behaviour change and intervention research
TRANSCRIPT
Behaviour change and intervention
researchSocial psychology with a real-world impact (?)
“If you want truly to understand something, try to change it.”
(Attributed to Kurt Lewin)
Source: Wikimedia Commons
Why do researchWhat’s the point?
The scientific landscapeMurky paths in the world of experiments
Kimmo Savolainen Photography (with permission)
The evolution of academiaScientific progress
results from the free play of intellects, dictated by their
curiosity
(Vannevar Bush, 1945)[see link]
you throw something at the wall, and P is less
than 0.05, you win
(Bruce Cuthbert, 2014)[see link]
Link to source (Nature)
Fear of the HARK• Hypothesising• After the• Results are• Known
(… without saying so and testing with new data)
Outcome switching
http://compare-trials.org/blog/jama-reject-all-correction-letters/
Publication bias• Positive results get published• The rest stay hidden, banished
in file drawers
But why…?• Incentives
– Surprising results media time fame grants
• “Publish or perish”– Replications & null results harder to get published
• Many on top of the academic food chain don’t see a problem
– Surprise surprise…
Solutions• Pre-registration:
– saying what you predict, in advance– great exercise to clarify what you’re
doing! As predicted DRKS
• New publishing platforms:– less corporate control
• Transparency and openness: – citizen science!
“We report how we determined our sample
size, all data exclusions (if any), all manipulations
and all measures in the study.”
- Simmons, Nelson & Simonsohn (2012):
A 21 word solution
Health behaviour interventionsA rationale
Dying in Finland
Source: WHO
11% of people aged 30-70 die prematurely due to cancer, diabetes and cardiovascular / chronic respiratory diseases
Mark Marek Photography
“Killed by death”… or one’s own behaviour?
Human body ill adapted to regular excess…
• boozing
• eating
• smoking
• inactivity
(Motörhead; Mark Marek Photography)
Causality?
(Excess…)• boozing• eating• smoking• inactivity
• Cardiovascular diseases• Cancer• Diabetes• Chronic respiratory
diseases
• Impaired quality of life & premature death
Causality?
(Excess…)• boozing• eating• smoking• inactivity
• Cardiovascular diseases• Cancer• Diabetes• Chronic respiratory
diseases
• Impaired quality of life & premature death
Intervention
Causality?
(Excess…)• boozing• eating• smoking• inactivity
BAD STUFF
GAME
OVER
Determinants• Social
norms• Knowledge• Attitudes• … etc.
Intervention
Causality?
(Excess…)• boozing• eating• smoking• inactivity
BAD STUFF
GAME
OVER
Determinants• Social
norms• Knowledge• Attitudes• … etc.
Intervention
Behaviour change methods translated to a hopefully effective application
Causality?
(Excess…)• boozing• eating• smoking• inactivity
BAD STUFF
GAME
OVER
Determinants• Social
norms• Knowledge• Attitudes• … etc.
Intervention
Behaviour change methods translated to a hopefully effective application
Theoretical Domains Framework (Michie et al. 2005) as a checklist?
Side note: Reporting matters”[Due to poor description in most RCTs] the reader is left with data on whether or not an intervention works, but little insight into what the intervention is”- MRC guidance on process evaluation, p. 39 [link]
Accumulation of knowledge…?
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Phase 1: A person’s dormant network in stable state
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Phase 2: External event appears
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Phase 2: The event activates the network
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Phase 3: Symptom spread
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Phase 3: Symptom spread
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Phase 4: Event ends, network stays in a stable, active state
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Cardiovascular disease
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Cardiovascular disease
Impaired quality of life &
premature death
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Phase 1: A person’s dormant network in stable state
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Intervention
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
External event appears
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
The event activates the network
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Symptom spread
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Unemployment
Spread stays incomplete
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Event ends, activation incomplete
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
In the absence of stressor, activation diminishes
Active lifestyle
Causality?
Boozing
Inactivity
Eating
Smoking
Hypothetical example; see Borsboom (2017) for overview of approach.
