1. ‘Building Bridges’ An innovative tool to capture small health behaviour changes; the development process. Mills, H., Uphill, M., & Weed, M. Introduction A UK regional community service highlighted a need for an assessment tool to allow patients and providers to observe more clearly health changes being made as a result of various lifestyle (exercise/diet) interventions. Based on this remit, a research programme evolved with the aim of designing an evaluative tool to capture small health related changes. Three parameters were provided: (1) the tool should be a visual scale; (2) the questions should be appropriately worded for patients from varying educational backgrounds; (3) the tool should be designed to be completed independently, without the need for support. The main purpose of the tool was to be that rather than capturing behaviour change (e.g. sustained increased exercise), it should capture pre-cursers to actual behaviour change, such as changes in health related knowledge, attitudinal changes, and experimental new behaviours.. Figure 1: Initial ideas for layout provided by regional community service Review of the literature Concepts such as: readiness to change; barriers and benefits to exercise; fitness attitudes; perceived behavioural control; intentions to exercise; considerations of best practice in evaluating complex interventions. Sounds nothing like me Sounds exactly like me Figure 2: Revised visual layout given to patients for feedback Being healthy is important to me... Pilot Draft Given to 15 exercise referral scheme participants to complete and to provide qualitative feedback on the process of completion. This feedback, in combination with a review from an academic peer group led to considerations for refinement. I am confident I can be a physically active person Figure 3 ‘Bridges to Better Health’ (example question). Principal component analysis (PCA) examined the factor structure (n=94). PCA is concerned with establishing which linear factors exist within the data and how a particular item might contribute toward that factor (Field, 2009), i.e. do patients’ answers consistently group around one or more of factors. The preliminary validation, utilising tolerances (.04 to.07) widely accepted in the social sciences (Costello & Osborne, 2005), suggests that Bridges to Better Health measures three factors. Labels ascribed to the 3 dimensions of health behaviour change that the PCA indicated are: 1. Perceived priority: The degree to which, at the present time, the patients see their health behaviours as a priority. 2. Self efficacy: The patients’ ‘confidence’ regarding their health behaviours and the control they feel they have over them. 3. Behaviour : The degree to which patients are ‘trying out’ behavioural changes (e.g. different shopping or cooking behaviours, or incidental exercise). Development process Preliminary Validation References Costello, A.B & Osborne, J.W (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation, 10,(7). Field, A. (2009). Discovering Statistics using SPSS. 3 rd ed. Sage: London The next steps... Current research is attempting to determine the precise factor structure and confirm it as stable and enduring. Following this, a pilot study will analyse data from pre and post (weight management related) local interventions to be able to comment more comprehensively on the measure’s ability to be a sensitive tool in an applied community setting. The early indications are that ‘Bridges to Better Health’ may indeed assess the crucial behaviour change concepts through the medium of small changes in intentions and behaviours. Referring to regular minor changes, for example - ‘less sugar in tea’ and ‘taking the stairs’ indicate that it may become a useful tool in retrieving indicators of small changes as the patients are guided toward better health decisions. The bridge trusses represent a clear, usable scale to aid data input for the researcher.