In the last two articles of this series, we explored two important considerations which can hinder behaviour change initiatives:
Intentions often fail to lead to actual behaviour.
The speed at which habits form depend on the behaviour in question and the reward for the behaviour, rather than a magic number of days.
In this article we take a holistic view of behaviour change and explore three fundamental factors which facilitate change: People, Place and Purpose.
Why changing health behaviours is so difficult
There are many examples of successful behaviour change programmes, although there are countless examples of programmes which have not been as effective as originally planned. Changing behaviour is difficult and people face substantial barriers to behave in health promoting ways.
Research has identified six common errors which have prevented the psychological and sociological evidence base from being implemented. These six ‘myths’ have made health related behaviour change more difficult.
It is just common sense — The argument that “it is obvious what needs to be done, so let us just get on and do it” has limited our progress. Accumulated learning from behavioural and social science has been ignored in favour of an assumption that we intuitively know how to change behaviour. This has led to ineffective interventions and missed opportunities.
It is about getting the message across — Some people propose that changing health behaviour is simply a matter of delivering the right message. The assumption is that if we can get the right message to people in a language they can understand, they will change in response. Social marketing campaigns play an important role, but they are one part of a much larger behaviour change strategy.
Knowledge and information drive behaviour — Giving people information does not help them change their behaviour. People are often aware of the benefits of healthy behaviours (such as eating healthy and exercising), however, competing pressures in their lives get in the way.
People act rationally — There is a commonly held belief that people act rationally, and they behave sensibly and logically after carefully considering their options. This also assumes that telling people what is good for them will change their behaviour. Although this is not the case. Behaviours such as exercise, eating habits, smoking and alcohol consumption are processes and practices embedded in social life. These behaviours are driven much less by conscious and cognitive processes and more by instinctive, emotional decision making.
People act irrationally — Whilst people do not behave rationally, they also do not always behave irrationally. Kelly and Barker highlight that “behaviours that persist tend to be functional for people”. It is important not to categorise people’s explanations for behaviour as ‘irrational’ just because evidence has shown that it carries a health risk. An unhealthy behaviour may be beneficial or rewarding in another way (i.e., psychologically, or socially).
It is possible to predict accurately — Although we have made significant progress in understanding what shapes behaviour, it is still difficult to predict how individuals will behave in any given situation. At a population level, stark differences in health behaviours can be seen. Whilst these patterns can be described in detail, they have not provided us with the tools to tackle health inequalities at scale. We need to understand the myriad situations and influences which are driving health behaviours at an individual level.
To positively influence behaviours, we must understand what motivates people and the individual, cultural, social and economic pressures which they face. By understanding these, we will be able to co-develop appropriate policies and programmes to support people more effectively.
Photo by Helena Lopes on Unsplash
A more rounded approach to behaviour change
For policies and initiatives to have the greatest chance of success, they need to align with what people value. There is a need for a more holistic application of behaviour change theory, which captures the interconnectedness of people and the places and spaces which surround them.
The environments in which people live and work play an important role in shaping health and wellbeing. There is a growing body of evidence which demonstrates a broad range of outcomes from programmes or initiatives that build social relations in places and spaces.
The COM-B model of behaviour change puts forward that one of the most important factors which determines behaviour is motivation. Motivation is the basic drives and automatic processes which guides our intentions. If sufficient motivation is in place, we also require the skills and abilities necessary to behave in the way we would like, and no environmental constraints which can act as a barrier to our desired behaviour.
Building on the foundations of the COM-B model, policies and interventions which aim to improve health and wellbeing should seek to connect people with each other and their local environment, whilst providing a common purpose. This will ensure that policies and interventions are suitably designed to capture not only the psychological contributors to behaviour, but also the broader sociological influences.
The takeaway
Changing behaviour at scale is a complex task. To have the greatest chance of achieving success, policies and initiatives which aim to encourage people to behave in health promoting ways could benefit from encouraging social participation, attaching new behaviours with existing values and purposes which people care about, and by localising initiatives.
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Sources:
Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult?. Public health, 136, 109–116.
Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 1–12.
Sternberg, E. M. (2010). Healing spaces: The science of place and well-being. Harvard University Press.
Bagnall A.M., Southby, K., Jones, R., Pennington, A., South, J., Corcoran, R. (2023) Systematic review of community infrastructure (place and space) to boost social relations and community wellbeing: Five year refresh. London: What Works Centre for Wellbeing.
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