By Katherine Brown, University of Hertfordshire, United Kingdom
The content of this blog post is in part drawn from my experiences working in a split role between a university and a local government public health department, with the opportunity to apply my research, intervention development and evaluation skills in practice.
Whether you’re commissioning, managing, designing or delivering health services, chances are there’s at least one behaviour that you need your service users to change for the service to successfully achieve its targets. This is because, regardless of the disease(s) your service targets, or whether these are communicable (e.g., flu, Covid-19, tuberculosis, sexually transmitted infections) or non-communicable (e.g., heart disease, COPD, type 2 diabetes, obesity), the way people behave contributes to the overall disease burden. This is not to say people should be blamed for their ill-health and considered to be solely responsible for their own health and wellbeing. Quite the opposite! A person’s health status is also the consequence of genetic, biological, social and environmental determinants. Consideration of these factors is key for health improvement and protection.
The importance of our behaviour in controlling disease has been highlighted on a global level during the current Covid-19 pandemic, as we have all been required to keep socially/physically distant, wash our hands regularly and/or use hand sanitizers, avoid face touching, wear masks, and self-isolate if we think we have symptoms of the virus, or quarantine on a return from certain travel destinations. When people do these things in large enough numbers, the spread of the virus is minimised, and health outcomes improved.
One of the major disciplines of study and research within health psychology is understanding the complex interacting factors which influence whether people engage in behaviours that will benefit their own health, the health of those around them and/or the health of the wider population. If we can understand what drives these behaviours, we can potentially create or adapt environments and/or directly intervene in ways that will increase healthy behaviours and decrease unhealthy ones.
We have a significant and rapidly building evidence base about what works to support change in a whole host of behaviours including but not limited to: engaging with services in the first place, healthy eating, physical activity, sedentary behaviour, hand hygiene, medication adherence, stopping smoking, and reducing alcohol consumption.
This evidence needs building into the design of healthcare, public health and social care services. For too long health psychologists with expertise in this field and those working to commission or deliver, have been operating individually. Trials of behaviour change interventions paid for by prestigious research funders that have been shown to be effective often don’t make it into widespread use and practice; too little of what happens in practice is fully evidence-based or evaluated robustly (if at all).
How has behavioural research been used to improve public health?
Those working across health and social care organisations have long been interested in how they can use and apply research evidence to ensure the highest quality services and interventions. Recently this has included a growing awareness of the behavioural sciences and health psychology’s contribution to understanding and changing health-related behaviours. For example, in the UK, Public Health England published a national strategy making the case for a behavioural and social science revolution in public health policy and practice. Similarly, the recently established Behaviour Change Unit at Hertfordshire County Council are frequently contacted by authorities across the UK and globally for advice on how they too can implement behaviour change methods and evidence to improve health and wellbeing and tackle major public health challenges.
As a healthcare professional, think flexibly about the health system you have and how behaviour change evidence might be applied, as total service redesign is often not what’s needed. For example:
- We worked with commissioners and service providers to adapt the family weight management services in Coventry so that the content applied evidence on what is known to work to change eating and physical activity behaviour. For example, we included ‘goal setting’, ‘action planning’ ‘problem solving’ and ‘review behavioural goal’ as we know that they are effective interventions for weight management.
- ‘Wrapped’ is a condom use promotion intervention based on behaviour change theory and evidence that if effective and cost-effective can be delivered online by health services. One of the strongest predictors of condom use in young people is affective (emotion-based) attitudes towards them (e.g., they reduce pleasure and interrupt the flow of sex). Part of the intervention specifically targets these negative beliefs about condom use by reframing condom use as erotic in videos of real couples using them as they have sex.
- ‘Stopapp’ is a brief behaviour change intervention that addresses the barriers smokers experience to accessing existing widely commissioned stop smoking services. It includes reframing of beliefs smokers often hold about the nature of services and breaks down opportunity barriers by allowing instant booking with email and SMS reminders to attend.
What can you do to build collaboration between behavioural research and practice to improve health?
- Researchers can build links with health services, public health services, or care services and their commissioners dealing with topics that interest them and apply their work in practice. If you’re addressing a clear, demonstrable health need this is a promising route to attract grant income.
- Health services or departmental leaders can look at using job descriptions and person specifications that utilise health psychologist skills and knowledge the next time they have a role to fill in their team. Examples are available from the British Psychological Society Division of Health Psychology Careers.
- Commissioners or other stakeholders delivering health services can reach out to local universities with health psychologists and behaviour change specialists to see if they’ll collaborate on service redesign and/or evaluation. They may be able to help bid for funding to support the collaboration.