Behaviour change communication targeting four health behaviours in developing countries: a review of change techniques

Behaviour change communication is vital for increasing the enactment of particular behaviours known to promote health and growth. The techniques used to change behaviour are important for determining how successful the intervention is. In order to integrate findings from different interventions, we need to define and organize the techniques previously used and connect them to effectiveness data. This paper reviews 24 interventions and programs implemented to change four health behaviours related to child health in developing countries: the use of bed nets, hand washing, face washing and complementary feeding. The techniques employed are organized under six categories: information, performance, problem solving, social support, materials, and media. The most successful interventions use three or even four categories of techniques, engaging participants at the behavioural, social, sensory, and cognitive levels. We discuss the link between techniques and theories. We propose that program development would be more systematic if researchers considered a menu of technique categories appropriate for the targeted behaviour and audience when designing their studies.     

Understanding behaviour change in context: examining the role of midstream social marketing programmes

This research examines how midstream social marketing programmes that adopt a relational and community‐based approach create opportunities for individuals to make incremental changes to health behaviour. Specifically, it applies Bourdieusian theory to explore how interactions between community healthcare workers (CHWs) and members of the public generate impetus for change and foster individual agency for improved health. Qualitative interviews were carried out with members of the public and CHWs engaged in a Smokefree home and cars initiative. The findings suggest that although CHWs are challenged by resource constraints, their practices in working with individuals and families build trust and enable dialogue that bridges smoking‐related health insight with home logics. These interactions can promote individual agency with a transformative effect through small changes to smoking‐related dispositions, norms and practices. However, tensions with the habitus of other household members and other capital deficits can inhibit progress towards embedding new practices. The study concludes that interventions built upon community relationships show potential for addressing limitations of information‐focused campaigns but there is a need to also respond to key social structures relating to the field of action for new health dispositions to become embedded in practice.     

Motivational interviewing within the different stages of change: An analysis of practice nurse-patient consultations aimed at promoting a healthier lifestyle

Combining the Stages of Change (SOC) model with Motivational Interviewing (MI) is seen as a helpful strategy for health care providers to guide patients in changing unhealthy lifestyle behaviour. SOC suggests that people are at different stages of motivational readiness for engaging in health behaviours and that intervention methods are most useful when tailored to a person's stage of change. However, it is unknown whether practice nurses (PNs) actually adapt their MI and more generic communication skills to a particular stage during real-life face-to-face consultations with their patients. The aim of this study was to explore whether and how PNs apply MI and general communication skills to the different SOC of patients, targeting behaviour change about smoking, alcohol use, dietary habits and/or physical activity.Real-life consultations between nineteen Dutch PNs and 103 patients were recorded on video between June 2010 and March 2011. All consultations focused on a discussion of patients' lifestyle behaviour. The Behaviour Change Counselling Index (BECCI) was used to code PNs' MI skills. Generic communication skills were rated with the MAAS-global. Patients' SOC was assessed for each consultation by observing the communication between patient and PN regarding the patient's current lifestyle behaviour.Multilevel analyses revealed that PNs adapt their MI skills to a patient's SOC to some extent. On average PNs apply MI skills more to patients in the preparation stage (P < 0.05) than during the other stages of change. PNs adjusted three MI skills and one generic communication skill to patients' SOC. This explorative study suggests that, at least to some extent, PNs intuitively assess the stage of patients' readiness to change and tailor their communication accordingly. However, differences between the stages were small. By teaching PNs to explicitly identify patients' SOC they could further enhance and adapt their MI and general communication skills to the individual.     

Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers

Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi‐structured interviews with 16 older people with mild frailty who received a pilot home‐based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio‐recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well‐being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.     

Partner number and use of COVID-19 risk reduction strategies during initial phases of the pandemic in British Columbia,Canada: a survey of sexual health service clients

ObjectivesInitial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic.MethodsIn British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p < 0.01).ResultsOf the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex).ConclusionSexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00566-9.     

