Response to reviewers – Methods for environmental change
We thank the reviewers for their thoughtful comments; we have tried to integrate their suggestions
and we think it made the paper better.
Editor:
We also need you to make the following Editorial changes: Please provide the specific name of the
ethics committee which granted the approval within your manuscript.
Done: The study was approved by the Ethics Committee of the School of Psychology and
Neuroscience, Maastricht University.
Reviewer: Stephan Dombrowski
Minor Essential Revisions
Abstract:
- It might be worthwhile to explicitly introduce the two key concepts of “bundling” and “At/From” in
the background section.
We mention: In this survey, the focus is on methods for environmental change; especially about how
these are composed of methods for individual change (‘Bundling’) and how within one environmental
level, organizations, methods differ when directed at the management (‘At’) or applied by the
management (‘From’).
- The abstract mentions the survey methodology in the background, which could be moved to the
methods section.
Done
Methods:- The methods are described at an adequate level allowing replication
- If possible, could the authors perhaps explain a little more on how the lists of methods were
initially developed?
We added an explanation to the methods table in the Appendix:
These definitions are originally based on theoretical descriptions in the literature, as indicated for
each method. Preliminary definitions were formulated and send out to 50 colleagues in the field of
health promotion and health psychology for evaluation and improvement. About 40 colleagues
responded with suggestions and the authors of the 3rd edition of Bartholomew et al. (2011)
formulated the final definitions.
- Similarly, it would be good if the authors could provide a little more detail regarding the choice of
particular methods from these lists. Currently it is stated that “Methods were chosen based on
theoretical clarity, on diversity over determinants and over environmental levels, and on preliminary
expectations of the research team (p.6)”, which could be elaborated on (e.g. what was meant by
theoretical clarity, which determinants, etc.)
We now write: Methods were chosen based on a) theoretical clarity, high consensus about the
definition of the method, 2) diversity over determinants, e.g.: attitudes, social influences and self-
efficacy, and diversity over environmental levels: interpersonal, organizational, community and policy
levels, and on d) preliminary expectations of the research team that the theory behind the method
already suggests the expected bundling or the specific use for At or From.
Discussion:
- The first sentence of the discussion might need some amending to increase clarity “The two-part
survey reported here constituted a study among health promotion experts on Bundling and ‘At’ and
‘From” (p.10).
We now say: The survey reported here constituted a study among health promotion experts with two
parts, one on Bundling and one on ‘At’ and ‘From’.
- Overall, the discussion of the findings of the research is well done. There might be some scope to
further integrate the current study within the wider literature.
For example, one interesting question could be how this approach relates to the other taxonomies
that have been published/are currently being developed.
- The authors might want to expand on how this work can aide intervention specification with a view
to application, by for example outlining future research on how parameters for change can be
integrated into method specifications.
We added the following to the last paragraph of the discussion: Finally, taxonomies of environmental
change methods should include the theoretical parameters that limit the effectiveness of the
theoretical process; in this case a combination of parameters associated with the various individual
level methods bundled in the environmental level method. For example, Participatory problem
solving is defined as: Diagnosing the problem, generating potential solutions, developing priorities,
making an action plan, and obtaining feedback after implementing the plan (see Appendix 1).
Bartholomew et al. (2011) mention the following parameters: Requires willingness by the health
promoter or convener to accept the participants as equals and as having a high level of influence;
requires target group to possess appropriate motivation and skills (p. 347). In table 1, the four most
often used individual level methods are: goal setting, facilitation, feedback, and consciousness
raising. These four methods have their own parameters which are different from those for
participatory decision making. For example, the parameters for goal setting are: Commitment to the
goal; goals that are difficult but available within the individual’s skill level (p. 344). The parameters
for consciousness raising are: Can use feedback and confrontation; however, raising awareness must
be quickly followed by increase in problem-solving ability and (collective) self-efficacy (p. 333).
Program planners, who apply environmental methods for change, need to be aware of the
parameters under which that method may be effective. And, as a consequence of the bundling, they
also need to be aware of the parameters for the individual level methods that are part of the
environmental method. Other taxonomies that have been published [3] or are currently being
developed, should not only focus on correct definitions but also on adequate parameters for use.
