Unlocking Behaviour Change A one-day workshop Robert West University College London Centre for Behaviour Change

Programme 10:00 Welcome and introduction to the course 10:15 Review of participants’ expertise and workshop goals 10:30 Milestones in behaviour change 11:00 Break 11:15 COM-B: Finding out what needs to change 12:00 Behaviour Change Techniques: How to promote change 12:30 Lunch

Programme 13:00 Introduction to practical exercises 13:15 Practical exercise 1: Deciding what to change and making a plan 14:30 Break 14:45 Practical exercise 2: Getting going and keeping going 15:30 Keeping records 15:45 Recap, quiz and feedback 16:30 Finish

Aims and scope This workshop is for behaviour change practitioners who give advice and support to clients It aims to improve success at helping clients to make lasting changes in their behaviour It does not address behaviour-specific knowledge

About behaviour change Behaviour change is doing something which causes people to behave differently from how they would have behaved With behaviour patterns such as smoking, overeating, drinking excessively, not taking enough exercise, it usually involves Encouraging them to try to make a change Supporting them so that they can sustain it Much of this involves public policies such as taxation, restrictions, running mass media campaigns It also involves providing individually tailored advice and support

Review of expertise and training needs What is your background and experience? What kinds of behaviour change do your clients tend to require? What levels of success do you think you achieve? What are the key issues that arise? What do you see as the key to behaviour change?

Milestones of individual behaviour change Deciding Planning Getting going Keeping going I intend to reduce my calorie intake to 1500 per day I know how I will reduce my calorie intake to 1500 per day I have started to reduce my calorie intake to 1500 per day I am still reducing my calorie intake to 1500 per day

Deciding what to change What does the client want to achieve? E.g., Lose 6 kg in weight over 3 months What is a realistic target? E.g., Lose 2 kg in a month What behaviour change is required? E.g., Consume no more than 1500 calories per day What does this entail? E.g., Cutting out snacks and second helpings

Key points Be specific: Achieving clients’ goals (e.g., weight loss) usually involves getting them to be much more specific about those goals and deciding on what specific behaviour change to go for. Less is more: It is important not to try to do too much, but focus on one achievable goal and set of behaviours to change (e.g., improving diet). Build on incremental successes.

Planning to change When to start? E.g., Tomorrow What support to put in place? E.g., Finding a ‘buddy’ How to beat off challenges? E.g., Not shopping when hungry How to check on and reward progress? E.g., Daily weighing and treats

Key points Seize the moment: Try to get clients to commit to starting as soon as possible. The longer they wait, the more likely clients will go off the boil. Be prepared: It is important to make sure clients are ready for specific challenges they will face in the first week or so. The big day: Get a clear voluntary commitment to a session on the start date.

Getting going Marking the event E.g., Sharing with friends or family Implementing the support plan E.g., Making first contact with the buddy Getting off to a flying start E.g., Reviewing plans for the first week Getting a ‘baseline’ E.g., Record starting weight

Key points Be there at the start: It’s important to have a contact with clients on the day they start, either in person or by phone or text. Be positive: Be positive and rewarding and send clients off with hope.

Keeping going Staying motivated E.g., Re-affirming one’s rules Dealing with temptation E.g., Not buying biscuits Dealing with setbacks E.g., Creating a new rule Monitoring progress E.g., Daily weighing

Key points Monitor and reward progress: Clients need to have a clear sense of achievement that they can build on. Deal with challenges: There will be set-backs; foster a problem-solving approach to getting back on track.

Milestones of individual behaviour change Deciding Planning Getting going Keeping going To achieve each milestone, need an understanding of: What needs to change in order for behaviour change to happen and be sustained? Added this in to try and help transition from milestones to COM-B (felt this wasn’t as clear before)

Break

COM-B: The key to unlocking behaviour change Behaviour occurs when, at that moment, we have the capability and opportunity, and we are more motivated to do that thing than anything else Capability Motivation Behaviour Opportunity

The physical or psychological ability to do something Capability The physical or psychological ability to do something Knowledge Skills* Strength* Stamina* * Mental and physical

Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Do they know what they need to do, why they need to do it and how they can do it? How confident are they in their ability to resist temptations? What skills and experiences can they build on? Opportunity Motivation Behaviour

Opportunity The social and physical environmental factors that enable us to do something Resources Access Norms Cues

Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Do they have the financial or other resources to support their change? Does their physical and social environment support change? What can they do to reduce exposure to temptation? Opportunity Motivation Behaviour

Reflective/ Conscious Automatic/ Unconscious Motivation The strength of desire or urge to do something Reflective/ Conscious Automatic/ Unconscious Wants and needs Impulses and inhibitions Developing a habit Intentions and goals Decisions and plans Beliefs about costs and benefits

Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability How committed are they to the goals they have set? How steadfast are they likely to be in the face of challenges? What habits do they have that may get in the way of change? Opportunity Motivation Behaviour

Other behaviours that may support or hinder behaviour change

Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability What other behaviours could get in the way of making the needed changes? What other behaviours could support the desired change? Opportunity Motivation Behaviour

Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Opportunity Motivation Behaviour