An economic and sociological interpretation of social differences in health-related behaviour: An encounter as a guide to social epidemiology

We argue that the group-centred analyses of social epidemiology should follow from theoretical considerations that take the situation of the individual as their natural starting point. In a tentative dialogue between economics and sociology, we develop a framework for the analysis of health-related behaviour. Such behaviour is modelled as a process of decision-making at the individual level. Within economics, we draw specifically on the demand-for-health literature and the new institutional economics. Within sociology, Bourdieu's habitus theory is presented in combination with a macro-structural approach where the focus is on the process of individualization. The relationship between these different approaches to health-related behaviour and their implications is discussed. We find that the encounter between different sciences provides valuable insights for future work in the socio-epidemiological tradition.     

Gascoyne Growers Market: a sustainable health promotion activity developed in partnership with the community

OBJECTIVE: To explore the social, health and economic impact of a farmers' market on a small rural community in the north of Western Australia. DESIGN: Qualitative and quantitative research using a random structured intercept survey, and focus group interviews around four domains of social capital: economic impact, governance and capacity building, healthy public places and social and civic participation. SETTING: The Gascoyne Growers Markets in Carnarvon. SUBJECTS: One hundred consumers and 28 market stallholders. RESULTS: Consumers demonstrated community pride and an increase in fruit and vegetable consumption since they commenced shopping at the markets. The stallholders appear to have gained economically, professionally and socially from the market experience. CONCLUSIONS: The Gascoyne Growers Markets demonstrate a sustainable health promotion activity developed in partnership with the community. It has contributed to the local economy, providing local quality fruit and vegetables directly to the community while also increasing social capital and creating a healthy public space.     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.     

“Love your body,move your body,feed your body”: Discourses of self-care and social marketing in a body image health promotion program

Over the past decade, a number of health promotion programs have been developed in western countries to address body image dissatisfaction and associated eating disorders among women and girls. There has, however, been little critical examination of the application of health promotion theory and practice in this area. This paper reports on an interview study with health promotion workers responsible for managing and implementing the most extensive, long-running body image health promotion program in Australia. The study explores the ways in which health promotion workers envision body image as a site for preventive intervention, and specifically attends to the power dynamics of subject constructions and the opportunities for community empowerment and involvement. The study reveals a dominant discourse of individualised self-care as a solution to body image dissatisfaction, and a simultaneous reliance on marketing frameworks and practices. The paper explores the dilemmas associated with the application of these approaches in this area, particularly the way they reproduce contradictions in the social body which are implicated in producing the pursuit of thinness itself, and the tendency of marketing discourse to dissipate the possibilities for resistance. The paper also considers other approaches to health promotion for their potential to overcome some of the dilemmas associated with the marketing of self-care.     

Minority status and health information search: a test of the social diversification hypothesis

Group differences in the search of health information were investigated, to test the diversification hypothesis that argues that disadvantaged groups in society will be more likely to use the Internet and computer mediated communication to access health information to compensate for their lack of social capital. Data were gathered from a sample of Internet users representative of the percentage of minorities in the general population in Israel (n = 1371). The results provide partial support for the hypothesis, indicating that in multicultural societies disadvantaged groups show greater motivation to use the Internet to access medical information than the majority group. We interpreted our findings as suggesting that minority groups that do not have access to specialized networks use the Internet to overcome their lack of access to specialized information. Implications of the finding are discussed.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.     

Causal narratives in public health: the difference between mechanisms of aetiology and mechanisms of prevention in non‐communicable diseases

Research in the health sciences has been highly successful in revealing the aetiologies of many morbidities, particularly those involving the microbiology of communicable disease. This success has helped form a narrative to be found in numerous public health documents, about interventions to reduce the burden of non‐communicable diseases (e.g., obesity or alcohol related pathologies). These focus on tackling the purported pathogenic factors causing the diseases as a means of prevention. In this paper, we argue that this approach has been sub‐optimal. The mechanisms of aetiology and of prevention are sometimes significantly different and failure to make this distinction has hindered efforts at preventing non‐communicable diseases linked to diet, exercise and alcohol consumption. We propose a sociological approach as an alternative based on social practice theory. (A virtual abstract for this paper can be found at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA ).