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      The behaviour change wheel: A new method for characterising and designing behaviour change interventions

        , 1 , 2 , 3

      Implementation Science : IS

      BioMed Central

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          Abstract

          Background

          Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.

          Methods

          A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity.

          Results

          Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity.

          Conclusions

          Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

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          Most cited references 24

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          Making psychological theory useful for implementing evidence based practice: a consensus approach.

          Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.
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            Reflective and impulsive determinants of social behavior.

            This article describes a 2-systems model that explains social behavior as a joint function of reflective and impulsive processes. In particular, it is assumed that social behavior is controlled by 2 interacting systems that follow different operating principles. The reflective system generates behavioral decisions that are based on knowledge about facts and values, whereas the impulsive system elicits behavior through associative links and motivational orientations. The proposed model describes how the 2 systems interact at various stages of processing, and how their outputs may determine behavior in a synergistic or antagonistic fashion. It extends previous models by integrating motivational components that allow more precise predictions of behavior. The implications of this reflective-impulsive model are applied to various phenomena from social psychology and beyond. Extending previous dual-process accounts, this model is not limited to specific domains of mental functioning and attempts to integrate cognitive, motivational, and behavioral mechanisms.
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              Effective techniques in healthy eating and physical activity interventions: a meta-regression.

              Meta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically specified BC techniques improve outcome. Interventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults, were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically derived combination of self-regulation techniques, were assessed using meta-regression. Valid outcomes of physical activity and healthy eating. The 122 evaluations (N = 44,747) produced an overall pooled effect size of 0.31 (95% confidence interval = 0.26 to 0.36, I(2) = 69%). The technique, "self-monitoring," explained the greatest amount of among-study heterogeneity (13%). Interventions that combined self-monitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 vs. 0.26). Classifying interventions according to component techniques and theoretically derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating. PsycINFO Database Record (c) 2009 APA, all rights reserved.
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                Author and article information

                Journal
                Implement Sci
                Implementation Science : IS
                BioMed Central
                1748-5908
                2011
                23 April 2011
                : 6
                : 42
                Affiliations
                [1 ]Research Dept of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
                [2 ]VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam
                [3 ]Health Behaviour Research Centre, University College London Epidemiology and Public Health, London, UK
                Article
                1748-5908-6-42
                10.1186/1748-5908-6-42
                3096582
                21513547
                Copyright ©2011 Michie et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research

                Medicine

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