Implementation and Health Through Behaviour Change

Lead Research Organisation: MRC Health Services Resrch Collaboration

Abstract

Achieving high quality health care and improving public health depends on ensuring that practice is based on the best possible evidence. This often requires health professionals to adopt new practices and change their behaviour. This may not be easy, especially if habits have developed. Interventions to help people adopt new practices have had only modest success, and are rarely informed by the science of how to change behaviour. This research programme is developing novel ways of applying theories and techniques of behaviour change to improve professional practice in line with best evidence. Four studies are currently being conducted.||To develop effective interventions to change professional practice, it is necessary to combine the results of many studies. Systematic reviews of evidence often do not use behavioural theories to understand and categorise interventions. This means that these reviews are not as useful as they could do. We are using a theory of behaviour change to describe and categorise the interventions in a published review of Audit and Feedback.|Translating research findings into practice requires making recommendations on the basis of evidence. National guidelines for clinical and public health practice are produced by the National Institute of Clinical Health and Excellence (NICE). In collaboration with NICE, we are studying the decision-making of teams that develop guidelines and practice recommendations. We are audiotape-recording the meetings of three Guideline Development Groups, and interviewing their members. By understanding the processes used, we aim to make recommendations to improve their practice.|Our third study investigates a range of theories relevant to behaviour change e.g. from psychology, sociology, anthropology and organisational development. We are reviewing literature and convening a workshop of experts to inform the development of a theory-based intervention to improve public health. This will lead to web-based guidance for public health researchers on how to design theory-based interventions.|To develop more effective interventions to change professional practice or behaviour to improve health, we need to understand how individuals change when they take part in interventions. We are applying single-case designs to evaluate the technique of self-monitoring. Although this method and technique have been successfully used to assess interventions designed to change psychological states such as mood, stress and pain, and abnormal behaviours, they have been used infrequently to assess interventions designed to change key behaviours that cause ill-health.|

Technical Summary

Achieving high quality health care and improving public health depends on translating evidence into practice. This, in turn, depends on health professionals and others changing their behaviour. One reason that interventions to improve public health and the implementation of evidence-based practice have had only modest effects is that they have not drawn on behavioural science. This research programme is developing novel ways of applying theories and techniques of behaviour change to understand and improve implementation. Four currently funded studies investigate evidence synthesis, translation of evidence into recommendations, application of theory to developing complex interventions, and of n-of-1 methodology to evaluating complex interventions.||Evidence synthesis: Systematic reviews of interventions to improve implementation seldom categorise interventions on the basis of relevant theory, and seldom produce a clear pattern of results. We are using a novel approach to synthesising evidence from a Cochrane review of Audit and Feedback, re-categorising the interventions used in the primary studies on the basis of self-regulation theory. |Evidence translation: Translating research findings into practice requires three stages: evidence synthesis, guideline development and implementation. The second stage, the translation of evidence into practice recommendations, remains an under-researched black box. In collaboration with, and partly funded, by NICE, we are studying three Guideline Development Groups (GDGs), from acute health care, chronic health care and public health. Transcripts of audio-taped GDG deliberations and interviews with GDG members are being analysed using an ethnographic approach, drawing on theories of decision-making and social influence.|Application of theory: There has been no systematic attempt to identify, operationalise and apply the range of theories (psychological, sociological, anthropological and organisational) relevant to understanding behaviour change and problems of implementation. A scoping review will be followed by a workshop of experts, leading to the development of a theory-based intervention to improve public health. This demonstration project will generate web-based guidance for public health researchers on how to design theory-based interventions will.|N-of-1 methodology: To create a cumulative scientific basis for behaviour change, new methods are needed to evaluate interventions, and test mechanisms of change in effective interventions. N-of-1 studies can both rigorously test theoretically specified causal pathways within individuals, and differences between individuals. Although these designs have been successfully used to assess efficacy and theoretical mechanisms in interventions designed to change psychological states such as mood, stress and pain, they have been used infrequently to assess interventions designed to change key behaviours that cause ill-health. We are investigating the feasibility of different single case methods to assess the outcome and mediation of single and combined techniques on behaviour (complex interventions), focusing on the under-researched technique of self-monitoring.|

Publications

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Abraham C (2008) A taxonomy of behavior change techniques used in interventions. in Health psychology : official journal of the Division of Health Psychology, American Psychological Association

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Eccles MP (2009) An implementation research agenda. in Implementation science : IS

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Francis JJ (2008) Importance of behaviour in interventions. in BMJ (Clinical research ed.)

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Glasziou P (2010) Taking healthcare interventions from trial to practice. in BMJ (Clinical research ed.)

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Michie S (2008) Advancing the science of behaviour change: a plea for scientific reporting. in Addiction (Abingdon, England)

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Michie S (2008) Designing and implementing behaviour change interventions to improve population health. in Journal of health services research & policy

 
Description MRC Guidance on developing and evaluating complex interventions
Geographic Reach National 
Policy Influence Type Membership of a guidance committee
 
Description Matched funding for ESRC grant
Amount £50,000 (GBP)
Organisation National Institute for Health and Care Excellence (NICE) 
Sector Public
Country United Kingdom
Start 06/2014 
End 05/2015
 
Description Research Grant, Knowledge Exchange Opps
Amount £86,217 (GBP)
Funding ID ES/L006995/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 06/2014 
End 05/2015
 
Description Advisory Group of Changing Health Behaviour study 
Organisation Newcastle University
Department Institute for Ageing and Health
Country United Kingdom 
Sector Academic/University 
PI Contribution Issued invitations and organised meeting
Impact Advice on the development of the systematic literature search
Start Year 2007
 
Description Advisory Group of Changing Health Behaviour study 
Organisation Peninsula College of Medicine & Dentistry
Department Behavioural Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Issued invitations and organised meeting
Impact Advice on the development of the systematic literature search
Start Year 2007
 
Description Advisory Group of Changing Health Behaviour study 
Organisation University of Aberdeen
Department School of Medicine & Dentistry Aberdeen
Country United Kingdom 
Sector Academic/University 
PI Contribution Issued invitations and organised meeting
Impact Advice on the development of the systematic literature search
Start Year 2007
 
Description Advisory Group of Changing Health Behaviour study 
Organisation University of Cambridge
Department Department of Public Health and Primary Care
Country United Kingdom 
Sector Academic/University 
PI Contribution Issued invitations and organised meeting
Impact Advice on the development of the systematic literature search
Start Year 2007
 
Description Department of Health seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Lord Darzi and other government ministers listed to the seminar, to inform them to make changes to government policy on the NHS

It sparked debate amongst policymakers
Year(s) Of Engagement Activity 2008