1. University College London September 2013
The potential for smartphone applications to deliver behaviour change techniques
Robert West
Susan Michie
University College London
September 2013

2. Outline Principles of behaviour change
Features of smartphone applications
Judging how well smartphones can deliver behaviour change techniques

3. Principles of behaviour change
To increase or decrease the incidence of a given behaviour it is necessary to alter one or more of:
capability (physical or psychological)
opportunity (physical or social)
motivation (reflective or automatic)
This can be done
directly by targeting the behaviour or
indirectly by targeting supporting or competing behaviours

4. The COM-B model of behaviour
Michie S, M van Stratten, West R (2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

5. The COM-B model of behaviour
Physical and psychological capability:
knowledge, skill, strength, stamina

6. The COM-B model of behaviour
Physical and social opportunity:
time, resources, cues/prompts

7. The COM-B model of behaviour
Reflective and automatic motivation:
plans, evaluations, desires, impulses and responses
West and Brown, 2013 Theory of Addiction: Oxford, Blackwell

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

9. Intervention functions
Education
Increasing knowledge or understanding
Persuasion
Using communication to induce positive or negative feelings or stimulate action
Incentivisation
Creating expectation of reward
Coercion
Creating expectation of punishment or cost
Training
Imparting skills
Restriction
Using rules that limit engagement in the target behaviour or competing or supporting behaviour
Environmental restructuring
Changing the physical or social context
Modelling
Providing an example for people to aspire to or imitate
Enablement
Increasing means/reducing barriers to increase capability or opportunity

10. Influencing capability
Knowledge
Educate about ways of enacting the desired behaviour or avoiding the undesired one
Skill
Train in cognitive, physical or social skills required for the desired behaviour or avoid the undesired one
Strength
Train or enable development of mental or physical strength required for the desired behaviour or to resist the undesired one
Stamina
Train or enable endurance required for desired behaviour or sustained resistance to undesired one

11. Influencing opportunity
Train or restructure the environment to reduce time demand or competing time demands for desired behaviour (and additionally use restrictions to reduce undesired behaviour)
Time
Resources
Restructure the environment to increase social support and cultural norms for desired behaviour (and additionally use restrictions to reduce undesired behaviour)
Cues/prompts
Restructure the environment to provide cues and prompts for desired behaviour (and converse for undesired behaviour)

12. Model desired behaviour to induce automatic imitation
Influencing motivation
Plans
Educate, train or enable to form clearer personal rules/action plans, and train to remember and apply the rules when needed
Evaluations
Educate or persuade to create more positive beliefs about desired, and negative ones about undesired, behaviour
Motives
Educate, persuade, train, incentivise, coerce and model to feel positively about the desired behaviour and negatively about the undesired one
Impulses/inhibition
Train or enable to strengthen habitual engagement in the desired behaviour or weaken the undesired one
Responses
Model desired behaviour to induce automatic imitation

13. Smartphone features Feature + - Accessibility
extremely low delivery cost, very easy to develop and deliver, almost always available
not universally affordable
Functionality
can present text, present graphics, play audio, play video, vibrate, link to other apps, link to websites
can record responses, third party information, information about other users, location, movement, date and time, video, audio, other data (e.g. expired air CO, GSR) through interfaces
cannot directly empathise, exert physical power or locomote
Flexibility
can be programmed, learn and be upgraded …
… up to a point!

14. Behaviour Change Technique Taxonomy (v1)
Comprehensive, expert generated list of behaviour change techniques (BCTs)
Able to be used reliably to characterise behaviour change interventions
Grouped pragmatically into 16 categories:
Michie et al (2013) Ann Behav Medicine, 46,

15. App suitability judgements
Rate smart phone apps using current technology for how effectively they can deliver or help deliver the following BCTs on a scale from 1-4: 1=not at all, 2=minimally, 3=moderately, 4=very well
SM and RW independent ratings of each BCT
Spearman r = 0.5, p<0.001 for the 93 BCTs
Judgements for 16 BCT categories:
High, Moderate, Low, Mixed
SM and RW agreement on 11 out of 16 categories

16. Delivery of Behaviour Change Techniques
BCT group
App suitability
Goals and planning (e.g. goal setting, problem solving)
High
Feedback and monitoring (e.g. self-monitoring of behaviour)
Shaping knowledge (e.g. instruction on how to perform the behaviour)
Natural consequences (e.g. salience of consequences)
Antecedents (e.g. restructuring physical environment, distraction)
Mixed
Scheduled consequences (e.g. punishment, reward approximation)
Comparison of behaviour (e.g. information about others’ approval)
Associations (e.g. prompts/cues, exposure, satiation)

17. Delivery of Behaviour Change Techniques
BCT group
App suitability
Social support (e.g. emotional support)
Moderate
Repetition and substitution (e.g. behavioural substitution)
Comparison of outcomes (e.g. pros and cons, credible source)
Self-belief (e.g. self-talk, focus on past success)
Covert learning (e.g. imaginary punishment, vicarious consequences)
Identity (e.g. valued self-identity, framing/re-framing)
Reward and threat (e.g. material reward, social reward)
Low
Regulation (e.g. pharmacological support, conserving mental resources)

18. Conclusions
An initial analysis of the features of smartphone applications suggests that they are likely to be:
Good at delivering BCTs related to:
goals and planning, feedback and monitoring, shaping knowledge, natural consequences
Quite good at delivering BCTs related to:
social support, repetition and substitution, comparison of outcomes, identity, self-belief, covert learning
Not generally good at delivering BCTs related to:
reward and threat, regulation
Mixed at delivering BCTs related to:
comparison of behaviour, associations, antecedents, scheduled consequences