Understanding Behaviour: how Health Psychology can contribute to Environmental Health

Beds and Herts Branch of the Chartered Institute of Environmental Health, 23 Sept 2014

Michelle Constable

Health Psychologist in Training

&

Jim McManus

Director of Public Health

Content

• Lets start a conversation!

• What is health psychology?

• Models of behaviour change

• Communication

• How to communicate your message

• Things to consider when planning a project

Lets start a conversation!

• What does current practice look like?

• What tools/support are available?

• What methods/theories do you use?

• How do you communicate your messages?

• What challenges do you face?

Health Psychology?

• Promotion and maintenance of health

• Prevention and treatment of illness

• Cause and diagnostic relationship of health and illness

• Health care system and health policy

• Consultancy

• Teaching and training

Areas Health Psychologists research

• Health cognitions/beliefs

• Communication

• Risk behaviours – smoking/alcohol

• Health protective behaviours

• Long term conditions – coping/resilience

• Stress

• Implementation of evidence based practice

Current Applications

• Public Health (various)

• Driver speeding and behaviour

• Young People

• Drug and Alcohol recovery

• Offending behaviour

• Recycling behaviour

• Pro social behaviour

Models of Behaviour change

Determinants of health

Next Slides

• We gratefully acknowledge the permission of UCL Centre for Behaviour Change to use some of their slides on the COMB model and behaviour change wheel, and we recommend their training. http://www.ucl.ac.uk/behaviour-change

• We hope to organise their training for Hertfordshire agencies soon

The COM-B Model

Michie S, M van Stralen, West R (2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

Michie, 2011

The Behaviour Change Wheel

Again

• Our thanks to UCL colleagues for permission to use the preceeding slides http://www.ucl.ac.uk/behaviour-change

Environmental Health

• Many environmental problems rooted in behaviour

• Consider the behaviour you are trying to target

• Contextual factors may facilitate or constrain e.g. availability of recycling bins

• Costs may outweigh motivation – need to consider infrastructure

• What is the evidence base?

Communication

Brief intervention

A

3 step

30 second

systems based

approach

Make Every Contact Count (MECC)

• Offering brief advice on healthy lifestyles opportunistically, smoking, weight, physical activity

• Giving information about importance of behaviour change

• Simple advice and signposting

• Aims to reduce health inequalities

• Encourages patient to take responsibility for own health• http://learning.nhslocal.nhs.uk/feature-list/making-every-

contact-count• http://www.alcohollearningcentre.org.uk/eLearning/IBA/

MOTIVATIONAL INTERVIEWING

What is MI?

MI is a collaborative, goal-orientated style of communication which pays particular attention to the language of change. It’s aim is to strengthen

personal motivation and commitment to a specific goal (like increasing physical activity) by

exploring the person’s own reasons for change.

FEATURES OF MI

• MI’s style is conversational and accepting

• It’s a shared decision making conversation

• It’s collaborative and solution focussed

• EQUALITY- They are the expert in their own behaviour but you have the skills and knowledge to help them!

THE TASK OF MI CONVERSATIONS• Identify when behaviour is inconsistent with the

client’s goals or ambitions. • Focus where there is a discrepancy between their

values i.e. I don’t want to smoke and their current behaviour i.e. smoking.

• It’s very hard to be resistant to someone who is trying hard to understand you.

• With MI we don’t necessarily wait for the client to be ready for change, MI is good for people who are in two minds.

Instead of…Could you? Have you thought of…?

TRY• How might you best go about that?• What would that be like for you?• What are your thoughts?• What strengths do you have?• How confident are you in making this change?• Where should the focus of our conversation be

today, to make it as helpful as possible for you?

Clear messages?

• Importance of clear information

• Stoke-on-Trent study

• Readability assessment

• Identify jargon

• Patient/public involvement group

• Lower then anticipated reading age

Things to consider in the planning phase

1. Base interventions on a proper assessment of the target group, where they are located and the behaviour that is to be changed

2. Work with other organisations and the community itself to decide on and develop initiatives

3. Build on the skills and knowledge that already exists in the community, for example, by encouraging networks of people who can support each other

4. Take account of – and resolve – problems that prevent people changing their behaviour (for example, the costs involved in taking part in or lack of knowledge about how to make changes)

5. Base all interventions on evidence of what works

6. Train staff to help people change their behaviour

7. Evaluate all interventions.

Next steps?

• Consider psychological factors when setting up a project/intervention

• Review the evidence to see what works

• Think about the skill mix within your team

• Work with partners

• Communication is key to success

• Contact the Public Health Service

• Health Psychology in Public Health Network

Thank you!

Jim.mcmanus@hertfordshire.gov.uk

michelle.constable@hertfordshire.gov.uk