Personalising support for smokers using the Behaviour Change

Personalising support for smokers using the Behaviour Change Wheel Susan Michie Professor of Health Psychology Director of Centre for Behaviour Change University College London @Susan. Michie UKNSCC Conference, London, 2016

Behavioral support for smoking cessation • Based on extensive evidence and forms the basis of Stop Smoking Services in many countries • In England the Stop Smoking Services provide behavioural support to about 500, 000+ smokers annually

Personalising support • There are many behaviours that a smoker needs to change to successfully quit • Each behaviour and each smoker will require different support for successful quitting • How to decide what the best support is for each smoker? • I will present a framework to help assess what needs to change for each smoker and guide the type of support to achieve that change

Behavioural support is complex • Made up of many behaviour change s T t BC n e ffer been i techniques (BCTs) d ave any ral – m k h aviou w n i o h H u t within behavioural “active ingredients” o y n i do tified ns? n o e i t d support designed to i en change behaviour v r e int – smallest components that have the potential to bring about change

e 3 1 0 , 2 B 3 9 s T C s l a Ann h e B of l. M a r avio cin i d e

The BCT smartphone app • Search by BCT label, BCT category or alphabetically or Find by search term: BCTs

Which BCTs are most effective for smoking cessation? • From the evidence … – Randomised controlled trials and observational evidence (service 4 -week quit rates) • 43 BCTs in behavioural support for smoking cessation – Michie et al, 2011, Addictive Behaviours • 16 with good evidence of effectiveness • 8 ‘core’ = good evidence + identified as important by experts

8 core BCTs supported by evidence 1. Capability 1. 2. 3. 4. Facilitate barrier identification and problem solving Facilitate relapse prevention and coping Facilitate goal setting Advise on stop-smoking medication 2. Motivation 1. Provide information on consequences of smoking and smoking cessation 2. Measure CO 3. Opportunity 1. Give options for additional and later support 4. General role 1. Provide information on withdrawal symptoms

Basis of NCSCT’s Standard Treatment Protocol (STP) www. ncsct. co. uk

Effective principles of behaviour change NIC for E Guid B Cha ehav ance iou 201 nge r 4) (20 07, • Maximise to regulate own behaviour – Develop relevant skills (e. g. goal setting, monitoring, feedback) – Develop specific plans to change • Increase to engage in the desired behaviour – Reward change – Develop appropriate beliefs e. g. benefits of changing, others’ approval, personal relevance, confidence to change – Develop positive feelings about changing Reduce to continue with the undesired behaviour • • Maximise to support self-regulation – Elicit social support – Avoid social and other cues for current behaviour – Change routines and environment

Personalising support • Assess the smoker in their context to • Decide which BCTs to include or emphasise – from the core set or beyond

Why personalise support? Different behaviours e n o • Successful quitting involves a system of ed b to s behaviours e. g. d e e – Turn up to sessions hat n w , e – Get and adherehetos medication ft , o h om – Change aroutines c e wh r o h situations, activities or people – Avoid F risky t i w en, • – Substitute above for less risky ones , whthe e r e • h – Seek social • w osupport w? h – Reward • oneself

Why personalise support? Different people & contexts • People – Capabilities • e. g. self-regulation skills – e. g. planning, distracting – Motivation • e. g. wants and needs, beliefs, routines • Contexts – Opportunity • e. g. social networks, living environments

Why personalise support? Research evidence • … that tailored interventions more effective – – Written messages Face-to-face counselling Self-management interventions Digital interventions

Steps for personalising support 1. Identify the behaviours that can support or interfere with quitting – Who need to do what, when, where, how 2. For the key behaviours, identify what needs to change to maximise likelihood that quitting will be successful – Make a “behavioural diagnosis” 3. Based on the above, use a systematic method to select BCTs – The Behaviour Change Wheel is a comprehensive framework for designing interventions

Make a ‘behavioural diagnosis’ • Why are behaviours as they are? • What needs to change for the desired behaviour/s to occur? • Answering this is helped by a model of behaviour – COM-B

Making a behavioural diagnosis: the COM-B model Psychological or physical ability to enact the behaviour Reflective and automatic mechanisms that activate or inhibit behaviour Physical and social environment that enables the behaviour Michie et al (2011) Implementation Science

Given the behavioural diagnosis, what support is likely to be most effective?

