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…

Climbing out of the hole

Kimmo Savolainen Photography (with permission)

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

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)

Human Behaviour-Change Project

www.humanbehaviourchange.org

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?

- …