Continuing professional development (CPD) for healthcare professionals is undoubtedly the most common intervention to change practice. Regulated health professionals all have some level of required CPD for continuing registration or revalidation. Furthermore, when changes are identified at policy level, such as the recent focus on ‘making every contact count’ or the need to improve antimicrobial stewardship, it is through education and training that the practice of healthcare professionals is targeted
Health psychology tells us that just because someone can do something, doesn’t mean that they will; capability is one of three overarching factors that leads to behaviour, the other two being opportunity and motivation (Michie, van Stralen, & West R, 2011). The focus on training, when trying to change healthcare professional practice, places the focus squarely on capability as the key driver. We argue that this leads to lost opportunities to focus more roundly on the three drivers of practice, and maximise the effectiveness of training as a behaviour change intervention.
In our work, we focus on three health psychology elements that can enhance the efficacy of training: behavioural diagnosis, specification of behaviour change techniques and evaluation by behavioural determinants. In respect of behavioural diagnosis, we find that many educators don’t view their courses as behavioural interventions but rather as interventions to improve knowledge and skills. As a result, they often have not specified what behaviours are crucial to the improved performance that the course is targeting. We have found that simply working with educators in this way can be transformational (Byrne-Davis et al., 2017). Although courses include behaviour change techniques that might change capability, opportunity and motivation, they are not specified as the active ingredients of the intervention. This means that they are not systematically tested and are often not detailed in course materials and tutor notes. The Behaviour Change Technique Taxonomy Version 1 (Michie et al., 2013) includes 93 behaviour change techniques, including some that might never be present in a training course. We coded courses as they were happening, with two coders reaching high inter-rater reliability, and found that there were 43 techniques commonly used. We also identified ‘near misses’ where techniques were not quite used. These could be highlighted to the educators so that they can use techniques that might have a higher chance of changing practice. The ability to ‘live code’ training and identify possible active ingredients opens up possibilities for testing the efficacy of techniques in teaching, and quality improvement (paper in preparation). Finally, training evaluations often include only assessments of knowledge, skill and satisfaction. Measuring opportunity and motivation pre and post course gives important information about how the course has changed the trainees, particularly if then tested for associations with changes in practice (for example see Byrne-Davis et al., 2015).
We are applying our work in UK and in Health Partnerships in low and middle-income countries (LMIC), conducting research, providing consultancy and facilitating LMIC volunteering opportunities for health psychologists. For more information about our work see www.mcrimpsci.org.
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., & ... Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals Of Behavioral Medicine, 46(1), 81-95. doi:10.1007/s12160-013-9486-6
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: IS, 642. doi:10.1186/1748-5908-6-42
Byrne-Davis, L. T., Bull, E. R., Burton, A., Dharni, N., Gillison, F., Maltinsky, W., & ... Hart, J. K. (2017). How behavioural science can contribute to health partnerships: the case of The Change Exchange. Globalization And Health, 13(1), 30. doi:10.1186/s12992-017-0254-4
Byrne-Davis, L. M., Byrne, G. J., Jackson, M.J., Abio, A., McCarthy, R., & Slattery, H. (2015), Understanding implementation of maternal acute illness management education by measuring capability, opportunity and motivation : a mixed methods study in a low-income country. Journal of Nursing Education and Practice, 6 (3), 59-70. doi:10.5430/jnep.v6n3p59
Lucie Byrne-Davis PhD CPsychol PFHEA, Health Psychologist & Senior Lecturer, Division of Medical Education in the School of Medical Sciences Faculty of Biology, Medicine and Health, The University of Manchester
Dr Jo Hart, PhD, C Psychol, Division of Medical Education in the School of Medical Sciences Faculty of Biology, Medicine and Health, The University of Manchester