The Behaviour Change Wheel: a method for linking the behavioural diagnosis to personalised support • A synthesis of 19 frameworks of behaviour change Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions, Implementation Science

Behaviour at the hub …. COM-B

Examples of BCTs according to behavioural diagnosis Give options for later social support Advise on stopsmoking medication Facilitate relapse prevention and coping Develop positive feelings about changing Develop appropriate beliefs

Selecting BCTs: the Behaviour Change Wheel

For links between intervention functions to BCTs, see Available from: www. behaviourchangewheel. com

Add policies to help prevent uptake & maintain change long-term

Policies Intervention functions Policies: decisions made by authorities concerning interventions Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions Implementation Science

Tailor BCTs & policies to people & to local context The APEASE criteria • • Affordability Practicability Effectiveness/cost-effectiveness Acceptability – public – professional – political • Side-effects/safety • Equity www. behaviourchangewheel. com

In conclusion … • Personalising behavioural support will help smokers quit • To personalise support: 1. Assess what needs to change – capability, motivation, opportunity 2. On basis of ‘behavioural diagnosis’ … • • identify BCTs most likely to be effective Identify intervention types most likely to be effective and associated BCTs

Acknowledgements • Robert West • Lou Atkins • Fabi Lorencatto • Andy Mc. Ewen • Leonie Brose • Susan Michie Funding

For more information • Susan Michie – s. michie@ucl. ac. uk • Book – www. behaviourchangewheel. com • UCL Centre for Behaviour Change – www. ucl. ac. uk/behaviour-change All proceeds from CBC teaching, training, books and products go to further development

CBC Summer School 2016 Behaviour Change – Principles and Practice 8 th – 12 th August 2016 University College London Course format • Monday to Friday, 9. 30 – 17. 00 • Highly participatory, with short presentations, discussions and small group work • End-of-day mentoring sessions to work on own project, guided by an expert • Networking reception on the first and penultimate evenings UCL Centre for Behaviour Change www. ucl. ac. uk/behaviour-change @UCLBehave. Change

ADDITIONAL SLIDES IF NEEDED

Use rules to reduce the opportunity to engage in the behaviour (or to increase behaviour by reducing opportunity to engage in competing behaviours) Increase knowledge or understanding Use communication to induce positive or negative feelings to stimulate action Change the physical or social context Create an expectation of reward Provide an example for people to aspire to or emulate Increase means or reduce barriers to increase capability (beyond education or training) or opportunity (beyond environmental restructuring) Create expectation of punishment or cost Imparting skills

Behaviour Change Wheel: many applications India • Smartphone app to reduce cardiovascular disease risk Kenya • Improve paediatric health care Netherlands • An organisational intervention tool Thailand • Preventing melioidosis USA • Improving colorectal cancer screening • Providing long-acting reversible contraception to adolescents • Improve parenting practices for children with challenging behaviour UK • Smartphone app for parents of overweight children • Promote recycling behaviours in university staff and students • Reduce cardiovascular disease risk in people with severe mental illness • Improve management of postnatal depression • Smartphone app to promote attentive eating • Internet intervention to promote condom use International Red Cross • Train volunteers

Selecting interventions and policies

Which policy categories should be used? Intervention Functions Educ Comm Guid Fiscal Regul Legisl Enviro Service Persuas Incent Coerc Train Restric Envir Model Enabl

Content different than modes of delivery: how content is delivered • Face-to-face – Individual – Group • Distance – Population-level • Mass-media: internet, TV, radio, billboard, print media, leaflet – Individually-tailored • Phone: helpline, text, app. • Individually accessed computer programme

www. bct-taxonomy. com

“Taxonomies” of techniques (BCTs) • Physical activity/healthy eating/mixed : 26 BCTs Abraham & Michie , 2008 • Physical activity & healthy eating: 40 BCTs … e c u d Michie et al, Psychology & Health, 2011 • Smoking cessation: 53 BCTs o pr Michie et al, Annals behavioural Medicine, 2010 o t d • Reducing excessive alcohol use: 42 BCTs if ne e r d Michie et al, Addiction, 2012 n a • Condom use: d 47 BCTs e t Abraham et g al, ra 2012 e t n I • General behaviour change: 137 BCTs Michie et al, Applied Psychology: An International Review, 2008 • Competence framework: 89 BCTs Dixon & Johnston, 2011

BCT Taxonomy v 1 • Applies to an extensive range of behaviour change interventions • Agreed by an international consensus to be potential active components of interventions • Clearly labelled, well defined, distinct, precise; can be used with confidence by a range of disciplines and countries • Hierarchically organised to improve ease of use

BCT Taxonomy v 1: 93 items in 16 groupings