Finding ways to build on and improve existing applications of behavioural theory in order to design more successful HCP behaviour change interventions depends on incorporating change elements on a wider basis. We are already quite good at designing interventions targeted at individual behaviours, but often, the efforts of individuals are let down by other environmental factors.
A wider view of existing barriers
There is much we can do to change the ways in which behaviour change interventions are designed. At the heart of the matter is the need to understand that successful interventions require a two-pronged approach. Many interventions target only individuals, and while all the identified components for success may be in place, there is a higher likelihood that changes won’t be sustainable when a similar intervention is missing at the organisational level.
No practice, procedure or operation exists in a vacuum. Every action has an effect on connecting systems so without appropriate organisational changes, any alterations in HCP behaviour change will have minimal impact.
A simple example could be an effort to shorten patient waiting times in order to improve patient outcomes. Providing care providers with a method of improving efficiency in the consultation room may ease congestion in the clinic’s own waiting room, but if a similar streamlining intervention is not put in place in the pharmacy, the bottleneck of patients waiting is simply moved from one area of the hospital to another. For the patient, all that has changed is where they spend their waiting time.
In other words, there is no improvement in the patient experience of visiting the hospital. In terms of intervention success measurement, working just on behaviour change to improve waiting times failed in its objective.
The above example is not meant to criticise interventions that target behaviour change, but rather to indicate that often, such interventions don’t reach far enough into the wider environment in which the care provider works.
Harnessing technological support
Technology use continues to grow, becoming a deeply integrated part of daily life. Most of us, even those with memories that extend back to the days when tapping handheld gadgets only existed in science fiction, cannot imagine life without the smartphone.
It provides instant access to knowledge and learning, and could be further used as a tool to enable HCP behaviour change. The opportunity is there, providing both capability and opportunity to prompt changes in behaviour by harnessing the personal habits we have already developed. Gadgets and devices are potentially a strong platform that could be put to greater use in:
- Improving communication, between HCPs and between them and their patients (because patients already have the gadget habit too).
- Supporting appropriate prescribing.
- Reducing adverse events.
- Improving patient outcomes.
The types of behaviour change interventions that could be designed to harness the power within Internet enabled gadgets include:
- More closely integrating clinical decision support systems.
- Point of care testing.
- Computer generated prompts.
- Interactive analysis systems.
- Electronic health records.
- Prescription services.
Enablement interventions such as these are generally well received, and are shown to increase HCP knowledge. And because they incorporate certain behaviours that are already familiar and practically instinctive, they fit well with existing psychological and behavioural theoretical values such as motivation, perceived capabilities, knowledge, and skill beliefs.
Going into the future
There is a continuing need to create effective behaviour change interventions that utilise research-based knowledge. Despite the implementation of many interventions that are intended to lead to changes in HCP behaviour, some poor design elements limit their potential for positive effects, either in sustained behaviour change or in the wider health care sphere.
Four essential design components must be incorporated into interventions for behaviour change. These are:
- Knowledge, use and application of theory.
- Identification of barriers to the preferred behaviour.
- What links exist between the barrier and the activity the intervention encourages.
- Feedback and experience of the end user.
As well as these four major components, there is another important ingredient which, when neglected, can impact the effectiveness of the entire intervention. The missing ingredient is a focus on organisational-level change. These design aspects may include segmenting the implementation of multi-disciplinary interventions, or a more systematic approach in success measurement.
When designing interventions for future HCP behaviour change, results gathered from specific intervention components could lead to a more cohesive, collaborative approach and understanding. This in turn could result in the design of targeted interventions that are more sustainable.