Developing applied behaviour change interventions to improve healthcare and reduce health inequalities

Bull, Eleanor (2020) Developing applied behaviour change interventions to improve healthcare and reduce health inequalities. Doctoral thesis (PhD by Published Works), Manchester Metropolitan University.

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Abstract

Improving public healthcare quality and reducing health inequalities are two major challenges for population health in the 21st century. Health initiatives require members of the public or their healthcare professionals to do things differently, so effective interventions to encourage health behaviour change (HBC) are needed. To accelerate behavioural science, psychologists recently developed the Behaviour Change Wheel (BCW) method and related Behaviour Change Technique Taxonomy (BCTT) tool. These help to systematically design and describe theory-based HBC interventions. This thesis presents some of the first research to apply and further develop the BCW and BCTT. I conducted seven applied research projects whilst embedded in multidisciplinary healthcare teams as an academic-practitioner health psychologist to help ‘set the wheel in motion’. Most took place in the UK; one applied the BCW in Mozambique. Three projects were with vulnerable groups at risk of health inequalities, exploring healthy eating, physical activity, smoking and sexually transmitted infection testing. Four projects were with health and social care professionals and focussed on their HBC conversation skills, medication safety, integrated team working and other healthcare quality improvements. Research methods included a systematic review with meta-analysis to identify effective intervention components, cross-sectional questionnaire research exploring psychological influences on behaviour, an observational study of training and pragmatic mixed-methods action research piloting new BCW interventions. These resulted in nine peer-reviewed publications and accompanying translational materials. Collectively, this programme of research A) identified new target populations, B) described and evaluated existing interventions, C) identified behaviours and psychological influences on change for key problems, D) developed new interventions bringing about positive changes in participants’ confidence, intentions and health behaviours and E) offered tools and guidance to optimise the BCW and BCTT’s feasibility for use in frontline healthcare. This work contributes knowledge to help translate psychological science into usable forms and co-develop feasible, theory-based HBC interventions.