Unlocking Behaviour Change A one-day workshop

1. Unlocking Behaviour ChangeA one-day workshop Robert West University College London Centre for Behaviour Change

2. Programme 10:00 Welcome and introduction to the course 10:15 Review of participants’ expertise and workshop goals 10:30 Milestones in behaviour change 11:00 Break 11:15 COM-B: Finding out what needs to change 12:00 Behaviour Change Techniques: How to promote change 12:30 Lunch

3. Programme 13:00 Introduction to practical exercises 13:15 Practical exercise 1: Deciding what to change and making a plan 14:30 Break 14:45 Practical exercise 2: Getting going and keeping going 15:30 Keeping records 15:45 Recap, quiz and feedback 16:30 Finish

4. Aims and scope • This workshop is for behaviour change practitioners who give advice and support to clients • It aims to improve success at helping clients to make lasting changes in their behaviour • It does not address behaviour-specific knowledge

5. About behaviour change • Behaviour change is doing something which causes people to behave differently from how they would have behaved • With behaviour patterns such as smoking, overeating, drinking excessively, not taking enough exercise, it usually involves • Encouraging them to try to make a change • Supporting them so that they can sustain it • Much of this involves public policies such as taxation, restrictions, running mass media campaigns • It also involves providing individually tailored advice and support

6. Review of expertise and training needs • What is your background and experience? • What kinds of behaviour change do your clients tend to require? • What levels of success do you think you achieve? • What are the key issues that arise? • What do you see as the key to behaviour change?

7. Milestones of individual behaviour change Deciding Planning Getting going Keeping going I know how I will reduce my calorie intake to 1500 per day I have started to reduce my calorie intake to 1500 per day I am still reducing my calorie intake to 1500 per day I intend to reduce my calorie intake to 1500 per day

8. Deciding what to change What does the client want to achieve? E.g., Lose 6 kg in weight over 3 months What is a realistic target? E.g., Lose 2 kg in a month What behaviour change is required? E.g., Consume no more than 1500 calories per day What does this entail? E.g., Cutting out snacks and second helpings

9. Key points • Be specific: Achieving clients’ goals (e.g., weight loss) usually involves getting them to be much more specific about those goals and deciding on what specific behaviour change to go for. • Less is more: It is important not to try to do too much, but focus on one achievable goal and set of behaviours to change (e.g., improving diet). Build on incremental successes.

10. Planning to change When to start? E.g., Tomorrow What support to put in place? E.g., Finding a ‘buddy’ How to beat off challenges? E.g., Not shopping when hungry How to check on and reward progress? E.g., Daily weighing and treats

11. Key points • Seize the moment: Try to get clients to commit to starting as soon as possible. The longer they wait, the more likely clients will go off the boil. • Be prepared: It is important to make sure clients are ready for specific challenges they will face in the first week or so. • The big day: Get a clear voluntary commitment to a session on the start date.

12. Getting going Marking the event E.g., Sharing with friends or family Implementing the support plan E.g., Making first contact with the buddy Getting off to a flying start E.g., Reviewing plans for the first week Getting a ‘baseline’ E.g., Record starting weight

13. Key points • Be there at the start: It’s important to have a contact with clients on the day they start, either in person or by phone or text. • Be positive: Be positive and rewarding and send clients off with hope.

14. Keeping going Staying motivated E.g., Re-affirming one’s rules Dealing with temptation E.g., Not buying biscuits Dealing with setbacks E.g., Creating a new rule Monitoring progress E.g., Daily weighing

15. Key points • Monitor and reward progress: Clients need to have a clear sense of achievement that they can build on. • Deal with challenges: There will be set-backs; foster a problem-solving approach to getting back on track.

16. Milestones of individual behaviour change Deciding Planning Getting going Keeping going To achieve each milestone, need an understanding of: What needs to change in order for behaviour change to happen and be sustained?

