds is unscaleable, increases inequalities, not very effective” (Professor Theresa Marteau) (Slide adapted from one by Theresa Marteau)8
  9. 9. Resist Environments Change Environments Change minds to… (Slide adapted from one by Theresa Marteau) Before After Changing behaviours: Two (not mutually exclusive) approaches 9
  10. 10. Two interacting systems Dual Process Theory Reflective Slow Effortful Self-aware Complete a tax form 17 x 24 Automatic Fast Effortless Unconscious Driving on an empty road 2 + 2 Kahneman, D. (2011). Thinking, fast and slow. Macmillan. 10
  11. 11. Health Psychology
  12. 12. Health Psychology and Behaviour Change • The science of human behaviour and experience • Aims to: • Promote and maintain health • Enhance the well-being of those affected by illness • Improve the health care system and support health policy formation • Understanding how people think, feel and learn can help us understand and predict how they will act If we can UNDERSTAND human behaviour, it gives us insight into how to CHANGE human behaviour At the heart of behaviour [change] is the person… Bio-Psycho-Social Model (Engel,1977,1980) Strength of Health Psychology lies in the application of theoretically- driven, evidence-based science Behavioural Science 12
  13. 13. Importance of Theory • Key questions to ask when developing interventions (individual, community or population based levels): 1. What things should be considered when trying to understand and change behaviour? • What bio-psycho-social factors might be important? 2. What factors might influence uptake/engagement? • What barriers/ facilitators might influence behaviour? • Must move away from ‘common sense’ models of behaviour change and draw on theory Imagine you wanted to change physical activity behaviour in an obese population to reduce diabetes and CVD risk… What would you need to consider?? Hold that thought… 13
  14. 14. Now imagine a population of Homer Simpsons! Theory: COM-B Capability Motivation Opportunity Behaviour Problem = Obesity Target behaviour = Physical Activity (Michie et al., 2011) 14
  15. 15. Behaviour Capability Psychological capability Physical capability Motivation Reflective motivation Automatic motivation Opportunity Social opportunity Physical opportunity Amore holistic model of behaviour change – COM-B  Capability, motivation and opportunity all need to be present for a behaviour to occur  They all interact as part of a system  Motivation must be stronger towards the target behaviour than competing behaviours (Michie et al., 2011) 15
  16. 16. COM-B model components Definition Psychological capability Knowledge, psychological skills (such as planning, attention, strength and stamina) to engage in the necessary mental processes (interpersonal skills, memory, attention, decision processes). Physical capability Physical skills, strength or stamina Reflective motivation Active thought processes – attitudes and beliefs about what is good or bad, the costs and benefits of doing something, beliefs about consequences, goals, plans, and intentions. Automatic motivation Less conscious thoughts processes that drive behaviour - emotional reactions, desires (wants and needs), impulses, drive states, habits, reinforcement, associative learning and reflex responses. Social opportunity Opportunity afforded by the social environment, social cues and cultural norms, social acceptability and expectations. Physical opportunity Opportunity afforded by the environment involving time, resources, locations, cues. 16 (Michie et al., 2011)
  17. 17. Behavioural Economics
  18. 18. Standard Economic Theory • Consistently rational (not emotional) • Self-interested (not altruistic) • Utility maximisers (the greatest amount of value possible for the budget) • Takes the optimal route to achieve goals • Subject to biases • Subject to irrationalities • Use heuristics (shortcuts) to make decisions • Context and time dependent (inconsistent) • Emotional ‘Homo-economicus’ In reality Behavioural Economics 18
  19. 19. 19 Heuristics Mental shortcuts or rules of thumb to aid in problem solving Cognitive Biases Systematic thinking errors that affect decisions and judgement Anchoring Availability Loss Aversion Status Quo
  20. 20. How can Behavioural Science be Utilised?
  21. 21. 21 Defaults We tend to ‘go with the flow’ of a pre-set option Salience Our attention is draw to what is novel and appears relevant to us Substitution Easier to substitute a behaviour than eliminate an entrenched one We are expecting you at St Barts Hospital on Sep 26 at 2.30. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange.
  22. 22. What can it do for you?  Help to achieve local and national public health outcomes  Provide theoretically-driven, evidence-based programmes  Provide low cost ways of enhancing existing systems or processes  Improve the effectiveness of delivery and outcomes of training  Provide rigorous, scientifically led evaluations 22
  23. 23. Analyse Advise Design Trial Train  Behavioural Analysis  Policy  Interventions  RCTs  Masterclasses  Literature review  Systematic review  Programmes  Communication  Mode of delivery  Programmes  Quasi- experimental studies  Evaluation  Qualitative research  Workshops  Seminars How can Behavioural Experts help? Translation of evidence into practice
  24. 24. Building the Evidence
  25. 25. Health Checks Increasing uptake of NHS Health Checks Health issue: Diabetes, CVD (heart attack and stroke), Kidney Disease and Dementia Behavioural target: Increasing uptake of NHS Health Checks Method: Altering the standard invitation letter and sending SMS messages 25
  26. 26. Control Treatment DH led trial NHS Health Check You will receive a letter about your NHS Health Check. Your NHS Health Check is due tomorrow at 13.30. vs. + Primer Reminder 26
  27. 27. NHS Health Check: Results 18% 30% 0% 5% 10% 15% 20% 25% 30% 35% 40% Standard letter and no texts Revised letter and primer and prompt messages Percentage uptake of NHS Health Checks All reported results are statistically significant at p< 0.05 level.27
  28. 28. Antimicrobial Resistance Reducing inappropriate antibiotic prescribing Health issue: Antimicrobial resistance Behavioural target: Reducing inappropriate prescription of antibiotics in primary care Method: Letter sent to the top 20% GP prescribers 28
  29. 29. AMR 29 “The great majority (80%) of practices in INSERT NHS AREA prescribe fewer antibiotics per head than yours.”