Network returns to dormant stable state
Active lifestyle
Inside an intervention
● A school-based multilevel intervention to increase physical activity and
decrease sitting among youth
● Planning started 2012
● RCT phase from 2015 to 2017
● Ca. 16–19 year-old vocational school students
● Waist-worn accelerometers, body composition, surveys
”Let’s Move It”
Study protocol @ BMC Public Health
The aim, in a nutshell:To evaluate…
• the effectiveness• processes/mechanisms of change• cost-effectiveness
… of a school-based, multi-level intervention, on physical activity and sedentary behaviour
Theoretical framework● Self-determination theory
● Control and self-regulation theories
● Reasoned action approach
● Habit theory
2 0 1 2 2 0 1 3 2 0 1 4
LITERATURE REVIEWS
ORIGINAL RESEARCH
STAKEHOLDER COLLABORATION
School-level needs assessment
2 0 1 5 – 1 7
Feasibi-lity trial
Cluster-randomized
effectiveness trial
(RCT)
TWEAKING
INTERVENTI
O N
DEVELOPMENT
Slide modified from Nelli Hankonen’s materials
REVIEW: Participatory strategies in intervention development
2 0 1 2 2 0 1 3 2 0 1 4
LITERATURE REVIEWS
ORIGINAL RESEARCH
STAKEHOLDER COLLABORATION
School-level needs assessment
REVIEW: SDT in youth PA promotion
SYSTEMATIC REVIEW: School-based interventions
2 0 1 5 – 1 7
Feasibi-lity trial
Cluster-randomized
effectiveness trial
(RCT)
TWEAKING
INTERVENTI
O N
DEVELOPMENT
Slide modified from Nelli Hankonen’s materials
REVIEW: Participatory strategies in intervention development
2 0 1 2 2 0 1 3 2 0 1 4
LITERATURE REVIEWS
ORIGINAL RESEARCH
STAKEHOLDER COLLABORATION
Interviews & IPA
SOLE/ALiAS Survey: Needs assessment
Writing competition & narrative analysis
School-level needs assessment
REVIEW: SDT in youth PA promotion
SYSTEMATIC REVIEW: School-based interventions
2 0 1 5 – 1 7
Feasibi-lity trial
Cluster-randomized
effectiveness trial
(RCT)
TWEAKING
Belief elicitation
study
INTERVENTI
O N
DEVELOPMENT
Slide modified from Nelli Hankonen’s materials
REVIEW: Participatory strategies in intervention development
2 0 1 2 2 0 1 3 2 0 1 4
LITERATURE REVIEWS
ORIGINAL RESEARCH
STAKEHOLDER COLLABORATION
Interviews & IPA
SOLE/ALiAS Survey: Needs assessment
Writing competition & narrative analysis
School-level needs assessment
Discussions, visits to schools
Staff surveyTeacher survey
Focus group interviews
REVIEW: SDT in youth PA promotion
SYSTEMATIC REVIEW: School-based interventions
2 0 1 5 – 1 7
Feasibi-lity trial
Cluster-randomized
effectiveness trial
(RCT)
TWEAKING
Belief elicitation
study
INTERVENTI
O N
DEVELOPMENT
Slide modified from Nelli Hankonen’s materials
REVIEW: Participatory strategies in intervention development
2 0 1 2 2 0 1 3 2 0 1 4
LITERATURE REVIEWS
ORIGINAL RESEARCH
STAKEHOLDER COLLABORATION
Interviews & IPA
SOLE/ALiAS Survey: Needs assessment
Writing competition & narrative analysis
School-level needs assessment
Discussions, visits to schools
Staff surveyTeacher survey
Focus group interviews
Stakeholder expert group
Student panel
REVIEW: SDT in youth PA promotion
SYSTEMATIC REVIEW: School-based interventions
2 0 1 5 – 1 7
Feasibi-lity trial
Cluster-randomized
effectiveness trial
(RCT)
TWEAKING
Belief elicitation
study
INTERVENTI
O N
DEVELOPMENT
Slide modified from Nelli Hankonen’s materials
Outcome expectations
Descriptive norm
Self-efficacy
Intention to engage in MVPA
Autonomy support
Autonomous motivation
Behavioural self-regulation
Goal setting
Plan-ning
Self-monitoring
Goal review
LPA /MVPA (leisure/commuti
ng)
What influences youth PA behaviour? A program
theory
Environmental opportunities to engage in PASelf-determination theory
(Deci & Ryan, 2000), Motivationalinterviewing (Rollnick & Miller)Control Theory (Carver & Scheier, 1982) Reasoned Action Approach (Ajzen & Fishbein) Slide modified from Nelli Hankonen’s materials
MeasuresFinal n ≈ 1000
Measurements at four time points:
T1 (baseline)
T2 (mid-intervention)
T3 (2-month follow-up)
T4 (12-month follow-up)
Towards greener pastures?
