Over the last several months I have had the pleasure of working with a number of people and projects around behaviour change. Changing behaviours particularly around physical activity is a fundamental part of Active Humber's role and this blog looks at how we learn about the concepts and attempt to implement them. Through my role I have had the opportunity to learn from some behaviour change experts, namely Andrew Darnton and Rachel Lilley, and begin to apply that learning locally with colleagues at Active Withernsea and across North Lincolnshire.
My perceived challenges from the outset were around:
Several months into the work and many of the above questions are unanswered, however change is happening. Ultimately what has become apparent is, to enable behaviour change you just have to start...somewhere, anywhere.
What I have seen taking place on the ground is people engaging with the principles of behaviour change, adopting the principles into everyday work, understanding that we need to listen, sense and feel what is happening for people in their context and this is made even more valuable when we can develop the ability to do this without placing our own biases and assumptions into this.
The two projects I have been linked with are both using different behaviour change models and different approaches to understand the people and behaviours. It seems that there are many models out there for behaviour change and it seems to be an incredibly difficult task to work out which one to use. The reality is it isn't, whilst they all have their own pro's and con's essentially they are all trying to do the same thing. What all of the models do is provide a process for understanding the behaviour in a context and start conversations around what could be done to enable change.
Change is happening, I am certain of that. However, attributing that to the behaviour change work can be incredibly difficult, time consuming and cost a lot. So what do we measure? It is important to think about how all of the work across a system is influencing behaviour change and identifying what is shifting the dial most that we can turn up more? And what is not having the desired impact that we can dial down?
What I am seeing are professionals changing their approaches to work, different types of conversations being held, working with people rather than doing to people, different partners starting to talk to each other and operational actions taking place to help behaviors to change. These things are not happening by chance but because there is a commitment to change certain behaviours that a range of stakeholders, including end users, are bought into and because through conversation and listening we are identifying factors that really matter to people that ease some of these multifaceted challenges facing people. Recently this has been best summed up with the phrase 'change is better than the attribution', for me this is about spending the majority of our time, effort and resources on creating the right environment and enabling behaviour change through improving certain factors that affect a behaviour and in doing that we can have some comfort that eventually the behaviour will start to change.
In North Lincolnshire we have been using the ISM behaviour change model, but not in the way it was originally designed. The model is used in Government and comes with a lengthy guidance document, however the approach we have taken is to strip that right back...Professionals have used the model firstly to plot what we know about a behaviour and asking questions such as, who is operating in this area and what has already been tried and tested. This initial stage allowed us to understand the behaviour we set out to change, and sometimes provided us with reason to change our thinking. The second step was to draw the model below and with a mixed group of stakeholders plot what we knew about the behaviour, effectively starting a conversation. This followed with what we could do about the behaviour, which ultimately led to shared actions, some small and easy to do, others more long term and complicated, but collaborative and aligned action around improving a behaviour happened and happened easily.
The Active Withernsea project has a greater resource behind it and I represent Active Humber as a partner on the project. The project is using the 'Theory U' behaviour change model, which relies on really listening to a community before making sense of what has been heard and only then taking action. This approach takes more time and you hear a lot about the behaviour but also about many other aspects of life in that community, which at first doesn't seem relevant but actually provides a real picture of what is happening for a person in their context.
This approach can only work when you have people who are developed enough to be able to really listen and hear a person, therefore we have held a number of training sessions about paying attention, understanding ourselves and how our minds operate. This has been enlightening, to realise we all operate with a number of biases affecting the way we feel, think and understand something. All of us are biased and to think we can operate without bias is naive, the trick with this has been knowing that we are biased, how that affects us and then being able to listen to someone else seeing things as much as possible from their perspective.
A particular cognitive bias which is particularly important to understand within behaviour change work is 'the empathy gap', this bias makes it difficult for people to account for the manner in which differences in mental states affect the way that they and others make decisions.
The above approaches are both very different, but they equally have great value and ultimately seek to create behaviour change. Which one is best is not possible to determine, they are both a suitable approach for the community they serve and what they are trying to do and therefore cannot be simply replicated. However, the principles of they work and their intentions can be considered and implemented as appropriate in other areas.
I have learnt a lot about behaviour change approaches over the last few months and I am sure there is much more learning to come. The challenges I originally perceived seem less relevant now and have become bypassed with thoughts around:
Whose behaviour are we trying to change? The constant challenge through both approaches is are we changing behaviours of individuals in communities or are we trying to change system behaviours and change the way we operate to be better connected and make better decisions. I feel we are trying to do more of the latter in the immediate work which will lead to change in the former.
Do we have the right people and culture? Behaviour change and new thinking can only happen when there is a commitment to it. Through the work I have been involved with, I have seen examples where someone is not bought in and doesn't want to go with the process. This has led to different results, one choosing to leave, one batting against it until it suddenly makes sense and others who have struggled initially but have at least gone with it and changed with it. A learning culture has to be fostered from the outset and the right mentality that we are trying things, some may work, some will not and some things will go in a completely different direction to what we originally thought. We have to be prepared to accept all outcomes and no matter what happens it will have a value, whether it be a positive outcome or a failure, but learning will take place.
How do we collectively learn across the sector? Approaches cannot be simply replicated, however the success factors and approaches generate a great deal of valuable learning that can be taken into other settings and enable behaviour change elsewhere. As a sector committed to improving physical activity behaviours, we must allow ourselves the time to take a step back to review what is happening and discuss that with others.
The people I have been working with over the last few months have all been fantastic and a real culture of open and honesty and a true desire to learn with each other is present. The outcomes of this work are yet to be realised and may not be seen for some while, however we are content that we are taking action to enable change and also committed to sharing what the impact of this. Watch this space for further updates or contact Active Humber to discuss the progress, approaches or answers to the questions we are grappling...