  30. 30. 30 Reduction of 3·3% in top 20% - equates to 0.83% across all GPs Estimated 73,406 fewer antibiotic items dispensed Cost of £4,335 - saving £92,356 in just prescription costs Quality Premium allocated up to £23m to reduce prescriptions by 1% 2014 2015 Letter reduced prescriptions Letter Letter reduced prescriptions in control group Rateofantibioticsdispensedper1,000weightedpopulationforstudyperiod,with95%CI AMR: Results Hallsworth, M., Chadborn, T., Sallis, A., Sanders, M., Berry, D., Greaves, F., Clements, L. and Davies, S.C., 2016. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. The Lancet, 387(10029), pp.1743-1752
  31. 31. Food Environment Encouraging Healthy Food and Drink Purchasing Health issue: High rates of obesity Behavioural target: Make the Healthy choice the Easy Choice Method: Product placement and pricing promotions on sales of food and drink within 3 NHS food environments 31
  32. 32. Three studies of choice architecture 32 Sales of water by 22 bottles a day Proportion of total water sales by 12% 23% in confectionary sales 63% in water and 67% in fruit sales No effect on crisps 12% Approx reduction of 14 kcals per drink
  33. 33. Embedding Behavioural Science in Public Health
  34. 34. NICE Guidance Public Health commissioning - lifestyle factors NICE Guidance PH6, PH49 and LGB7 o Develop a local behaviour change policy and strategy o Commission interventions at population, community, and individual levels o Embed behaviour change all programmes from initial planning to evaluation 34
  35. 35. National Developments Health Psychology in Public Health Network o Network launched in 2014 to build on the synergy between health psychology and public health agendas.  Behavioural Sciences Strategy for Public Health o Strategy for all public health organisations being developed by a range of partners: ADPH, PHE, HPPHN, FPH, LGA, BPS  Campaign for Social Sciences – The Health of People o Launched in 2017 - How the social sciences can improve population health 35
  36. 36. Local Opportunities Explore shared agendas Different approaches to embedding behaviour change in England oJointly funded posts – Warwickshire oEmploy a behaviour change specialist – Herts, Solihull oFund a PhD oInterns, MSc & PhD training placements, secondments oDiscrete pieces of research for MSc or Doctoral students oCommission research, consultancy, training oJoint funding bids oAcademic evaluations 36
  37. 37. Interventions and Collaborations 37 Hertfordshire – Active Herts  Joint Sport England funding bid – PH, CCGs, Herts Sports Partnership  Systematic review (Howlett et al. 2016)  Evidence based intervention developed  Behaviour Change training for those delivering interventions  Academic evaluation of behaviour change constructs, level of activity, wellbeing and fidelity
  38. 38. Interventions and Collaborations cont. 38 Hertfordshire Health Improvement Service  Stop Smoking Service delivering weight management intervention  Health Psychologist input: o Development of service spec. and evaluation of bids ensure behaviour change embedded in intervention o Developing training plan including behaviour change (Dixon & Johnston 2011) o Comprehensive evaluation framework
  39. 39. ABehavioural and Social Sciences Strategy
  40. 40. 40 Proposal • develop a framework strategy for maximising the contribution of behavioural science to the protection and improvement of the public’s health and wellbeing in England; • with a particular focus on enhancing the effectiveness of public health interventions and reducing health inequalities through better application of behavioural science.
  41. 41. 41 Toward a behavioural sciences strategy for public health and wellbeing in England A prospectus for conversation and development February 2017 Conversation Event – Fri 17th March 2017
  42. 42. 42 Potential objectives 1. Enhanced pre-service curricula 2. Strengthened in-service training 3. Guidance on approaches and frameworks 4. Inclusion in governance processes 5. Improving access to evidence 6. Capacity through networks and procurement 7. Community of evidence and practice 8. Advise on research priorities
  43. 43. Questions and Next Steps
  44. 44. Further learning opportunities Health Psychology in Public Health Network: http://www.hpphn.org.uk Online training http://www.bct-taxonomy.com/ Teaching, training & events http://www.ucl.ac.uk/behaviour-change Public Health England’s Behavioural Insights Masterclasses: Tim.Chadborn@phe.gov.uk Behavioural Economics Seminars at the London School of Economics http://www.lse.ac.uk/LSEHealthAndSocialCare/events/BehavioralEconomicsSeminars.aspx Behavioural Economics Events http://be-events.org/ Campaign for Social Sciences: YouTube: The Health of People: Part 2 Recommended Reading Chater, A. & Cook, E. (2014). Health Psychology. London: Pearson. (Chapter 3, Intervention Design: Changing Health Behaviour.) Kahneman, D. (2011). Thinking, fast and slow. Macmillan.

×