Future(s) of behaviour change
Kimmo Savolainen Photography (with permission)
http://www.agilescience.org/how-it-works.html
Thank you!
@heinonmatti www.mattiheino.com
Additional Slides
Framework for designing and evaluating complex interventions:
Pre-phase Phase I Phase II Phase III Phase IV
Theory
Modelling
Exploratory trial
Definitive (randomised
controlled) trial
Long term implementation
Explore relevant theory
Identify and develop the components
Further development of intervention components and delivery
system
Compare a fully defined intervention
Replicate your
intervention
&
translation
Pre-phase Phase I Phase II Phase III Phase IV
Theory
Modelling
Exploratory trial
Definitive (randomised
controlled) trial
Long term implementation
Explore relevant theory
Identify and develop the components
Further development of intervention components and delivery
system
Compare a fully defined intervention
Replicate your
intervention
&
translation
Continuum of increasing evidence
Campbell, M et al. (2000). MRC framework for designing and evaluating complex interventions. British Medical Journal 321: 694 – 696.
INTERACTION PRINCIPLES• 1. Show empathy for students• 2. Ask open questions• 3. Roll with students’ resistance• 4. Evoke change talk• 5. Show interest in students’ experience and
perspectives• 6. Provide students with options and choices• 7. Provide students with structure and agenda• 8. Use reflective listening • 9. Validate students´ concerns• 10. Provide positive feedback
Deci & Ryan: Self-determination theory, e.g. 2000Miller & Rollnick: Motivational Interviewing, e.g., 1986
Example Intervention Activity Identifying Personal Motives Group Activity (Hankonen et al 2016)
– Participants 1. are shown cards with known positive
consequences (benefits) of PA (e.g. better mood, better sleep, higher energy levels)
2. choose a card with a reason why they personally are OR would be physically active
3. talk about the card to the group: why they chose that card, i.e. elaborate on why they would like to increase PA
Outcome expectations
Autonomous motivation
(esp. Identified motivation)
Change talk (MI)Descriptive norm
THEORETICAL DETERMINANTS:
Behavioural determinants: COM-B
65
Behaviour Change Wheel
Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. 2011;6(1):42.
COM-B <-> Theoretical Domains Framework
Theoretical domain
Capabilities Psychological KnowledgeSkillsMemory, attention and decision processesBehavioural regulation (e.g. self-monitoring)
Physical Skills
Opportunities Social Social influences (e.g. social norms / -support / -comparison / -power)
Physical Environmental context and resources (e.g. material resources, person-environment interaction, organisational culture)
Motivation Reflective Social / professional role and identityBeliefs about capabilities (e.g. self-efficacy, perceived behavioural control, empowerment)OptimismBeliefs about consequencesIntentions (e.g. stability of intentions)Goals (e.g. goal prioritisation and autonomy)
Automatic Social / professional role and identityOptimismReinforcement (e.g. rewards and punishments)Emotion (e.g. anxiety, stress)
Dying in Finland
Source: Statistics Finland
• Leading causes of death among men aged 15 to 64 in 2010
Dying in Finland
Source: Statistics Finland
• Leading causes of death among women aged 15 to 64 in 2010
Dying in Finland
Source: WHO
Premature mortality due to non-communicable diseases (NCDs)• 11% of population between 30 and 70 die of the 4 main NCDs
Dying in Finland
Source: WHO
Premature mortality due to non-communicable diseases (NCDs)• 11% of population between 30 and 70 die of the 4 main NCDs
Mechanisms
Intervention Physical activity
Mechanisms
Intervention Physical activity
Autonomous motivation
- Spousal support?- Media exposure?
- Habit?- Past experiences?
- …