May 31, 2017 - Rewind the Future! The choices you teach your child today ... they take into their adulthood. https://www.youtube.com/watch?v=xUmp67YDlHY ...
Developing behaviour change interventions in healthcare: benefits and challenges Kostas Tsattalios School of Nursing and Midwifery Annual Postgraduate Research Symposium 31st May, 2017 Robert Gordon University
This talk • Part 1 – Health – (un)healthy behaviours – Health psychology – Behaviour change interventions • Part 2 – Current project: the case of healthcare-associated infections – Role of theory-integrative literature review – Next steps
Part 1
Rewind the Future!
The choices you teach your child today become the habits they take into their adulthood. https://www.youtube.com/watch?v=xUmp67YDlHY
What is health? • World Health Organisation: ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity • A multi-dimensional concept: people may define it differently according to gender, life-stage, culture • The personal level of health affects how we look, how we act, our feelings, attitudes and performance in school, work, recreation etc.
(Un)healthy behaviours Sutton et al (2004) • Positive (healthy, healthful, health-enhancing) and negative (unhealthy, risky, health-compromising) • Dichotomies that have a positive and negative alternative • Promotion of positive behaviours; prevention of negative behaviours • Behaviour change
Health psychology • Young discipline; term first used in 1979 (Stone et al) • Matarazzo (1980, 1982): ‘the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the: – Promotion and maintenance of health, – Prevention and treatment of illness, – Identification of etiologic and diagnostic correlates of health, illness, and related dysfunction’ – Analysis and improvement of the health care system and health policy formation
Mental Disorders
Clinical Psychology
Psychiatry
Medicine
Psychology
Health Psychology
Behavioural Medicine Liaison Psychiatry Medical Psychology
Physical Disorders
Behaviour change interventions Michie et al (2011, 2013) • Illness behaviour vs health behaviour • Most are complex – Made up of many interacting components
• To design more effective intervention we need to: – Know what the components are and why they work – Unpack the “black box” of interventions
• How to make health behavior change that persists over time? • Behaviour change techniques-taxonomy
Effect
F.A.S.T campaign – stroke recognition
https://www.youtube.com/watch?v=yXONEHmupy0
F.A.S.T campaign – effectiveness Dombrowski et al (2013) • Perceived impact and views to identify potential ways to optimise mass-media interventions in stroke • Semi-structured interviews with patients and clinicians Patients: the majority reported no impact Clinicians: success in raising awareness, but few thought it would change response behaviour • […] omission of relevant evidence and theory in the process of designing the campaign content
Part 2
The current project – the case of healthcare-associated infections (HAIs) Initially aimed at designing, developing and pilot-testing an intervention: combining theory and visualisations. A lot of groundwork to find out what is already known. Specifically: what has been tried, what works well and how in terms of theory-based interventions, visualisation-centred interventions, and combinations of the two.
But, more things to consider… • Content of intervention • How to be delivered and for how long • Format of intervention and stages • How to be effective • Sustainability of effect • Feasibility Thesis working title: The integration of visualisation in theory-based interventions to help healthcare staff prevent and control healthcareassociated infections: exploring the relationship, what works, how and why?
Influencing factors: • Patient or physician • Age • Sex • Culture • Race • Ethnicity • Cross-cultural communication
Skills
Attitudes Social norms Self efficacy
Knowledge and accurate risk perception
Intention for health behaviour
Health behaviour
Environmental influences
Theoretical basis of the intervention Low health literacy
Adherence
• Quality of life • Health life expectancy • Risk factors • Prevention
Behaviour change techniques Mode of delivery
An integrative model of behaviour prediction, adopted from Fishbein & Yzer (2003)
Design and development of the intervention
Integrative review 1: theory-based interventions • HAIs prevention and control is typically targeted at training staff within a ‘health and safety’ climate. • A growing body of research focusses on changing healthrelated behaviours by applying pertinent theories in dedicated interventions. • However, the type of theories and the extent to which they have been applied remains unknown.
Integrative review 1: theory-based interventions
Aim: To synthesise the best available evidence on • theory type • how the interventions have been structured and applied • the effectiveness of these interventions.
Integrative review 1: theory-based interventions Methods • 7 electronic databases: Web of Knowledge, CINAHL, AMED, MEDLINE, PsycARTICLES, ERIC, American Doctoral Dissertations • Inclusion/exclusion criteria-use of screening grid • CASP and QATSDD: to appraise studies’ quality • ‘Integrative approach’ (Whittemore & Knafl 2005) and narrative synthesis
Integrative review 1:theory-based interventions Findings (16 included studies) • Range of interventions: large & general – small and specific – Quality improvement, quasi-experimental, RCTs
• • • • •
Range of outcomes: behaviour change, awareness, knowledge Multi-component (majority) Sustainability was often questioned Range of underpinning theories/models/frameworks Most of the time, no/unclear justification for selection of particular theory!
Integrative review 1: theory-based interventions • Heterogeneity of findings
• No single theory-based intervention was evidently better than another, confirming the absence of a ‘gold-standard’ in intervention development in the HAIs field. • The non-immediate effects of HAIs and their invisibility should be considered in-depth by future research.
Next steps • Integrative review 2 (in progress): visualisation-based interventions – Role of visuals in HAIs-related interventions: what is out there and how is it implemented; any link to theory? • Semi-structure interviews with: • key authors (from IRs) • key experts (from general literature review) and • healthcare staff: identified gaps from IRs ➢ to shed light and deepen understanding around issues related to the use of theory and visualisations
Intervention development in HAIs Some of the challenges… • HAIs-related interventions are trying to change behaviours that primarily impact on others (i.e., influencing staff to stop patients getting HAIs) • Less motivation to change? • Pathogens are invisible to the naked eye and are “out there” VS other health-related issues whose aetiology is an internal process
Implications of current research • Implementation science and not mere application of health psychology principles • Its findings will be of interest to, and inform scientists involved with intervention development and healthcare professionals engaging with intervention delivery • Of particular interest to nursing practice as being the most numerous and ubiquitous profession involved in infection prevention and control.
References 1.Dombrowski, S. et al. (2013). The impact of the UK ‘Act FAST’stroke awareness campaign: content analysis of patients, witness and primary care clinicians’ perceptions. BMC Public Health, 13(1), 915. 2.Fishbein, M., and Yzer, M. (2003).Using theory to design effective health behavior interventions. Communication theory, 13(2), 164-183. 3.Matarazzo, D. (1980). Behavioral health and behavioral medicine: frontiers for a new health psychology. American Psychologist 35, 807–17. 4.Matarazzo, D. (1982). Behavioral health’s challenge to academic, scientific, and professional psychology. American Psychologist 37, 1–14. 5.Michie, et al. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), p.42.
6.Michie, S., et al. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of behavioral medicine, 46(1), 81-95. 7.Stone, C., Cohen, F. and Adler, E., eds. (1979). Health Psychology – A Handbook. San Francisco: Jossey-Bass. 8.Sutton, S., Baum, A., & Johnston, M. (Eds.). (2004). The Sage handbook of health psychology. Sage. 9.Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of advanced nursing, 52(5), 546-553.