17. Break

18. COM-B: The key to unlocking behaviour change Behaviour occurs when, at that moment, we have the capability and opportunity, and we are more motivated to do that thing than anything else Capability Motivation Behaviour Opportunity

19. Capability The physical or psychological ability to do something Knowledge Skills* Strength* Stamina* * Mental and physical

20. Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Do they know what they need to do, why they need to do it and how they can do it? How confident are they in their ability to resist temptations? What skills and experiences can they build on? Opportunity Motivation Behaviour

21. Opportunity The social and physical environmental factors that enable us to do something Resources Access Norms Cues

22. Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Do they have the financial or other resources to support their change? Does their physical and social environment support change? What can they do to reduce exposure to temptation? Opportunity Motivation Behaviour

23. Motivation The strength of desire or urge to do something Reflective/ Conscious Automatic/ Unconscious Wants and needs Impulses and inhibitions Developing a habit Intentions and goals Decisions and plans Beliefs about costs and benefits

24. Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability How committed are they to the goals they have set? How steadfast are they likely to be in the face of challenges? What habits do they have that may get in the way of change? Opportunity Motivation Behaviour

25. Behaviour Other behaviours that may support or hinder behaviour change

26. Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability What other behaviours could get in the way of making the needed changes? What other behaviours could support the desired change? Opportunity Motivation Behaviour

27. Unlocking behaviour change Find out which of capability, opportunity and/or motivation will need to change and how that can be sustained Capability Opportunity Motivation Behaviour

28. Example: Childhood weight management • Goal: To get parents to provide their overweight children with appropriate portion sizes across five food groups • Focus group with parents • Investigation structured around COM-B

29. Example: Childhood weight management Capability • Many parents … • do not recognise that their child is overweight • do not know about age-appropriate portion sizes • cannot measure food portions correctly Opportunity Motivation Behaviour

30. Example: Childhood weight management Capability • Many parents … • Lack knowledge of appropriate balancing across food groups • Have difficulty talking with children and partners around eating and weight issues Opportunity Motivation Behaviour

31. Example: Childhood weight management Capability • There are often … • Adverse influences of partners, grandparents, parents of other children • Problems finding time to figure out portion sizes • No facilities for make measuring portion sizes quickly and easily Opportunity Motivation Behaviour

32. Example: Childhood weight management • Parents often … • Do not want to accept that there is a problem • Feel guilty about restricting food and fear the child becoming anxious about weight/ food • Lack confidence in their ability to prepare healthy meals Capability Opportunity Motivation Behaviour

33. Behaviour Change Techniques What needs to change: Capability, Opportunity, Motivation, Behaviour?

34. Behaviour Change Techniques • Behaviour Change Techniques (BCTs) are specific things you can do to help clients to change their behaviour, such as goal setting, monitoring, rewarding etc. • The time spent in consultations is precious and every part of the consultation needs to be focused on the task in hand • Friendly chatting can be useful in establishing rapport but everything in the consultation must have a clear purpose behind it

35. Improving capability

36. Increasing opportunity

37. Changing motivation

38. Changing other behaviours

39. Deciding priorities • You can’t do everything so you need to decide what is likely to have the biggest impact • For each BCT, think about: • How much of an impact is it likely to have? • How acceptable is it to the client or members of their family or friends? • How practicable is it? • Can they afford it? • Are there going to be any unwanted side-effects?

40. Lunch

41. Recap Behaviour Change Techniques

42. Practical exercises

43. Example: Getting more active • 45 year-old man who wants to become more physically active • Been referred by his GP • Unemployed • Does very little walking • Overweight and unfit • Has asthma and high blood pressure

44. How will you go about helping him decide what to change?

45. Deciding what to change What does the client want to achieve? C O B M What is a realistic target? What behaviour change is required? What does this entail?

46. How will you help him make a suitable plan?

47. Making a plan When to start? C O B M What support to put in place? How to beat off challenges? How to check on and reward progress?

48. How will you ensure he gets off to a great start?

49. Getting going Marking the event C O B M Implementing the support plan Getting off to a flying start Getting a ‘baseline’

50. How will you help him stay on track?