Behaviour Centred Design: towards an applied science of behaviour change
Research and article by Robert Aunger and Valerie Curtis of the London School of Hygiene and Tropical Medicine originally published online in the Health Psychology Review, August 18, 2016.
Behaviour change has become a hot topic. We describe a new approach, Behaviour Centred Design (BCD), which encompasses a theory of change, a suite of behavioural determinants and a programme design process. The theory of change is generic, assuming that successful interventions must create a cascade of effects via environments, through brains, to behaviour and hence to the desired impact, such as improved health. Changes in behaviour are viewed as the consequence of a reinforcement learning process involving the targeting of evolved motives and changes to behaviour settings, and are produced by three types of behavioural control mechanism (automatic, motivated and executive). The implications are that interventions must create surprise, revalue behaviour and disrupt performance in target behaviour settings. We then describe a sequence of five steps required to design an intervention to change specific behaviours: Assess, Build, Create, Deliver and Evaluate. The BCD approach has been shown to change hygiene, nutrition and exercise-related behaviours and has the advantages of being applicable to product, service or institutional design, as well as being able to incorporate future developments in behaviour science. We therefore argue that BCD can become the foundation for an applied science of behaviour change.
Professionals including policy-makers, marketers, educationalists, environmentalists, international development practitioners, governance and justice campaigners, health promoters, city planners, sports psychologists and web designers, as well as individuals seeking to improve their own lives, are all looking for advice on how to change behaviour. However, there are myriad ideas about how to go about it. Health promotion, for example, has a long tradition of theorising the problem, based mainly in cognitive psychology (e.g., Ajzen, 1991Ajzen, I. (1991). The theory of planned behavior.Organizational Behavior and Human Decision Processes, 50,179–211. doi: 10.1016/0749-5978(91)90020-T; Bandura,1986Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.; Becker, 1974Becker, M. H. (1974). The health belief model and sick role behaviour. Health Education Monographs, 2, 409–419. doi:10.1177/109019817400200407; Michie, Stralen, & West, 2011Michie, S., Stralen, M. M. v., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions.Implementation Science, 6, 42 doi:10.1186/1748-5908-6-42.; Mosler, 2012Mosler, H.-J. (2012). A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: A conceptual model, a review, and a guideline. International Journal of Environmental Health Research. doi:10.1080/09603123.2011.650156; Schwarzer, 2008Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology: An International Review, 57, 1–29.). More recently, behavioural economists have demonstrated a variety of ways of changing behaviour using specific aspects of human decision-making (Anand & Lea, 2011Anand, P., & Lea, S. (2011). The psychology and behavioural economics of poverty. Journal of Economic Psychology, 32(2), 284–293. doi: 10.1016/j.joep.2010.11.004; Ariely, 2009Ariely, D. (2009). Predictably irrational. New York, NY:Harper Collins.; Sunstein & Thaler,2008Sunstein, C., & Thaler, R. (2008). Nudge: Improving decisions about health, wealth, and happiness. New Haven, CT: Yale University Press.). Marketing and design professionals also have practical techniques for creating sales, advertising and new products (Brown, 2009Brown, T. (2009). Change by design: How design thinking transforms organizations and inspires innovation. New York,NY: HarperCollins.). Each of these distinct fields has its own theoretical foundations and standards of practice. But despite calls for more cross-disciplinary learning and greater integration (e.g.,http://commonfund.nih.gov/behaviorchange/index (Rowson, 2011Rowson, J. (2011). Transforming behaviour change: Beyond nudge and neuromania. London: Royal Society of the Arts.)), and the initiation of new journals, university departments and centres devoted to behaviour change (e.g.,http://www.mdrc.org/project/center-applied-behavioral-science-cabs#overview), a fully-fledged applied science of behaviour change has yet to emerge.
An applied science needs both science and application. First, it has to be able to stay current with, and incorporate, the latest thinking in relevant scientific disciplines, and, second, it needs access to the latest and best tools for applying this knowledge to real-world problems. In the case of behaviour change, the relevant scientific disciplines include the burgeoning field of the brain and behavioural sciences, as well as the social and ecological sciences. Practical tools for applying this science to behavioural problems are to be found in many places including in industry (in creative and PR agencies, with professional designers and marketers), in public sector organisations and, to a lesser extent, in academia. Unifying such diverse material requires a generic framework.
In this paper, we introduce a generic approach to behaviour change called Behaviour Centred Design (BCD). The BCD framework offers both a theory of change for behaviour (De Silva et al., 2014De Silva, M. J., Breuer, E., Lee, L., Asher, L., Chowdhary, N.,Lund, C., & Patel, V. (2014). Theory of change: A theory-driven approach to enhance the Medical Research Councils’ framework for complex interventions. Trials,15(1), a1655. doi: 10.1186/1745-6215-15-267; Retolaza,2011Retolaza, I. (2011). Theory of change: A thinking and action approach to navigate in the complexity of social change processes.; Vogel, 2012Vogel, I. (2012). Review of the use of ‘Theory of Change’ in international development. London: UK Department for International Development.), and a practical process for designing and evaluating interventions. Theories of change are increasingly used to facilitate programme design because they force programmers to make explicit claims about the cause–effect relationships that follow from an intervention, together with the assumptions underlying such claims. Analysis then allows programme stakeholders to attribute results to programme activities, even in complex contexts. The BCD theory of change incorporates some of the latest developments in behavioural science, including reinforcement learning (RL) theory (Sutton & Barto,1998Sutton, R. S., & Barto, A. G. (1998). Reinforcement learning: An introduction. Cambridge, MA: MIT Press.), the evolution of behavioural control (Aunger & Curtis, 2015Aunger, R., & Curtis, V. (2015). Gaining control: How human behaviour evolved. Oxford: Oxford University Press.), the evolved structure of human motivation (Aunger & Curtis, 2013Aunger, R., & Curtis, V. (2013). The anatomy of motivation: An evolutionary ecological approach. Biological Theory, 8,49–63. doi: 10.1007/s13752-013-0101-7) and a revised version of behaviour settings theory (Barker, 1968Barker, R. G. (1968). Ecological psychology: Concepts and methods for studying the environment of human behavior.Palo Alto, CA: Stanford University Press.). It also sets out a practical five-step process for designing and evaluating interventions. This process incorporates a novel approach to formative research (FR), applies design thinking and professional creativity to intervention production, and relies on academic best practice for process and impact evaluation. A fundamental tenet of BCD is its single-minded focus on behaviour in its physical, social, biological and temporal context. We suggest that following the five-step BCD process should lead to novel, creative and sustainable solutions, as well as to the accumulation of learning about what works, thus contributing to a progressive applied science of behaviour change.
BCD has been applied successfully to behaviours ranging from handwashing, to oral rehydration, food hygiene, child and maternal nutrition, and post-operative exercise (Biran et al., 2014Biran, A., Schmidt, W.-P., Varadharajan, K. S., Rajaraman,D., Kumar, R., Greenland, K., … Curtis, V. (2014). Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): A cluster-randomised trial. The Lancet Global Health, 2(3), e145–e154. doi: 10.1016/S2214-109X(13)70160-8; Doyle, 2015Doyle, C. (2015). Evaluation of a home-based walking exercise program on fatigue and health related quality of life in prostate cancer patients undergoing radiation therapy: A pilot study. (DrPH). London School of Hygiene and Tropical Medicine, London.; Gautam & Curtis, 2016Gautam, O. P., & Curtis, V. (2016). Design and test of an Intervention to change 5 food hygiene behaviours in Nepal. Manuscript submitted for publication.; Greenland, 2015Greenland, K. (2015). Evaluation of the Komboni Housewives multiple behaviour change intervention: Preliminary findings.London: London School of Hygiene and Tropical Medicine.). It has been used in the design and marketing of bathroom, soap and food products and is currently being applied to new challenges such as creating demand for sanitation and HIV prophylaxis. Below, we first set out the components of the BCD theory of change, then the practical steps in its application, using the context of a large-scale public health behaviour change programme. We finish with a discussion of its limitations and possibilities.
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