Behaviour change guidance

Abstract

Scope and purpose

This guidance was produced by the UK National Institute for Health and Clinical Excellence (NICE), in response to a request from the Department of Health, to produce public health guidance on the most appropriate generic and specific interventions to support attitude and behaviour change at population and community levels.

Methods

This guidance was developed using the NICE public health programme process. Details of this process can be accessed at the NICE website (www.nice.org.uk/phmethods).

Review and updating

With all NICE guidelines, a check for new evidence is made at 2 and 4 years after initial publication to decide whether all or part of the guidance should be updated. If important new evidence is published at other times, NICE may decide to update some recommendations at that time.

Recommendations

This guidance outlines seven principles, the target audience and recommended actions. Three principles are related to planning of interventions and programmes, three to programme delivery and one to the evaluation of programmes (see Table 1). A number of gaps in the evidence were highlighted, as follows:

Table 1 National Institute for Health and Clinical Excellence recommendations on behaviour change

• Evidence about the cost-effectiveness of behaviour-change interventions is lacking.

• Interventions frequently fail to make a satisfactory link to health outcomes. Clear, consistent outcome measures need developing.

• Evaluations based on specific psychological models tend not to relate the outcome measures to the model. As a result, it is difficult to assess the appropriateness of using the model as a means of describing behaviour change.

• Few studies explicitly address the comparative effect that behaviour change interventions can have on health inequalities, particularly in relation to cultural differences.

• There is a need for more information on the links between knowledge, attitudes and behaviour. Conflation between them should be avoided.

• There is a lack of reliable data from which to extrapolate the long-term health outcomes of behaviour change interventions.

A series of recommendations relating to future research were also made.

Commentary

Dental health professionals are regularly involved in activities designed to help people to change their health-related knowledge, attitudes and behaviour. There have been a number of specific reviews related to the effectiveness of oral health education and promotion.^{1, 2, 3, 4, 5} This new guidance from NICE has been developed using standard procedures for public health programmes and provides a set of generic principles that can be used as the basis for planning, delivering and evaluating public health activities aimed at changing health-related behaviours. The guidance provides a useful update to the more specific oral health reviews and this reinforces many of the issues raised in those reviews.

The appendices in the full guideline provide helpful short summaries of the key behaviour theories but recognise that the reviews conducted for the guidelines were unable to capture all the material related to the very broad behaviour-change field.

This guidance reminds us of the difficulties not only in changing behaviour but understanding how this is achieved, and how we should plan and develop programmes to achieve behaviour change. This should be a starting point for all those engaged in these processes.