To improve and maintain the way we deliver healthcare, we need to understand human behaviour. It is important that people who are healthy can maintain positive behaviours such as not smoking, managing their stress and weight. On the other hand, we want people who are ill, to change their behaviour to adhere to medication and health advice. Finally, it would be good to know that our healthcare practitioners are up to date with research and that they are prepared to change their practice when necessary. All of these situations require individuals to change their behaviour, and then for groups and sometimes organisations to encourage individuals to maintain these new behaviours.
It all sounds too simplistic! Humans are not robots and our behaviour is not pre-programmed. Yet we are likely to behave in ways that make us feel good, and we know that with practice we get better at doing things and most of us adopt routines to do things efficiently. In fact many of us are creatures of habit and we don’t like change, especially when the benefits are not clear.
So one of the challenges of improving healthcare is to encourage and support people to change when it is beneficial and important to do so. There is a good model to consider 3 necessities for behaviour change. First you need the capability; the skills and knowledge that there will be a benefit to you. You need the motivation and intention to do something differently, and usually this is also linked to a positive emotional expectation. Lastly, you need the opportunity and appropriate environment to change.
Still quite simplistic, but there is also a lot of research evidence to describe the barriers and reasons we do not change our behaviour. Almost 15 years ago, in a systematic review of 76 articles, 293 different reasons for doctors not following clinical guidelines were described. More recently, a theoretical domains framework has been developed to described 14 key areas where reasons for and against changing behaviours might lie. These include having the right knowledge, skills, identity, belief about your capability, optimism, belief about consequences, reinforcement, intentions, goals, memory & attention, environment, social influences, emotion and behavioural regulation. So the complexity of this area is well recognised and researched. Therefore, it is important when planning or reviewing ways to improve the implementation of research evidence into practice, that we carefully consider where behaviour change might be expected, and identify barriers and facilitators to be addressed. This is more complex!