Abstract
In the interest of promoting healthy lifestyles, behavioural change and the theories that underpin this have gained much attention. Behaviour is highly complex with many external and internal influences on perception, attitude and action. Lifestyle choices are the result of both decisions that are based on routines that require very little active decision-making and reflective, elaborate decision-making where options are carefully considered. The dual process theories (DPTs) describe these two routes as automatic/heuristic and reflective/systematic processing of information, present in choice situations. However, choices are not just about individual factors, and consideration of an ecological approach positions behaviour change within a much broader multilevel framework. For example, at the societal level, there is the influence of organisational, institutional or cultural factors, laws, policies and the impact of manufacturing and commercial distribution of products. While at the community level there is the physical and social environment, at the household level, there is the influence of close friends and neighbours. 1 Fundamental to any debate on this topic is the relationship between knowledge, behaviour and intention to change. ‘Back on Track’ has been successful in raising awareness of the importance of back care education in school children, 2 and ease of access and increased knowledge were key issues of effectiveness from the condom distribution scheme in a study by Kinsella et al. 3
No commentary on behaviour change would be complete without a mention of the Nuffield Intervention Ladder, 4 where the least intrusive step to ‘nudge’ behaviour is generally ‘to do nothing’, or at most monitor the situation; whereas, the most intrusive is to legislate in such a way as to restrict the liberties of individuals, the population as a whole or specific industries. In between, there are more modest interventions such as the one described by Folaranmi. 5 The use of mobile devices is reconstructing all aspects of our lives, and the potential of this media to transform the face of health care by serving as a vehicle for delivering specific health interventions is immeasurable. mHealth is an exciting area of research, and we welcome the opening of this debate. An expanding proportion (40% and rising) of European Union (EU) adults now own smartphones, with prediction that this will increase to 65.8% by 2017, 6 and Africa too has experienced an incredible boom in mobile phone use. In 1998, there were fewer than 4 million mobile subscriptions on that continent, but today, there are more than 800 million subscriptions, and this is projected to reach 1.12 billion by 2017. Clearly, technology has much to offer and identifies a new and emerging world for public health.
Finally, the article by Pine and Fletcher 7 considering the contribution that behavioural science offers to the understanding of why people develop, and persist with, behaviours that are adverse to their wellbeing provides an interesting case study describing an online behavioural intervention that addresses people’s habits, rather than their knowledge, to bring about sustainable improvements in health. The debate on behaviour change is lively and ever expanding with the Royal Society for Public Health (RSPH) featuring a range of behaviour change articles on its member pages, and running a successful conference in October 2013 centering on using behaviour change within the current economic, social and cultural context. In addition, the RSPH provides a Level 2 qualification on this topic ‘Understanding Behaviour Change’, which focuses on how best to support individuals in adopting a positive change in behaviour.
This issue of Perspectives is therefore timely and brings together many activities where the RSPH can demonstrate engagement with this important agenda and provide a platform for resource dissemination.