4. The COM-B system: Behaviour occurs as
an interaction between three necessary
conditions
Capability
Motivation
Opportunity
Behaviour
Psychological or physical ability
to enact the behaviour
Reflective and automatic
mechanisms that activate or
inhibit behaviour
Physical and social
environment that enables
the behaviour
Michie, van Stralen, & West, 2011
6. Successful behaviour change
techniques
• Michie et al (2009) Meta-analysis of 84 physical activity
and healthy eating interventions
– Which behaviour change techniques are most
frequently featured in effective interventions?
– Interventions combining ‘self-monitoring’ and at least
one other technique related to self-regulation were
twice as effective as other interventions, e.g. goal-
setting, providing feedback, rewards…
7. Commercial programmes are promising
From: Efficacyof Commercial
Weight-LossPrograms: An
Updated Systematic Review
Ann Intern Med.2015;162(7):501-
512.doi:10.7326/M14-2238
8. A psychological approach to
managing eating and physical activity
over the long term
Strong emphasis on lifestyle change
not dieting
Peer learning OR self-help
Via behaviour change techniques&
modified CBT = weight management
through permanent lifestyle change
10. • Used by more than 15,000 adults in the UK to date
• Mean weight loss 2.8kg over 8 weeks, 5.3% at 6 months
• Over 90% of users report feeling more in control of
their eating habits
• 98% would recommend Shape-Up to a friend trying to
manage their weight
Shape Up Audit: Preliminary results
11. Habit development
• Habits are (relatively)
automatically triggered actions
• Formed through repetition in a
consistent context = ↑
automaticity
• Can be used to help
individuals ‘learn’ healthy
lifestyle behaviours
Lally et al, Eur J Soc Psychol, 2009
12. Habit-based interventions
• Require less engagement or motivation
• Less time-consuming to explain
• Easier to implement
• Promotes long-term maintenance
16. Jacksonet al. (2014). BMJ
Open. 3: e003693-e003693
Health professionals can play an important role
Only 17% of overweight and
42% of obese respondents
recalled ever having
received HP advice to lose
weight.
19. ‘Teachable moment’-
A window of time following an event in which a patient is more amenable to
lifestyle change’
Affective reactions Self-conceptPerceived risk
Event
Teachable
moment
McBride et al., 2003
Health Educ Res
Behaviour
change
20. Effect of advice on fruit and vegetable intake after bowel
screening (n=742; 85% follow-up (Baker & Wardle, 2002)
Knowledge Intake
Pre Post Pre Post
Control 4.1 4.1 3.0 3.3
Intervention 4.0 4.7 3.1 4.1
Evidence from interventionstudies [shows] that comprehensive interventions
are acceptable for asymptomatic subjects targeted for cancer screening. A
positive impact on dietary behaviors was observed in all studies, conflicting
results were reported for physical activity, and no impact was observed for
interventions on smoking cessation (9 trials)
22. ‘a technique that alters a person’s decision-makingcontext without
removing options or changing the incentives in order to promote
choice and behaviour in accordance to their own preferences, such as
choosing healthy food over unhealthy food in a supermarket’
Nudging
23. van Kleef et al. BMC Public
Health 2012, 12:1072
24. • We have a raft of effective (ish) strategies for inspiring
behaviour change
– The who, the when and the where might also be important
• Personalised behavioural medicine and digital
technologies offer novel approaches
• We need to understand how to inspire behaviour change
in policy makers & industry
• Need to tackle social inequalities
• Given the challenge of inspiring change, the importance of
establishing healthy behaviours in early life (and
preventing unhealthy behaviours) cannot be understated
Conclusions & Future Directions
25. Acknowledgments
• Dr Helen Croker
• Dr Pippa Lally
• Dr Laura McGowan
• Dr Sarah Jackson
• Nathalie Kliemann
• Professor Jane Wardle (1950-2015)
r.beeken@ucl.ac.uk
