Enhancing Behavioural Science application across public health policy and practice in Wales

Nicky Knowles and Dr Alice Cline, Senior Behavioural Science Specialists Behavioural Science Unit, Public Health Wales.

Public Health Wales Behavioural Science Unit

In May 2022, Public Health Wales launched its newly established Behavioural Science Unit (BSU) for health and wellbeing. The BSU provides specialist expertise on behavioural science, and champions and enables the increasingly routine application of it, to improve health and wellbeing in Wales. The unit supports stakeholders in the wider public health system, to deliver a step change in improving health and wellbeing outcomes. It provides specialist support to integrate behavioural science as a way of optimising policies, interventions, services, and communications designed to improve wellbeing; develops resources to increase the routine application of behavioural science; and facilitates the development of capability and capacity.

The role of applied behavioural science in public health

Behaviours play a key role in improving health and wellbeing; identifying and understanding such behaviours and how best to influence them is integral to achieving the ambitions of public health policy and practice. The systematic application of behavioural science is increasingly being applied to optimise intervention design, delivery, and evaluation. Behavioural science applies scientific methods to understanding and influencing behaviour. It involves gathering data, selecting, and applying appropriate models and theories, and using these to understand behaviour in specific contexts. The application of behavioural science involves various phases including:

• Defining a problem in behavioural terms and identifying target behaviour(s) and target population(s)
• Understanding the influences on the target behaviour in the target population
• Identifying what interventions are needed to influence the target behaviour and how they can be implemented
• Monitoring and evaluating the process, outcomes, and impact of interventions
• Implementing effective interventions and policies on a wider scale to benefit a greater number of people

These phases are not linear, and it may not always be necessary to undertake all the phases to achieve the desired impact depending on the complexity of the challenge, the amount already known on the topic and the time and resource available. Additionally, public health policy and practice is generally delivered by people who are not behavioural science experts. Increasing capability therefore requires a basic understanding of behavioural science across the system to inform decisions as to when behavioural science can help to address an issue, how to apply behavioural science, and when specialist expertise is required to support with the application of the approach.

Enhancing behavioural science capability within the public health workforce

Through work undertaken as part of the response to COVID 19, the benefits of applying behavioural science approaches have been widely recognised across public health practice in Wales. This has led to a desire to enhance the application of behavioural science in day-to-day practice and consideration of how best to achieve this. Some of the Local Public Health Teams in Wales have undertaken surveys to explore factors that help and/or hinder the application of behavioural science. Insights from these surveys have led to collaborations with the BSU in considering how best to address any barriers identified and how to maximise the facilitators.

The routine application of behavioural science requires changes to practice; behavioural science frameworks provide a systematic, evidence-based approach to understanding and influencing such changes to practice. The capability building work being undertaken by PHW BSU applies behavioural science models and frameworks including the Capability, Opportunity, Motivation, Behaviour model (COM-B) and the Behaviour Change Wheel (BCW) (Michie et al., 2011), and the Theoretical Domains Framework (TDF) (Cane et al., 2012). These have previously been applied to a range of health professional behaviours and their determinants (Atkins et al., 2017; Bull et al., 2019; Curtis et al., 2018; Heslehurst et al., 2014). Our work is also based on principles of collaboration and co-production to ensure that the needs of our stakeholders, and the context in which they practice, are addressed.

Key objectives of the work include:

• Understanding current knowledge of, and confidence in, applying behavioural science
• Identifying changes to practice that enable increased, routine application of behavioural science
• Identifying barriers and facilitators to such changes to practice both in relation to individual practitioners and the operating environment
• Developing and testing activities/interventions to address the barriers and enhance the facilitators identified

To date we have facilitated several workshops with different stakeholder groups; these have provided invaluable insight into current practice and ways in which this can be enhanced using behavioural science. Some of the practice related behaviours identified include:

• Undertaking behavioural systems mapping for key areas of work
• Identifying if/when, and how, behavioural science can support a piece of work
• Identifying and specifying the behaviours that we want to influence
• Identifying and specifying target groups / populations
• Reviewing existing interventions to see how behavioural science could improve them
• Identifying the barriers to a behaviour before considering solutions
• Using the COM-B model as a structure for engaging with the public / partners
• Sharing behavioural science practice, and lessons learnt, across the team

The application of COM-B and the BCW have helped to identify and further explore the barriers to changing such practice related behaviours. Table 2 highlights some of the common barriers we have identified when exploring practice related behaviours and the interventions we are delivering/planning to implement to address them:

We are currently in the process of developing and implementing the interventions identified with Table 2.; to date this has included delivering workshops, co-creating guidance with key stakeholders, identifying and disseminating case studies of notable behavioural science practice, and integrating prompts into existing tools such as Project Initiation Documentation. As we are still in the delivery phase, we are yet to consider the impact of these interventions but plan to undertake both process and outcome evaluations over the coming months.

Being a newly established unit, we are keen to learn and adapt our approach and have been regularly reflecting on how we engage with and support stakeholders. So far, we have experienced a strong appetite for enhancing behavioural science practice across the system and continue to explore ways of enabling this. We have learnt that whilst increasing psychological capability is important to enhancing application of behavioural science, knowledge alone is not enough. There is also a need consider the context in which stakeholders operate and to understand how such factors may influence the routine application of behavioural science. Another key reflection, in the true spirit of behavioural science, is that what we think people need is often not what they actually need or want. We are therefore keen to co-create tools and resources with our stakeholders to ensure that they are fit for purpose and meet the needs of the intended audience.

The work described here is part of a larger project aiming to assess, understand, and enhance behavioural science capability within the public health workforce across Wales. We have also undertaken surveys, interviews, and focus groups with different stakeholder groups and have collated observations from all the engagement undertaken to date. We plan to summarise these insights, and the subsequent recommendations, in a report early next year. These will help to inform the future work of the unit alongside the projects already underway. The unit is already responding to the request of stakeholders and is currently developing an online repository of behavioural science tools and resources, exploring a training offer, creating guidance, and establishing a community of practice for Wales in collaboration with the Behavioural Science and Public Health Network. If you would like to know more about this work or are undertaking similar work and would like to connect, please contact nicky.knowles@nhs.wales.uk

References

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2. Bull, E. R., Hart, J. K., Swift, J., Baxter, K., McLauchlan, N., Joseph, S., & Byrne-Davis, L. M. T. (2019). An organizational participatory research study of the feasibility of the behaviour change wheel to support clinical teams implementing new models of care. BMC Health Serv Res, 19(1), 97.
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