Using behavioral insights in public health programming - NDPHS

Using behavioral insights in public health programming

28 March, 2023

Often, when people know how to behave healthily, they choose not to do so. For example, people who know how to eat healthily may choose an unhealthy option. Or people who know effective treatment instructions for a medical problem may choose not to follow them. This is because behaviors are driven by multiple socioeconomic and cultural factors. Public health professionals’ education or training do not necessarily change behaviors alone.

Healthy behaviors are triggered by different factors

Behavioral Insights (BI) can help us to change persistent unhealthy behaviors. Firstly, it can be used to explore factors that affect health behaviors and secondly these can be used to improve the outcomes of health policies, services, and communication. Theories from social and behavioral sciences can be used to identify both positive and negative triggers for the behavior. Theoretical Domains Framework (TDF) is one of these theories. It includes 14 domains that explain behavior including knowledge, skills, social and professional roles, social influences, beliefs in consequences, beliefs in capabilities, psychological processes, emotions, optimism, intention, goal, behavioral regulation, emotions, environmental factors, and resources. It has been used to understand various behaviors including alcohol use, antibiotic use, and the uptake of vaccines and ARVs, among others (Rosario et al 2021; Lohiniva et al 2020; Bell et al 2021).

Cultural context matters

Behavior triggers are often context-specific, making it important to explore them in time and place. There are individual differences between us as well as many demographic and cultural factors that shape our perceptions and beliefs. For example, for decades, anthropologists have been studying hygiene by determining how dirt and contamination are understood in different subcultures which, as a result, influence hygiene behaviors (Kleinman 1987; Curtis 2007). Years ago, I was conducting formative research on motivators for hand hygiene among patients in a low-resource country. I learned that among the local nursing staff, patients were perceived as “contaminated,” which triggered the need to wash their hands, not only when they had visible dirt or an odor, but also when dealing with patients who spoke in a loud voice or had an unfriendly attitude towards the staff. Quiet and polite patients did not trigger the need to wash their hands. The findings were used to help inform a communication campaign that emphasized the risk of infection from various types of patients.  We tend to think that cultural concepts and practices are barriers to healthier behaviors, but my example shows that cultural concepts can actually be utilized to promote healthier behaviors. Cultural understanding feeds into the acceptability and sustainability of behavior change.

Theory-based intervention can lead to sustained behavior change

Often, public health interventions are developed based on what we think will be effective or easy to implement. However, when we follow BI as an approach, we use social and behavioral sciences theories to develop data-driven interventions to support behavior change or modification. One of these frameworks is the Behavior Change Wheel, which consists of nine behavioral interventions including coercion, education, environmental restructuring, incentivization, persuasion, restrictions, training, modeling, and enablement which include +80 different tactics to be used to change behavior (French et al 2012). For example, if the behavior is a tendency to forget the uptake of Tuberculosis medication, the appropriate intervention would be persuasion and the tactic would be the use of reminders to take the medication.

BI is an effective approach to changing health behaviors though more data are needed about behavioral triggers and what interventions change different behaviors in different settings. Our network of experts in the NDPHS is an ideal platform to explore vital health behaviors in different settings and to co-create best practices, programs, and policies for the region that are based on theories and principles of BI.

 

Text: Anna-Leena Lohiniva, Chair, the NDPHS Expert Group on HIV, TB&AI, Finnish Institute for Health and Welfare

 

References

Bell J, Sharma S, Malone S, Levy M, Reast J, Ciecieląg J, Gogolina S, Ansons T, Fourie S, Braz R, Little K, Hasen N. Targeting interventions for HIV testing and treatment uptake: An attitudinal and behavioural segmentation of men aged 20-34 in KwaZulu-Natal and Mpumalanga, South Africa. PLoS One. 2021 Mar 10;16(3):e0247483. doi: 10.1371/journal.pone.0247483.

Bolsewicz K, Debattista J, Vallely A, Whittaker A, Fitzgerald L. Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom. AIDS Care. 2015;27(12):1429-38. doi: 10.1080/09540121.2015.1114992. Epub 2015 Dec 7. PMID: 26641139.

Curtis VA. Dirt, disgust and disease: a natural history of hygiene. J Epidemiol Community Health. 2007 Aug;61(8):660-4. doi: 10.1136/jech.2007.062380.

 French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw JM. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012 Apr 24;7:38. doi: 10.1186/1748-5908-7-38.

Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Soc Sci Med (1967). 1978 Apr;12(2B):85-95. doi: 10.1016/0160-7987(78)90014-5.

Lohiniva AL, Elwali E, Abuobaida D, Abdulrahim A, Bukuluki P, Talaat M. A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan. Implement Sci Commun. 2021 Dec 4;2(1):132. doi: 10.1186/s43058-021-00229-3.

Rosário F, Santos MI, Angus K, Pas L, Ribeiro C, Fitzgerald N. Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework. Implement Sci. 2021 Jan 7;16(1):6. doi: 10.1186/s13012-020-01073-0.

Seidlein AH, Salloch S. Illness and disease: an empirical-ethical viewpoint. BMC Med Ethics. 2019 Jan 9;20(1):5. doi: 10.1186/s12910-018-0341-y.

Other News
World Antimicrobial Awareness Week: Global Collaborations and Collective Action
Antimicrobial resistance (AMR) is a major global health threat across human, animal, plant, food, and environmental sectors. AMR is also one of the thematic areas of the NDPHS and every year in November, we join the global campaign to raise awareness and understanding about this pressing health threat.
20 November, 2023
Registrations open to the Thematic Side Event of the Partnership Annual Conference on January 16, 2024
The NDPHS Expert Group on Antimicrobial Resistance in collaboration with the NDPHS Secretariat and the Swedish Chair invite you to the conference in Stockholm about the prevention of antibiotic resistance by using health promotion and behavioral insights.
30 October, 2023
Fall 2023 Newsletter
30 October, 2023
Policy Area Health in the EUSBSR Annual Forum 2023
The 14th EUSBSR Annual Forum, organized in the City of Riga on 4-5 October, invited participants to celebrate and reinforce multilevel cooperation in the Baltic Sea Region. The official programme included the joint PA Health and PA Education workshop and the kick-off event for the project – “Economy of Wellbeing of People”, financed by the Swedish Institute. 
27 October, 2023
Arts on Prescription pilot programmes started in cities and regions in Denmark, Germany, Poland, Latvia and Sweden
Public authorities and cultural and health institutions have started their first out of three piloting phases in October 2023. The idea behind the Arts on Prescription concept is that people dealing with mild to moderate mental health problems get a prescription not for medicine or therapy, but for taking part in creative and participatory activities in group settings.
20 October, 2023
The NordAN Conference and 2023 resolution: Upholding the alcohol retail monopoly system in nordic alcohol policy
The Nordic Alcohol and Drug Policy Network (NordAN) conference on 5-6 October 2023 in Tallinn, Estonia was organized under the theme "Rethinking Addiction: Policy, Prevention, and Progress". The 2023 resolution was adopted during the NordAN General Assembly meeting on October 5.
10 October, 2023
MentalHealthMatters partners tackle challenges and gaps related to mental health at work
Since the beginning of the MentalHealthMatters project in August, the partners in Finland, Estonia, Latvia, Poland, and Norway have been working with policymakers, employers, employees, researchers and other stakeholders to identify the national gaps in data and policy related to workplace psychosocial risks. Read what happened when the partners got together to discover the joint gaps and challenges.
28 September, 2023
The NDPHS Expert Group on HIV, Tuberculosis & Associated Infections welcomes a new International Technical Advisor
The NDPHS family is pleased to welcome Ms Marja Suomela from the Finnish Institute for Health and Welfare as the new International Technical Advisor (ITA) of the HIV, TB & AI Expert Group. Read our express interview with Ms Suomela about her thoughts on the topic and what the Expert Group has on its agenda for the months and years to come.
12 September, 2023
All News >