Introduction to behaviour change techniques
Changing health-related behaviours in people can have a major impact on their risk of lifestyle-related disease (e.g. cardiovascular disease, type II diabetes). This is because behaviour plays an important role in the health and well-being of people (e.g. smoking, poor diet, lack of physical activity). Research shows peoples' behavioural patterns are largely determined by their social circumstances and cultural contexts. Although genetic pre-dispositions contribute to physical illness in some people, they are generally less important than many people think.
Changing behaviour isn’t easy. It is difficult to change your own behaviour and even more challenging to achieve change in other people. But the good news is, it is possible (think about the huge impact of “nudging” interventions, such as a small charge on plastic bag usage).
Many people know what a healthy diet looks like and that physical activity is good for them, but still struggle to live healthily. Education may be important (and for some may be enough to instigate behavioural change), but for many people education alone will not change behaviour. Therefore families are more likely to change if, rather than simply giving information, you use behaviour change techniques (BCT) to help them change their physical activity and diet.
A behaviour change technique (BCT) is a strategy that helps an individual change their behaviour to promote better health (e.g. setting goals, taking unhealthy foods out of the house, or packing your sports kit the evening before). Parents can learn to apply behaviour change techniques in their own life to increase their chances of keeping up a healthy lifestyle.
Useful behaviour change techniques for healthy eating and physical activity
A wide range of behaviour change techniques have been identified in psychological research1. It is likely you already use a number of these in your own life and in your day-to-day practice (e.g a number of practitioners in Blackburn with Darwen reported to be already using follow-ups to continue support and assess progress of families2). Commonly used behaviour change techniques for promoting healthy eating and physical activity include:
- Providing information on consequences of behaviour (to the individual): this involves providing information about the costs and benefits the individual’s actions may have (e.g. explaining that being physically active together may improve family relationships)
- Environmental restructuring: this involves altering the environment to make healthy living easier (e.g. not having unhealthy food in the house, and putting fruit/healthy snacks where a child can see them)
- Fear arousal: this involves using visual or emotive images to help people change their thinking about something (e.g. showing people how much sugar is in a can of coke or how much fat is in a burger and chips)
- Time management: this involves working with someone to help them identify how they can best manage their time in order to prioritise a healthy behaviour (e.g. physical activity as a family).
Three of the most useful techniques for changing physical activity and dietary behaviour are goal setting, action planning and self-monitoring3. These will be covered in detail on the following pages.Goal setting
Goal setting is the process of identifying something you would like to change and has been found to be an essential part of self-management interventions. Generally, goals fit into two categories; outcome goals and process goals.
Outcome goals are measurable health outcomes or targets that an individual would like to achieve through changing their behaviours (e.g. lose weight, lower blood pressure, run a 5k). The goal may be the expected result of performing a behaviour but it does not involve planning how an individual’s behaviour will change to achieve the goal.
A process goal involves the steps an individual is going to take to reach their outcome goal. For example, if an individual has set an outcome goal to lose weight, one of their process goals might be to go running three times a week.
Both outcome and process goals are vital for behaviour change. One is unlikely to work without the other. Clear outcome goals are needed to clarify what you want to achieve, but the process goals are essential to know the action steps required to achieve this.
Example: If you’re meeting a friend for lunch, first you need to decide where you’re going (outcome goal) then you would need to work out how you’re going to get there (process goal). If you focus on the lunch destination without considering your mode of transport, time will pass and you won’t get anywhere. Conversely, if you focus on transport and not on the end goal you won’t know where you’ve ended up. It is important to focus on both your destination and your transport to get there. Including check-ins along to way to ensure you are still on track.
When setting goals with families, goals will be more effective if you follow some simple principles:
Goals should be specific
Goals should be specific (i.e. say exactly what the individual plans to do). It is not specific to set a goal “to increase physical activity”. A better goal would be to “go swimming twice a week”. Being specific increases the likelihood of the goal being achieved and it allows the goal to be measured (therefore the individual knows when they have reached their goal and feels a sense of achievement).
Goals should be realistic
Goals should be realistic (i.e. something the parent can achieve). When setting goals with parents you need to first learn about the family’s starting point. For a child who is not eating any fruit or vegetables now, it would not be realistic to start eating 5-a-day straight away. A better starting point might be to try and eat 1 or 2 portions of fruit and vegetables a day.
Goals can be broken down into small manageable steps
Goals can be broken down into small manageable steps (i.e. take one step at a time rather than trying to do everything at once). As in the above example, a series of progressive small goals can be set to help someone change over time. This can help the family feel a sense of achievement along the way, and it can help a big change seem less daunting. So on your first meeting with the family the goal might be to eat 1 portion of fruit and vegetables a day. If this is going well on your next meeting they might then increase this to 2 portions a day. Then 3. And so on – small steps lead to big changes!
Make sure the goal is important to them
Make sure the goal is meaningful to the parents (i.e. Something they want to achieve). Individuals are more likely to pursue a goal if it is meaningful to them, and if it is something they have chosen to do. This comes back to the point of autonomy, (see module on communicating with parents about child weight) and the importance of working with families to set their own goals, rather than setting goals for them. This may take more time but means parents are more likely to be motivated to work towards these goals.
Hint: Remember to use the open questions you learned in the module on communicating with parents about child weight to help explore aspects of the family’s lives they may want to change.
What if parents don’t know what they want to change?
Although many people have heard of goal setting, many people find this difficult to do in practice. So if you ask a parent to set their own goal you might find they struggle to come up with ideas. Rather than jumping in and setting a goal for them, you can use a technique called “guided goal setting”, which involves providing parents with some ideas to choose from (based on what you have already learned about the family through your discussions) but ultimately the parent still chooses and sets their own goal.
One way of setting guided goals is by using a “bubble task” whereby you write some options down in “bubbles” on a piece of paper and ask the parent if they see anything they would like to work on changing. It is important when doing this to leave one or two bubbles blank so they can add something themselves if they wish (sometimes seeing your examples is enough of a prompt to help them come up with an idea). Once they have chosen a bubble or two, you can ask which aspect they would like to work on first, then work with them to set a specific goal that is realistic and manageable for them. This technique can also help focus someone who feels they have a lot to change and does not know where to start.
Helping parents focus: It is common for people to want to change everything at once, but this can be daunting, unsustainable and may be setting them up for failure. Instead try and encourage parents to change one or two small things at a time, and work with parents to turn those changes into habits. After all, it is much better to make a few small changes and keep them up, than try and change everything and end up changing nothing.
1Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychology & health, 26(11), 1479-1498.
2Bradbury et al. 2017 (in preparation). Multiple stakeholder views of pre-school child weight management practices: a mixed methods exploration.
3 Samdal, G. B., Eide, G. E., Barth, T., Williams, G., & Meland, E. (2017). Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 42.