Behaviour change training development:

A Needs Assessment Questionnaire

Stephan Dombrowski

Health Psychologist in Training

s.dombrowski@nhs.net

Anticipatory Care Practitioners Network Event 5th May 2009

The Importance of Behaviour

General populationPrimary Prevention↓ harmful behaviours

– Smoking– Alcohol use– Poor diet– Unsafe sex– Risky driving

↑ protective behaviours– Physical activity– Healthy diet– Safe driving– Safe drinking– Safe sex

PatientsSecondary prevention↑ Adherence to treatment

↓ Delay in seeking help

Health professionals ↑ implementation of evidence-based practice

“Lifestyle” behaviours major cause of avoidable deaths (Mokdad, 2004)

Needs Assessment Outline

Five questionnaire sections1. Previous training

2. Specific behaviour change techniques

3. Thoughts on behaviour change practice

4. Training preference

5. Barriers to training

1. Previous Training

Why?

• Shows where people are at

• Shows the difference between people

• Shows what has been useful/ less useful

• Avoids repetition

2. Specific Behaviour Change Techniques

Why?• Used in behaviour change

practice aimed at what the client thinks and does

Behaviour

Change

Attitude

Motivation

Intention

Planning

Action Control

Knowledge

Verbal persuasion

Overall goal setting

Specific goal setting

Action & coping planningSelf-monitoring

Information provision

Meeting with health care professional:

Behaviour change techniques

What the client thinks:

Perceptions, beliefs and cognitions

Abraham, Sheeran, & Johnston, 1998; Michie & Abraham, 2004; Michie et al., 2005

Behaviour Change Techniques

• Key strategies aimed at changing behaviour• “Tools” that make up behaviour change practice

– Reportable– Replicable– Effective– Generic

• How many techniques are there?– Taxonomy: 26 techniques Abraham & Michie (2008)

– Literature search: 137 techniques Michie et al. (2008)

A Taxonomy of Techniques

1. General information 2. Information on consequences3. Information about approval4. Prompt intention formation 5. Specific goal setting 6. Graded tasks7. Barrier identification8. Behavioral contract9. Review goals10. Provide instruction11. Model/ demonstrate 12. Prompt practice13. Prompt monitoring

14. Provide feedback 15. General encouragement16. Contingent rewards17. Teach to use cues 18. Follow up prompts19. Social comparison20. Social support/ change21. Role model22. Prompt self talk

23. Relapse prevention24. Stress management25. Motivational interviewing26. Time management

Michie & Abraham, 2008

Evidence

• Suggests which techniques to use/teach• Can prevent:

– Ineffective training – Backfire effects– Unwanted effects

• Suggests how to use the techniques

Which message might be more effective if you want to change somebody‘s smoking behaviour?

Sources of Evidence

• Research studies, e.g. Randomised Controlled Trials• (Systematic) reviews, e.g. Cochrane reviews, HTA

reviews• Guidelines, e.g. SIGN, NICE

3. Thoughts on Behaviour Change Practice

Why?• Understand health care

professional’s view on proving behaviour change practice (a behaviour in itself)

HealthPatientHealth care professional

Behaviour change

Behaviour change

Marteau, Dieppe, Foy, Kinmonth, & Schneiderman, 2006

4. Training preference

Why?• Pick up any perceived

training need• Match perceived training

needs with the evidence base

• Get further indication which techniques might be most important for training

5. Barriers to training

Why?• Make sure health care

professionals can actually turn up for training.

“What use is the nicest son-in-law if he doesn’t score?”

Uli Hoeneß

Take home mesasges

• Behavioural focus is important

• Behaviour change is complex

• Behaviour change techniques = tools for change

• Evidence is crucial in plannning training

• Practicalities limit training

• The needs assessment combines evidence with need & available resources

References• Importance of behaviour:

Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the united states, 2000. Journal of the American Medical Association, 291(10), 1238-1245.

Marteau, T., Dieppe, P., Foy, R., Kinmonth, A. -., & Schneiderman, N. (2006). Behavioural medicine: Changing our behaviour. British Medical Journal, 332(7539), 437-438.

• Behaviour change techniques:

Abraham, C., & Michie, S. (2008). A taxonomy of behaviour change techniques used in interventions. Health Psychology, (3), 379-87.

Michie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008). From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology: An International Review, 57(4), 660-680.

• Behaviour change evidence:

Health Scotland. (2008). Interventions: Overview of guidelines and evidence. Edinburgh: Health Scotland. Retrieved from http://www.healthscotland.com/uploads/documents/8363-Keep%20Well%20Interventions%20Report%20low-res.pdf

Michie, S., Jochelson, K., Markham, W. A., & Bridle, C. (2008). Low-income groups and behaviour change interventions: A review of intervention content and effectiveness No. 2008). London: The King's Fund. Retrieved from http://www.kingsfund.org.uk/publications/other_work_by_our_staff/lowincome_groups.html

National Institute for Health and Clinical Excellence. (2007). Behaviour change at population, community and individual levels. London: NICE. Retrieved from http://www.nice.org.uk/nicemedia/pdf/PH006guidance.pdf

• Psychological theory:

Abraham, C., Sheeran, P., & Johnston, M. (1998). From health beliefs to self-regulation: Theoretical advances in the psychology of action control. Psychology and Health, 13(4), 569-591.

Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality & Safety in Health Care, 14, 26-33.

Michie, S., & Abraham, C. (2004). Interventions to change health behaviours: Evidence-based or evidence-inspired? Psychology and Health, 19(1), 29-49.

Behaviour change training development:

A Needs Assessment Questionnaire

For further questions, comments

or thoughts please contact:Stephan Dombrowski

Health Psychologist in Training

NHS Grampian

Summerfield House

2 Eday Road

Aberdeen

AB15 6RE

Tel.: 01224 558483

Email: s.dombrowski@nhs.net