The Behaviour Change Wheel:
a system for designing effective
interventions
Susan Michie
Professor of Health Psychology, University
College London
Chair, Behaviour and Communications group, UK’s
Scientific Pandemic Influenza Advisory Committee (SPI)
Purposes of communication in relation to
pandemic flu
• In terms of public health, the ultimate purpose
of communication is to change behaviour
• Increase knowledge and understanding for its
own sake?
– Purpose: social and political
• Increase knowledge and understanding in
order to change health-related behaviour
– Purpose: reduce disease transmission and severity
Behaviour
• After vaccines, changing behaviour is the
most important factor in reducing harm
caused by influenza
• Vaccines, themselves, depend on behaviour
– Health professional offer and delivery
– Attendance at clinic
What other behaviours?: WHO, 2010
• Keep at least 1 metre distance from people who show
symptoms of influenza-like illness
• reduce the time spent in crowded settings
• improve airflow in living spaces by opening windows
• avoid touching mouth, nose and eyes if possible
– and most importantly,
• clean hands thoroughly with soap and water, or with an
alcohol-based hand rub on a regular basis.
What can I do to protect myself from catching pandemic (H1N1) 2009?
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/
index.html (27.11.2010).
Communicating to change behaviour
• Health Education model
X not sufficient
– Give information
• About risk and what to do
• Increase worry
• Other influences on behaviour
– Skills and confidence
• That people can conduct the recommended behaviours
• That the recommended behaviours will be beneficial
– Mental models
• about illness, risk, behaviours
– Context
• Social influences and environment
This talk: a system for designing
effective interventions
1. Start with the target behaviour
•
•
Precise description
Understanding of its determinants
2. Consider full range of possible interventions and
policies
3. Identify specific behaviour change techniques
4. Design communication strategy to support the
above
Effective communication requires …
• An analysis of the target behaviour
– Who needs to do what, when and how
– understanding as to why desired behaviour is not
occurring
• A method for selecting types of intervention and
specific behaviour change techniques
• Modes of delivery of behaviour change techniques
– Media, messages, images, source
An analysis of the target behaviour: Why are
desired behaviours not happening?
• Use theories of behaviour change
• We have many relevant psychological
theories and models of behaviour and
behaviour change
• Not generally used in communications design
and delivery
• Need to integrate and simplify to make
useable
Behaviour change theories: 3 groups
• Motivational: explain behaviour of people who
have not yet established intention
– e.g. Theory of Planned Behaviour, Operant Learning Theory
• Action: explain behaviour of people who have
identified a need to change
– e.g. Control Theory/Self-regulation Theory
• Organisational: explain ‘institution’ level change
– e.g. Diffusion of Innovation
Consensus study to integrate and simplify
behaviour change theory
• Participants
– 18 researchers in health psychology with an interest in
theory and implementation research
– 14 implementation researchers from UK, Netherlands and
Canada
• 33 theories and 128 constructs generated
• Simplified into 12 domains of theoretical constructs
• Interview questions associated with each domain
Michie et al (2005) Making psychological theory useful for implementing evidence
based practice: a consensus approach, Quality and Safety in Health Care, 14, 2633
What is the purpose of the
guidelines?
What do they think about the
credibility of the source?
Results: Theoretical domains
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Do they think guidelines should
determine their behaviour?
Knowledge
Is doing x compatible or in conflict
with professional
Skills
standards/identity?
Professional role and identity
Beliefs about capabilities
Beliefs about consequences
How much do they want to do x?
Motivation and goals
How much do they feel they need
to do x?
Memory, attention and decision processes
Are there other things they want to
Environmental context and resources
do or achieve that might interfere
with x?
Social influences
Does the guideline conflict with
others?
Emotion
Are there incentives to do x?
