1. Personalising support for smokers using the Behaviour Change Wheel
Susan Michie
Professor of Health Psychology
Director of Centre for Behaviour Change
University College London
@SusanMichie
UKNSCC Conference, London, 2016

2. Behavioral support for smoking cessation
Based on extensive evidence and forms the basis of Stop Smoking Services in many countries
In England the Stop Smoking Services provide behavioural support to about 500,000+ smokers annually

3. Personalising support
There are many behaviours that a smoker needs to change to successfully quit
Each behaviour and each smoker will require different support for successful quitting
How to decide what the best support is for each smoker?
I will present a framework to help assess what needs to change for each smoker and guide the type of support to achieve that change

4. Behavioural support is complex
Made up of many behaviour change techniques (BCTs)
“active ingredients” within behavioural support designed to change behaviour
smallest components that have the potential to bring about change
How many different BCTs do you think have been identified in behavioural interventions?

5. 93 BCTs Annals of Behavioral Medicine, 2013

6. The BCT smartphone app
Search by BCT label, BCT category or alphabetically or
Find by search term: BCTs

7. Which BCTs are most effective for smoking cessation?
From the evidence …
Randomised controlled trials and observational evidence (service 4-week quit rates)
43 BCTs in behavioural support for smoking cessation
Michie et al, 2011, Addictive Behaviours
16 with good evidence of effectiveness
8 ‘core’ = good evidence + identified as important by experts

8. 8 core BCTs supported by evidence
Capability
Facilitate barrier identification and problem solving
Facilitate relapse prevention and coping
Facilitate goal setting
Advise on stop-smoking medication
Motivation
Provide information on consequences of smoking and smoking cessation
Measure CO
Opportunity
Give options for additional and later support
General role
Provide information on withdrawal symptoms

9. Basis of NCSCT’s Standard Treatment Protocol (STP)

10. Effective principles of behaviour change
NICE Guidance for Behaviour Change (2007, 2014)
Effective principles of behaviour change
Maximise to regulate own behaviour
Develop relevant skills (e.g. goal setting, monitoring, feedback)
Develop specific plans to change
Increase to engage in the desired behaviour
Reward change
Develop appropriate beliefs e.g. benefits of changing, others’ approval, personal relevance, confidence to change
Develop positive feelings about changing
Reduce to continue with the undesired behaviour
Maximise to support self-regulation
Elicit social support
Avoid social and other cues for current behaviour
Change routines and environment

11. Personalising support
Assess the smoker in their context to
Decide which BCTs to include or emphasise
from the core set or beyond

12. Why personalise support? Different behaviours
Successful quitting involves a system of behaviours e.g.
Turn up to sessions
Get and adhere to medication
Change routines
Avoid risky situations, activities or people
Substitute the above for less risky ones
Seek social support
Reward oneself
For each of these, what needs to be done
with whom,
when,
where,
how?

13. Why personalise support? Different people & contexts
Capabilities
e.g. self-regulation skills – e.g. planning, distracting
Motivation
e.g. wants and needs, beliefs, routines
Contexts
Opportunity
e.g. social networks, living environments

14. Why personalise support? Research evidence
… that tailored interventions more effective
Written messages
Face-to-face counselling
Self-management interventions
Digital interventions

15. Steps for personalising support
Identify the behaviours that can support or interfere with quitting
Who need to do what, when, where, how
For the key behaviours, identify what needs to change to maximise likelihood that quitting will be successful
Make a “behavioural diagnosis”
Based on the above, use a systematic method to select BCTs
The Behaviour Change Wheel is a comprehensive framework for designing interventions

16. Make a ‘behavioural diagnosis’
Why are behaviours as they are?
What needs to change for the desired behaviour/s to occur?
Answering this is helped by a model of behaviour
COM-B

17. Making a behavioural diagnosis: the COM-B model
Psychological or physical ability to enact the behaviour
Reflective and automatic mechanisms that activate or inhibit behaviour
Physical and social environment that enables the behaviour
Michie et al (2011) Implementation Science

18. Given the behavioural diagnosis, what support is likely to be most effective?

19. The Behaviour Change Wheel: a method for linking the behavioural diagnosis to personalised support
A synthesis of 19 frameworks of behaviour change
Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions, Implementation Science

20. Behaviour at the hub …. COM-B20

21. Examples of BCTs according to behavioural diagnosis
Give options for later social support
Advise on stop-smoking medication
Facilitate relapse prevention and coping
Develop positive feelings about changing
Develop appropriate beliefs