- The main limitations are addressed by the authors. Limitations which the authors might want to
address in addition are:
o Labels and definitions for methods might need optimising in some cases (e.g. reinforcement/
punishment as the authors acknowledge). The definitions are relatively brief in comparison to other
behaviour change techniques (although this is adequate for the current purpose of the study).
o The current study focuses primarily on the organisation as an example of an environmental agent,
not on the full spectrum of environmental agents. This should be acknowledged.
We added to the limitations: Some of the methods and definitions were inadequate, for example the
combination of reinforcement/punishment. This study was focused on the organizational level and
future studies should also focus on other levels: interpersonal, community, and policy level.
Discretionary Revisions
Introduction:
- The authors do a good job explaining several complex and often abstract concepts. The examples
are particularly helpful in this regard. One addition which might further increase clarity for some
readers could be a diagrammatic presentation which shows how different concepts which the
authors outline are interrelated.
We added four figures that may help the reader understand parameters, bundling and At/From
better
- The authors use the “At/From” distinction, but also refer to this switch in perspective as
“outside/inside” an organisation. I find the latter figure of speech intuitively more appealing,
although “At/From” is perfectly adequate, albeit more abstract.
That is true, however, inside/outside is often used in organizational psychology to indicate the source
of the innovation, which would be confusing here.
Results:
- Although the presented tables are informative by themselves, is there a possibility of combining
these? Individual methods could be put in rows, environmental methods in columns and individual
means (SDs) in the individual boxes where methods meet. Scores above a certain number could still
be indicated through emphasis or colour. This would also allow ranking of methods according to the
number of bundles to which it could be assigned (according to the used cut-off).
We already tried a number of alternatives and every time concluded that the result made it more
difficult to understand. We think this presentation is the best.
Discussion:
- One further area that the authors might want to discuss is that the use of environmental methods
might lead to a different mix of individual level techniques which are often unspecified. This would
further stress the importance of the current work and suggest that interventions described at the
environmental level might need to specify techniques at a lower level which might invariably be
involved within these interventions.
We hope our addition to the conclusion section already covers that.
Reviewer: Caroline Wood
Minor Essential Revisions:
1a) In the results section of the abstract, the authors state 'Methods at the individual level are
frequently bundled together as part of a method at a higher ecological level. However, the
differences are not large; a number of individual level methods...'. In my view, it is somewhat
difficult for the reader to ascertain the 'differences' to which the authors are referring and instead,
distracts the main findings.
Yes, we see the confusion. We left out the differences statement and now formulate this as follows:
Moreover, a number of individual level methods are popular as part of most of the environmental
level methods, while some others are obviously not chosen very often.
1b) In the second paragraph of the discussion section, the authors state again that 'the differences
are not extremely large'. It is unclear that this relates to the differences between mean ratings for
the individual/environmental methods. Perhaps use of the term 'differentiation' or 'distinction'
between methods instead of 'differences' might address points 1a and 1b.
Idem: Only a few methods show substantial differences in use, for example Advocacy and Lobbying,
Organizational Diagnosis and Feedback, Persuasive Communication, and Forming Coalitions are
clearly seen as more popular with the health promoter targeting an organization than with a
manager targeting employees. For Direct Experience, it is the other way around.
2) In the introduction section within the 'Ecological approach' paragraph, the authors state 'the
planner has to identify the desired behaviors...'. To add clarity this should read 'program planner' as
in Bartholomew et al. (2011).
Done
3) The last sentence of the background section within the abstract: 'All of the 20 respondents are
experts in the field of health promotion' relates more to the method section of the abstract.
Done
Discretionary Revisions:
The authors suggest in their conclusions that one direction for future research in this area would be
to 'cover more methods to rate and more methods to be rated'. Acknowledging the exploratory
nature of this study, I would agree with the authors' decision to initially assess 'bundling' of levels by
mean ratings. However, and as mentioned within the discussion section, the use of a scale may have
restricted the extent to which large 'differences' or 'differentiation' between the methods could be
drawn. My feeling would be that use of other evaluative methods e.g. a closed card sort grouping
task, in which respondents are invited to allocate individual level to environmental level methods
might help exploration of groupings in future research. This methodology would work well alongside
future possibilities of a qualitative design as suggested by the authors.
Agreed; we now say: Future research needs to cover more methods to rate and more methods to be
rated, while exploring alternative ways to allocate individual to environmental level methods.