The handout for a CPD session on behaviour change to accompany the slide presentation on behaviour change

1. Locating Behaviour Change in Public Health Practice :
The Hertfordshire Propositions
Jim McManus, CPsychol, CSci, AFBPsS, FCIEH, FFPH
Director of Public Health for Hertfordshire Jim.mcmanus@hertfordshire.gov.uk
February 2014
I: Policymakers and commissioners need a clear Context within which
Behaviour Change is used
1. The epidemiology of the UK is such that behavioural sciences can make a
significant contribution to primary prevention of non-communicable disease,
secondary prevention especially self-management and resilience and tertiary
prevention (e.g. coping skills for breathlessness in heart failure.) Behaviour
change needs to be seen within this context.
2. This contribution is alongside not instead of policy and population measures
(like regulation of tobacco etc). Behaviour change is not the answer to our
public health challenges. It is a part of the answer
3. A balanced public health strategy will have interventions at policy,
environmental, social, sub-population and individual levels (eg the 6 levels of
public health action in the Hertfordshire Public Health Strategy taken from
Dettels et al,2009 http://slidesha.re/1e4CVzY ) Another way of looking at this is
the Health Impact Pyramid
https://www.idph.state.ia.us/adper/common/pdf/healthy_iowans/health_pyrami
d.pdf
Levels
Social – changing social norms about
health, e.g. acceptability of binge drinking,
acceptability of taking smoking breaks
Example of how they can be applied –
Tobacco
Behavioural economics, social marketing
Young people
Biological – immunisation, vaccinations,
treatments
Nicotine replacement therapy and cognitive
tools for cravings
Environmental – encouraging green
transport, reducing pollution, changing the
public realm
Environmental cues, display legislation
Smokefree playgrounds
Individual Behavioural – helping
individuals to stop smoking
Legislative – the smoking ban,
legislation on alcohol sales
Individual and group behavioural change and
support
The ban on smoking
Legislation on displays
Structural – policy changes such as
workplace health, school health policies
Workplace policies
Tobacco control partnerships
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2. Locating Behaviour Change in Public Health Practice :
The Hertfordshire Propositions
II: Policymakers need Clarity of the aims and uses for Behaviour Change
4. Behaviour change can be used at population or individual or sub-population
levels. Different theories, approaches and methods work for different settings.
Policymakers should be aware of this.
5. Including behavioural science skills (e.g. health psychologists) in your service
is essential to get it right . They need links with the academics to keep track of
the field. We’ve recognised the need for links between public health practice
and academic public health starting with our training and running all through
our careers. It’s time behaviour sciences had this parity of esteem.
6. Behaviour change can target “automatic” cognitive/emotive processes (e.g.
choice architecture and also eye position tracking on cigarette package
warnings) or conscious deliberative ones (e.g. behavioural skills to negotiate
safer sex.) You need to be clear which you are using for what, and why
III: Policymakers need Clarity of methods, settings and audiences for
Behaviour Change
7. The experts in the field need to work with policymakers to create a framework
or architecture within which local areas can understand and roll out behaviour
change strategies and methods. A preliminary attempt at this is below
IV: A first step at a ready reckoner for behaviour change tools and methods
A ready reckoner for behaviour change tools and methods
Population Level
Group Level
Individual Levels
“Automatic”
“Conscious”
“Automatic”
“Conscious”
“Automatic”
“Conscious”
processes
processes
processes
processes
processes
processes
Choice
Advertising
Nudge
Groupwork for Choice
Health
Architecture
e.g. change4
behaviour
Architecture
Trainers
life
Targeted
social
marketing
We still have gaps and weaknesses in science and tools across all of these
(i.e. the science is still developing)
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