Action plans
12. Nature of the behaviour
Behaviour emerges from interactions
between three necessary conditions …
Capability
Motivation
Opportunity
Psychological or physical ability to
enact the behaviour
Behaviour
Reflective and automatic mechanisms
that activate or inhibit behaviour
Physical and social environment that
enables the behaviour
“COM-B system”
Motivation: reflective and automatic
Reflective
Beliefs about what is good and bad,
conscious intentions, decisions and
plans
Automatic
Emotional responses, desires and
habits resulting from associative
learning and physiological states
Reflective-Impulsive Model, Strack & Deutsch, 2004
PRIME Theory of Motivation, West, 2006
Need a framework for designing interventions
with following criteria:
1. Comprehensive coverage
2. Coherence
3. Clear link to a model of behaviour
Useable by, and useful to, policy makers,
service planners and intervention designers
Systematic review of current frameworks
• Search
– 3 electronic databases were systematically searched for
frameworks of behaviour change interventions
– 8 experts in behaviour change were consulted
• 19 frameworks identified covering
– 16 categories
– distinction between
• ‘interventions’ whose target is behaviour and
• ‘policies’ that enable or support those interventions
Behaviour at the hub …. COM-B
Result
• The Behaviour Change Wheel
– A system for choosing interventions and policies
Behaviour at the hub …. COM-B
Behaviour at the hub …. COM-B
Model of Behaviour
Physical
Psychological
Reflective
Physical
Automatic
Social
The Behaviour Change Wheel
• Model of behaviour at the hub of a wheel (COM-B)
• Around this, 9 intervention functions
•
Interventions:
– activities
Each include one or more specific
techniques
designed
to
change
Around
this, 7 policy categories
behaviours
behaviour change
– that could enable or support these interventions to
occur
Intervention functions
Policies:
decisions
made by
authorities
concerning
interventions
Policy categories
Communication/ marketing Using print, electronic,
telephonic or broadcast media
Guidelines
Creating documents that
recommend or mandate practice
Fiscal
Using the tax system
Regulation
Legislation
Establishing rules or principles of
behaviour or practice
Making or changing laws
Environmental/ social
planning
Service provision
Designing and/or controlling the
physical or social environment
Delivering a service
Applying this system to designing behaviour
change interventions
Steps
1. Analyse behaviour using COM-B
2. Link to possible intervention functions
3. Select intervention functions
– Feasibility, acceptability, cost effectiveness
4. Choose specific behaviour change techniques
5. Select supportive policies
Behaviour Change Techniques (BCTs)
• “Active ingredients” within the intervention
designed to change behaviour. They are
observable, replicable and irreducible components
of an intervention. Can be used alone or in
combination with other BCTs.
Guidelines for specifying interventions
• CONSORT guidelines for reporting RCTs
– Evaluators should report “precise details of interventions [as]
actually administered” Moher et al, 2001
• Which details? Davidson et al, Annals of Beh Med, 2003
–
–
–
–
–
–
–
–
the content or elements of the intervention
characteristics of those delivering the intervention
characteristics of the recipients,
characteristics of the setting (e.g., worksite)
the mode of delivery (e.g., face-to-face)
the intensity (e.g., contact time)
the duration (e.g., number sessions over a given period)
adherence to delivery protocols
To describe content ….
• Need a reliable method
– distinct BCTs
– standardised and precise language
• Examples of taxonomies
– 40 BCTs identified from interventions to change physical activity
and healthy eating
Michie et al, Psychology & Health, 2011
– 71 techniques used in smoking cessation interventions
Michie et al, Annals Behavioral Medicine, 2010
– 137 identified by consulting textbooks for applied psychology
training
Michie et al, Applied Psychology: An International Review, 2008
Behaviour change techniques: reliable taxonomy
to change physical activity and healthy eating behaviours
Involves detailed planning of what the person will do
including, at least, a very specific definition of the
behaviour e.g., frequency (such as how many times a
15. (e.g.,
General
encouragement
day/week), intensity
speed)
or duration (e.g., for how
General information
long for). In addition,
at least one ofrewards
the following contexts
16. Contingent
Information on consequences
i.e., where, when, how or with whom must be specified.
17.identification
Teach toofuse
cues or preparatory
sub-goals
Information about approvalThis could include
contexts
in which the behaviour
18.specific
Follow
up prompts
Prompt intention formationbehaviours and/or
will be performed.
1.
2.
3.
4.
5. Specific goal setting
6. Graded tasks
7. Barrier identification
8. Behavioral contract
9. Review goals
10. Provide instruction
11. Model/ demonstrate
12. Prompt practice
13. Prompt monitoring
14. Provide feedback
19. Social comparison
20. Social support/ change
21. Role model
22. Prompt self talk
23. Relapse prevention
24. Stress
The
personmanagement
is asked to keep a
25. Motivational
record
of specified interviewing
behaviour/s.
This
take the form of a
26.could
Time e.g.
management
diary or completing a
questionnaire about their
behaviour.
Abraham & Michie (2008). A taxonomy of behavior change techniques used in
interventions. Health Psychology.
Conclusion: a system for designing
effective interventions
1. Start with the target behaviour
•
•
Precise description
Understanding of its determinants
2. Consider full range of possible interventions and
policies
3. Identify specific behaviour change techniques
4. Design communication strategy to support the
above
For more information
Susan Michie
s.michie@ucl.ac.uk
Website: Google ‘Susan Michie’