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The application of behavioural science at Public Health England

Dr Tim Chadborn from the Public Health England Behavioural Insights Team (PHEBI) offers his perspective on the contribution of Behavioural Science to Public Health.

How does behavioural science contribute to improving public health?

Changing behaviour is central to shifting public health outcomes. Traditionally, many approaches to behaviour change have existed across a range of disciplines.  Behavioural science synthesises insights from disciplines including social psychology, health psychology and behavioural economics in an interdisciplinary approach which aligns theory, evidence-base and practice. As such, behavioural science offers a method of understanding behaviour within a given content and developing and robustly evaluating interventions geared towards shifting it.

A behavioural approach

A behavioural approach is based on the identification of the specific target behaviour, which may be distinct from both the public health problem and of the desired outcome.  It requires clarity in definition of the target individual/group or population and recognises that all behaviour exists as part of a system.
Effective behavioural change is dependent on understanding why a given behaviour is or isn’t occurring. One way to conceptualise this is through understanding the interaction between capability, opportunity and motivation (Michie, van Stralen, & West, 2011). A behavioural diagnosis utilises a tool such as the Behaviour Change Wheel (Michie et al., 2011) to identify which components of this interrelated system are the effective target and levers for change.  This can be extended by incorporating the associated theoretical constructs identified within the Theoretical Domains Framework (Cane, O’Connor, & Michie, 2012) and mapped across to intervention functions and policy categories. Specific behaviour change techniques can then be selected in response to this analysis (Ambler et al., 2011; Michie et al., 2013; Service et al., 2014).

Strategic Behavioural Analysis

Strategic behavioural analysis is a method of investigating the extent to which interventions in a policy area are addressing the key behaviours and drivers of behaviours, using appropriate behaviour change techniques and interventions for delivery of those techniques. It combines a literature review to identify the behaviours and drivers of behaviour and can include effect sizes of intervention components and compares the results with an analysis of the behavioural components of currently implemented national or local interventions. This reveals the extent to which the appropriate behaviours and drivers are being targeted and also the missed opportunities - intervention and policy options which are not being currently drawn upon but which would be expected to have an impact.

Behavioural Analysis in a Digital Context

Digital interventions provide a powerful opportunity to drive individual behaviour change across the public health domain. The PHE Behavioural Insights team (PHEBI) was involved in the design and ongoing development of Good Thinking, a pan-London digital wellbeing service targeting the 2 million Londoners who experience poor mental wellbeing in a given year. This was created through user-centred co-design, with clear embedding of behavioural models to gain an understanding of the problem, target behaviour and the service user. Behavioural science was also used to inform the design of supportive user end-to-end journeys, appropriate digital marketing, effective actionable content, and a robust evaluation process. The beta phase of the site has seen >5,000 visitors per month, with 30% of visitors returning.

Increasing application of Behavioural and Social Science across Public Health

In order to increase the potential for positive changes to health outcomes in public health interventions, PHE supports greater application of behavioural science research evidence, theory and methods in public health service design and delivery. Indeed, PHE has been working with the Association of Directors of Public Health, Local Government Association, HPPHN and many other national organisations to collaboratively develop a Behavioural and Social Science Strategy for Public Health in England, which will soon be launched. This is intended to be the first word in a national conversation about how we deliver the next revolution in public health practice and provides the first steps in a roadmap to get us there together. We welcome all those interested to be part of that conversation via the developing Behavioural Science and Public Health Network.

References

Ambler T, Braeutigam S, Stins J, Rose S, Swithenby S, Bates B, et al. (2011). MINDSPACE:  Influencing behaviour through public policy. Available from:  https://www.instituteforgovernment.org.uk/publications/mindspace (accessed 24 July  2018)

Cane J, O’Connor D, Michie S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. (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.

Michie S, van Stralen M, West R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42.

Service O, Hallsworth M, Halpern D, Algate F, Gallagher R, Nguyen S, et al. (2014). EAST Four simple ways to apply behavioural insights. Available from: http://www.behaviouralinsights.co.uk/wp-content/uploads/2015/07/BIT-Publication-EAST_FA_WEB.pdf (accessed 24 July 2018)