Download Using Implementation Science to Develop Behaviour Change Training

Presented by : Dr Vivien Swanson, NHS Education for Scotland
Developing Sustainable
Behaviour Change Training
Dr Vivien Swanson, Dr Deirdre Holly
NHS Education for Scotland
50%
The intention – behaviour gap
“Bitter personal experience and meta-analysis converge on the conclusion that
people do not always do the things that they intend to do”
(Sheeran & Webb 2016)
Why Health psychology…?
‘Health is all about behaviour’
o
o
NHS needs more effective behaviour change interventions
..... and a ‘psychologically aware’ skilled workforce to work
collaboratively with patients to deliver better care
What do health psychologists contribute?
o
o
o
o
expertise in the science of health behaviour change
understanding mechanisms, complexities of barriers to change
added value (theory, evidence base, skills) to existing programmes
service improvement design and effectiveness of interventions
What do we want to do?
• develop state-of-the-art resources, build
knowledge and skills for NHS staff in Scotland
in changing health-related behaviour
• develop generic and specific training
adaptable to individual needs and contexts
• ensure sustainability by developing follow-up
coaching and mentoring
Implementation science:
Formula for success
Effective
innovations
x
Effective
implementation
=
x
Socially significant
outcomes
Enabling
contexts
Implementation Stages
Exploration
Assess need
Decide intervention
components
Consider
implementation drivers
Assess fit
Installation
Acquire resources
Prepare
organisation
Prepare
implementation
drivers
Prepare staff
2-4 years
Initial
Implementation
Adjust
implementation
drivers
Manage change
Deploy data
systems
Initiate
improvement
cycles
Full
Implementation
Monitor, manage
implementation
drivers
Fidelity and
outcome
benchmarks
Improve fidelity
and outcomes
Exploration
Installation
Implementation
Needs
assessment
Develop
evidence
based
intervention
Test in
different
contexts
Gather
Feedback
Develop
and deliver
on-line
training,
manualised
support
Developing behaviour change training
Recruit
and train
trainers
Evaluate
skills,
fidelity
Develop
coaching
network
Evaluate
impact
feedback,
support
top-ups
Exploration
Exploration:
what
techniques?
Exploration : mapping
techniques to competencies
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Health Behaviour Change
Competency Framework:
Competencies to deliver interventions to
change lifestyle behaviours that affect health
10/11/2010
Diane Dixon and Marie Johnston
Foundation Competencies:
examples
High Intensity
Interventions
Medium Intensity
Interventions
Low Intensity
Interventions
Basic Behaviour Change
Competencies:
examples
Behaviour Change Techniques:
number for each route
capacity to adapt
interventions to client need
capacity to implement models
in a flexible manner
M = 7 BTCs A = 11 BCTs P = 39 BCTs
ability to foster and maintain
a good intervention alliance
capacity to select and apply the
most appropriate intervention
method
M = 9 BTCs A = 13 BCTs P = 5 BCTs
knowledge of professional and
ethical guidelines
ability to take a generic
assessment
M = 5 BTCs A = 6 BCTs P = 3 BCTs
Strengthening Collaborative Practice:
The MAP of Behaviour Change
Action
Planning
Motivation
Behaviour
Prompts,
Cues
Automatic, habitual, unconscious, prompted, emotionally,
environmentally cued route
Reflective, goal directed, rational
thinking of motivations, goals and values
Environmental Context
Behaviour change techniques
Rational / deliberate behaviours
Motivation
Behaviour
Action
Planning
Automatic
Prompts, Cues
Habits
Maintenance
Automatic/cued behaviours
Behaviour change techniques
Environmental Context
Theme 1: Collaboration and
Motivation
BCT: Verbal persuasion
about capability
Draw on collaborative care
planning (needs of client and
health professional are met).
“Tell the person that they can
successfully perform the
wanted behaviour, arguing
against
self-doubts
and
asserting that they can and
will succeed”
Identify values and goals,
using these to encourage
behaviour change
Identify and address personal
and environmental barriers to
behaviour change
Theme 2: Planning,
Action and Maintenance
BCT: Action
planning
“Prompt detailed planning
of performance of the
behaviour (include context,
frequency, duration and
intensity)”
•
•
•
•
•
•
•
•
Identify, agree goals
Set goals
Action plan (‘if … then’).
Self-monitoring (tailored, using
diaries, apps)
Planning, identify barriers, problem
solve, coping planning
Maintenance, re-evaluating goals,
re-engaging with behaviour,
Support
Environmental restructuring
Theme 3: Prompts,
Cues, and Habits
• Understand the role of
habits
• Use environmental
cues and prompts
• Encourage rehearsal
and repetition
• Support long-term
maintenance
BCT : Restructure the
Physical and Social
Environment
“Change the environment to
facilitate target behaviour…”
Installation:
WHO?
Practice nurses
FNP nurses
Pharmacists
Dentists
Public health
practitioners
Health promotion
specialists
Clinical psychologists
•
•
•
•
Knowledge is useful but need skills
Generic / Profession specific
Develop confidence
Change ‘fix-it’ mindset?
Installation:
HOW?
–
–
–
–
Face to face
On-line
Manual
Soundbites
–
–
–
–
Coaching/mentoring
Webinars
Local events
Real life examples - videos, vignettes
deliver
coach
assess
Implementation
disseminate
monitor
target
improve
Please contact us at:
[email protected]
[email protected]