Behavioural Science in

Public Health

Lecture delivered by: Dr Vic Archbold

Associate Professor - School of Nursing and Healthcare
Leadership
Objectives of the session
:
Gain a critical overview of Behavioural
Science

Understand the relevance and application in Public

Health

Critically reflect on its role in intervention design &

evaluation in Public Health
Part 1: First Challenge of the Day….
 Second Challenge……
• Identify & write on the post it note- just 1 behaviour you
would like to change…

This Photo by Unknown Author is licensed under CC BY-SA-NC

Changing Behaviour

The goal of behaviour change is to develop positive,

clear steps to empower and support individuals to
abandon at risk behaviours in favour of healthy,
sustainable lifestyles

Behaviour change has become a central part of public

health interventions

(Royal Society of Public Health, 2013)

 Definition of Behaviour
Behaviour is anything a person does in response to
internal or external events.

(Hobbs, Campbell, Hildon & Michie, 2011)

What it is not...

Emotions / self efficacy = determinants

QoL, Weight status = Outcomes
 Behavioural Science

Draws on discipline insights primarily from Health

Psychology and behavioural economics

Applied at an ‘Individual / professional/ community

or population level

Applied in prevention and treatment - both upstream and

downstream

Important to demonstrate effectiveness - robust

evaluations
Behavioural science in public health is not
new…
• Behaviour Change: General Approaches (2007): PH6

• Behaviour Change: Individual Approaches (2014):PH49

• Nice guidelines on alcohol, diet, physical activity, sexual health and

smoking.

• LGA – Changing behaviours in Public Health (2012)

 Traditional Theories of Behaviour?
• Social Learning Theory, Social Cognitive Theory Bandura
(1977) - self efficacy/ modelling and social environment.
Limitations - focus is on conscious and reflect decision making

• The Health Belief Model -Becker (1974) - perceived benefits &

barriers to action, stimulus cue to action. Limitations - focus is on
conscious and reflect decision making

• Theory of Reasoned Action/ Theory of Planned Behaviour-

Ajzen (1985)- Limitations -assumes people make rational choices
all of the time!

• Stages of Change/ Transtheoretical model (TTM)- Prochaska

and DiClemente (1997). Limitations- proposes BC occurs in a
linear fashion and through stages
What did you notice about all these
Theories?

The Intention - Behaviour gap!

 Lydia is trying to maintain a healthy
balanced diet

BUT

-She has had very little sleep - a

teething baby

Vey busy day at work

She grabs the large coffee and and

extra large cake in her lunch break
Shift in the traditional landscape?
Why we use theory? (Antikainen & Ellis, 2011)

Understand the determinants of

the behaviour

Enhances
Inform intervention design
effectiveness

Theoretically-informed Enhances
evaluations provide information replicability
about how interventions work ‘Real life setting’
Not all interventions are
effective
Epic Fails!
“Changing health related behaviour is difficult
because Policy Makers make it so!”

Epidemics (i.e. inactivity/ obesity) are not driven just by

individual behaviour but ‘social environments’ too…

Default of PH?
Two interacting systems -
Dual Process Theory
Health Psychology & Behaviour Change
Why Understanding Human Behaviour is so important

• Enhances well-being for

those effected by illness

• Promotes * maintains health

• Improves healthcare systems

and policy

Bio-Psycho-Social Model

(Engel, 1977,1980)
Improving People’s Health (2018)
 To Change
Behaviour

• You must examine the problem or do a

behavioural analysis:

• To change behaviour you need to

understand your population

• Why are they choosing not to be active?

• •What needs to change for the desired

behaviour/s to occur?
What level is the
intervention you
have chosen
intervening?….
When I started to understand complexity of
behaviour!

Examples of Children’s Write and Draw Images: Study 1

This Photo by Unknown Author is licensed under CC BY-SA
COM-B Model
Have you Mapped the Target Groups Needs?

The Behaviour Change Wheel

(Mitchie, van Stralen & West, 2011)
Are these appropriate approaches for ALL populations?
Behaviour Change
Techniques?
Challenge 1…in small groups (15 mins)
Problem: Resistance to antibiotics is increasing due to
high levels of prescribing from GPs. This means that a
growing number of infections such as pneumonia are
becoming more difficult to treat because antibiotics are less
effective.

High Level Goal: To reduce antimicrobial resistance.

Specific behaviours we want to change: GP’s do not

prescribe an antibiotic unnecessarily.
Using COM-B, discuss and report back what you think the
following barriers could be that are preventing GPs from
reducing their antibiotic prescription behaviours – Using
COM-B

Capabilities

These refer to the person's physical or psychological ability to

perform the behaviour.

Opportunities
This Photo by Unknown Author is
These refer to anything in the physical or social environment licensed under CC BY

that may encourage or discourage a behaviour.

Motivations

These refer to internal reflective and automatic mechanisms

that activate or inhibit a behaviour.
Daly-Smith et al., (2021)
No real consideration of differences of
variance within subgroups
 • Intention –
Behaviour
Gap!…
• Join forces with
other disciplines

• Behavioural
Economics

So…. What’s The

Answer?
 This Photo by Unknown Author is licensed under CC BY-SA-NC

Behavioral
Economics
‘Nudge’
Defaults:
As humans

We tend to opt for the pre-

set options….

‘go with the flow’

Salience: We are drawn to what i
relevant and novel to us
TED lecture – Why Design Thinking is useful in Public Health
 Self
Directed
Read:
Thank you for
Listening!
This Photo by Unknown Author is licensed under CC BY
 References
• Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide
to Designing Interventions. Great Britain: Silverback Publishing.
2014.
• Michie S, van Stralen M, West R. The behaviour change wheel: A
new method for characterising and designing behaviour change
interventions. Implement Sci. 2011;6(1):42.
• NICE GUIDELINES. Behaviour change: general approaches |
Guidance and guidelines | NICE. [Internet]. 2007 [cited 2019
Jan28]; (Public health guideline [PH6]). Available from:
https://www.nice.org.uk/guidance/Ph6
• NICE. Behaviour change: individual approaches | Guidance and
guidelines | NICE. Natl Inst Heal Care Excell [Internet]. 2014 [cited
2019 Jan28];PH 49. Available from:
https://www.nice.org.uk/guidance/ph49