Example: Childhood weight management Goal: To get parents to provide their overweight children with appropriate portion sizes across five food groups Focus group with parents Investigation structured around COM-B

Example: Childhood weight management Capability Many parents … do not recognise that their child is overweight do not know about age-appropriate portion sizes cannot measure food portions correctly Opportunity Motivation Behaviour

Example: Childhood weight management Capability Many parents … Lack knowledge of appropriate balancing across food groups Have difficulty talking with children and partners around eating and weight issues Opportunity Motivation Behaviour

Example: Childhood weight management Capability There are often … Adverse influences of partners, grandparents, parents of other children Problems finding time to figure out portion sizes No facilities for make measuring portion sizes quickly and easily Opportunity Motivation Behaviour

Example: Childhood weight management Parents often … Do not want to accept that there is a problem Feel guilty about restricting food and fear the child becoming anxious about weight/ food Lack confidence in their ability to prepare healthy meals Capability Opportunity Motivation Behaviour

Behaviour Change Techniques What needs to change: Capability, Opportunity, Motivation, Behaviour?

Behaviour Change Techniques Behaviour Change Techniques (BCTs) are specific things you can do to help clients to change their behaviour, such as goal setting, monitoring, rewarding etc. The time spent in consultations is precious and every part of the consultation needs to be focused on the task in hand Friendly chatting can be useful in establishing rapport but everything in the consultation must have a clear purpose behind it

Behaviour Change Technique (BCT) Improving capability Behaviour Change Technique (BCT) Inform Describe what to do, how to do it and why Explain Promote understanding Promote practice Schedule repetition of the activity Support Provide psychological or biological enhancement Demonstrate Show what to do or how to do it Correct Show difference between current and desired action

Increasing opportunity Behaviour Change Technique (BCT) Alter affordability Decrease the cost or increase ability to pay Alter accessibility Increase ease of access Provide resources Provide equipment or materials required Change cues Re-position, add or remove cues to action Change norms Make clearer what other people do

Behaviour Change Technique (BCT) Changing motivation Behaviour Change Technique (BCT) Set goals Set clear achievable goals for behaviours Monitor Record progress and give feedback Persuade Use discussion/imagery to change how people feel Reward Help make activities more attractive Punish Help make the activities unattractive Model Provide an example to copy

Changing other behaviours Behaviour Change Technique (BCT) Substitute Help find an activity that serves the same purpose Distract Help find an activity that takes their mind off Commit Get them to make a voluntary commitment Engage Keep them engaged with the support

Deciding priorities You can’t do everything so you need to decide what is likely to have the biggest impact For each BCT, think about: How much of an impact is it likely to have? How acceptable is it to the client or members of their family or friends? How practicable is it? Can they afford it? Are there going to be any unwanted side-effects?

Lunch

Behaviour Change Techniques Recap Behaviour Change Techniques

Practical exercises

Example: Getting more active 45 year-old man who wants to become more physically active Been referred by his GP Unemployed Does very little walking Overweight and unfit Has asthma and high blood pressure

How will you go about helping him decide what to change?

Deciding what to change What does the client want to achieve? C O M B What is a realistic target? Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage What behaviour change is required? What does this entail?

How will you help him make a suitable plan?

Making a plan C O M B When to start? What support to put in place? Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage How to beat off challenges? How to check on and reward progress?

How will you ensure he gets off to a great start?

Getting going C O M B Marking the event Implementing the support plan Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage Getting off to a flying start Getting a ‘baseline’

How will you help him stay on track?

Keeping going C O M B Staying motivated Avoiding temptation Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage Managing temptation Monitoring progress

Break

Example: Stopping smoking 52 year-old woman wants help with stopping smoking Been referred by GP Suffers from depression Has tried nicotine patches with some success High in motivation but low in confidence Married to smoker Worried about weight gain Thinking about using an e-cigarette

How will you go about helping her set a goal?

Setting a goal C O M B What does the client want to achieve? What is a realistic target? Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage What behaviour change is required? What does this entail?

How will you help her make a suitable plan?

Making a plan C O M B When to start? What support to put in place? Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage How to beat off challenges? How to check on and reward progress?

How will you ensure she gets off to a great start?

Getting going C O M B Marking the event Implementing the support plan Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage Getting off to a flying start Getting a ‘baseline’

How will you help her stay off cigarettes?

Keeping going C O M B Staying motivated Avoiding temptation Inform Explain Promote practice Support Demonstrate Correct Alter affordability Alter accessibility Provide resources Change cues Change norms Set goals Monitor Persuade Reward Punish Model Substitute Distract Commit Engage Managing temptation Monitoring progress

Thoughts?

Keeping records Impact = Throughput x Success rate How many clients? What kinds of clients? From what sources? What counts as success? How many successes? At what follow-up point?

Behaviour Change Techniques Recap Behaviour Change Techniques

Quiz What are the four milestones in individual behaviour change? What does COM-B stand for? What is a behaviour change technique? Give one example each of a BCT focusing on C, O, M and B What are the key things that need to be recorded to assess impact?

Resources www.unlockingbehaviourchange.com

Feedback

Thank you! C O M B