Behaviour change training development: A Needs Assessment Questionnaire

1. 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

2. The Importance of Behaviour “Lifestyle” behaviours major cause of avoidable deaths (Mokdad, 2004) General population Primary Prevention ↓ harmful behaviours • Smoking • Alcohol use • Poor diet • Unsafe sex • Risky driving ↑ protective behaviours • Physical activity • Healthy diet • Safe driving • Safe drinking • Safe sex Patients Secondary prevention ↑ Adherence to treatment ↓ Delay in seeking help Health professionals ↑ implementation of evidence-based practice

3. Needs Assessment Outline Five questionnaire sections • Previous training • Specific behaviour change techniques • Thoughts on behaviour change practice • Training preference • Barriers to training

4. 1. Previous Training Why? • Shows where people are at • Shows the difference between people • Shows what has been useful/ less useful • Avoids repetition

5. Meeting with health care professional: Behaviour change techniques Information provision What the client thinks: Perceptions, beliefs and cognitions Knowledge Verbal persuasion Attitude Overall goal setting Motivation Behaviour Change Specific goal setting Intention Action & coping planning Planning Self-monitoring Action Control 2. Specific Behaviour Change Techniques Why? • Used in behaviour change practice aimed at what the client thinks and does Abraham, Sheeran, & Johnston, 1998;Michie & Abraham, 2004;Michie et al., 2005

6. 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)

7. A Taxonomy of Techniques 1.General information 2. Information on consequences 3. Information about approval 4. Prompt intention formation 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 15. General encouragement 16. Contingent rewards 17. Teach to use cues 18. Follow up prompts 19. Social comparison 20. Social support/ change 21. Role model 22. Prompt self talk 23. Relapse prevention 24. Stress management 25. Motivational interviewing 26. Time management Michie & Abraham, 2008

8. Evidence Which message might be more effective if you want to change somebody‘s smoking behaviour? • Suggests which techniques to use/teach • Can prevent: • Ineffective training • Backfire effects • Unwanted effects • Suggests how to use the techniques

9. Sources of Evidence • Research studies, e.g. Randomised Controlled Trials • (Systematic) reviews, e.g. Cochrane reviews, HTA reviews • Guidelines, e.g. SIGN, NICE

10. 3. Thoughts on Behaviour Change Practice Why? • Understand health care professional’s view on proving behaviour change practice (a behaviour in itself) Behaviour change Behaviour change Health care professional Patient Health Marteau, Dieppe, Foy, Kinmonth, & Schneiderman, 2006

11. 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

12. 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

13. 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

14. 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.

15. 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