22. Selecting BCTs: the Behaviour Change Wheel

23. For links between intervention functions to BCTs, see
Available from:

24. Add policies to help prevent uptake & maintain change long-term

25. Intervention functions
Policies
Intervention functions
Policies: decisions made by authorities concerning interventions
Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions Implementation Science

26. Effectiveness/cost-effectiveness Acceptability
Tailor BCTs & policies to people & to local context The APEASE criteria
Affordability
Practicability
Effectiveness/cost-effectiveness
Acceptability
public
professional
political
Side-effects/safety
Equity

27. In conclusion …
Personalising behavioural support will help smokers quit
To personalise support:
Assess what needs to change – capability, motivation, opportunity
On basis of ‘behavioural diagnosis’ …
identify BCTs most likely to be effective
Identify intervention types most likely to be effective and associated BCTs

28. Acknowledgements Funding Robert West Lou Atkins Fabi Lorencatto
Andy McEwen
Leonie Brose
Susan Michie

29. For more information Susan Michie Book UCL Centre for Behaviour Change
Book
UCL Centre for Behaviour Change
All proceeds from CBC teaching, training, books and products go to further development

30. UCL Centre for Behaviour Change
CBC Summer School 2016
Behaviour Change – Principles and Practice
8th – 12th August 2016
University College London
Course format
Monday to Friday, 9.30 – 17.00
Highly participatory, with short presentations, discussions and small group work
End-of-day mentoring sessions to work on own project, guided by an expert
Networking reception on the first and penultimate evenings
UCL Centre for Behaviour Change
@UCLBehaveChange

31. ADDITIONAL SLIDES IF NEEDED

32. Use rules to reduce the opportunity to engage in the
behaviour (or to increase
behaviour by reducing
opportunity to engage
in competing
behaviours)
Increase knowledge or understanding
Use communication to induce positive or negative feelings to stimulate action
Change the physical or social context
Create an expectation of reward
Provide an example for people to aspire to or emulate
Increase means
or reduce barriers to
increase capability (beyond
education or training) or opportunity
(beyond environmental restructuring)
Create expectation of punishment or cost
Imparting skills

33. Behaviour Change Wheel: many applications
India
Smartphone app to reduce cardiovascular disease risk UK
Smartphone app for parents of overweight children
Kenya
Promote recycling behaviours in university staff and students
Improve paediatric health care
Reduce cardiovascular disease risk in people with severe mental illness
Netherlands
An organisational intervention tool
Improve management of postnatal depression
Thailand
Preventing melioidosis
Smartphone app to promote attentive eating
Internet intervention to promote condom use
USA
Improving colorectal cancer screening
Providing long-acting reversible contraception to adolescents
International Red Cross
Train volunteers
Improve parenting practices for children with challenging behaviour

34. Selecting interventions and policies

35. Which policy categories should be used?
Intervention Functions
Educ
Persuas
Incent
Coerc
Train
Restric
Envir
Model
Enabl
Comm
Guid
Fiscal
Regul
Legisl
Enviro
Service

36. Content different than modes of delivery: how content is delivered
Face-to-face
Individual
Group
Distance
Population-level
Mass-media: internet, TV, radio, billboard, print media, leaflet
Individually-tailored
Phone: helpline, text, app.
Individually accessed computer programme

38. “Taxonomies” of techniques (BCTs)
Physical activity/healthy eating/mixed : 26 BCTs Abraham & Michie , 2008
Physical activity & healthy eating: 40 BCTs
Michie et al, Psychology & Health, 2011
Smoking cessation: 53 BCTs Michie et al, Annals behavioural Medicine, 2010
Reducing excessive alcohol use: 42 BCTs Michie et al, Addiction, 2012
Condom use: 47 BCTs
Abraham et al, 2012
General behaviour change: 137 BCTs
Michie et al, Applied Psychology: An International Review, 2008
Competence framework: 89 BCTs
Dixon & Johnston, 2011
Integrated and refined to produce …

39. BCT Taxonomy v1
Applies to an extensive range of behaviour change interventions
Agreed by an international consensus to be potential active components of interventions
Clearly labelled, well defined, distinct, precise; can be used with confidence by a range of disciplines and countries
Hierarchically organised to improve ease of use

40. BCT Taxonomy v1: 93 items in 16 groupings