1. Changing healthcare professional behaviour: the Behaviour Change Wheel
Robert West
University College London
March 2013

2. Aims
To provide a structured way of thinking about behaviour change to help develop an optimal intervention strategy
To prompt a discussion in how to apply this to promote appropriate prescribing of varenicline

3. Changing behaviour: the basics of designing an intervention strategy
Decide exactly what do you want your target group to do?
Perform a ‘behavioural diagnosis’ of ‘what it would take’ to achieve this in terms of improving capability, opportunity and motivation
Identify relevant ‘intervention functions’ and ‘behaviour change techniques’

4. What should health professionals do?
Find out if their patients smoke
If they smoke,
advise on the best ways of stopping
offer help with stopping
act on the response

5. Behavioural diagnosis: the COM-B model
have the physical and psychological capability
have the physical and social opportunity
be more motivated to do it at the relevant time than anything else
For any behaviour to occur the individual or group must
Michie et al 2011 Implementation Sci

6. What does being capable mean?
We know, understand, accept and remember
what to do
why we should do it
how to do it
We have the mental and physical skills to act appropriately when appropriate

7. What does having the opportunity mean?
Physical opportunity
access to necessary resources
absence of competing demands on time
exposure to necessary prompts
Social opportunity
social norms

8. What being motivated mean?
At every moment we act in pursuit of what we most want or need at that moment
We can only want what we can imagine
We want things that we feel positive anticipation about
We need things that promise relief from physical or mental discomfort

9. Behaviour Change Wheel
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, 42.

10. 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

11. Health professional interventions
Education
Ensure that HPs know, understand and believe the benefits of recommending and prescribing varenicline to their patients where appropriate, and how to do it
Persuasion
Ensure that HPs feel positively about engaging with patients in this way
Incentivisation
Not appropriate
Coercion
Training
Ensure that HPs have the clinical and communication skills needed to engage with patients in this way
Restriction
Environmental restructuring
Provide prompts for recommending and prescribing varenicline
Modelling
Provide models for appropriate prescribing behaviour
Enablement

12. Policy options Comms/marketing
Using print, electronic, telephonic or broadcast media
Guidelines
Creating documents that recommend or mandate practice. This includes all changes to service provision
Fiscal
Using the tax system to reduce or increase the financial cost
Regulation
Establishing rules or principles of behaviour or practice
Legislation
Making or changing laws
Env/Soc Planning
Designing and/or controlling the physical or social environment
Service provision
Delivering a service

13. Policy options to promote appropriate varenicline prescribing
Comms/marketing
Develop paid and unpaid media, direct communications campaigns,
Guidelines
Sponsor and help to shape guideline development and implementation
Fiscal
Not appropriate
Regulation
Contribute to regulatory processes
Legislation
Env/Soc Planning
Service provision
Provide accessible, attractive training courses (e.g. online)

14. Discussion What is the target behaviour? What will it take? Capability
Opportunity
Motivation
What intervention functions offer most promise?
How can these be implemented?