Notes

Week 1

What is a Behaviour? A behaviour is an observable action.  Behaviour is different from emotion (a feeling state), disorders (a functional abnormality or disturbance), personal attributes or dispositions (traits or characteristics of an individual) and processes (a series of steps towards a specific end).  Although emotions, disorders, personal attributes and processes can involve behaviours, they are not behaviours. In 3018PSY we will focus on volitional behaviours, that is actions that are (for the most part) voluntary and under personal control. Identifying Behaviours Across Contexts  Understanding and changing behaviour in individuals, organisations, and populations starts with identifying the specific behaviour of interest.  This may be associated with: Specific context (e.g., workplaces, schools) Issue (e.g., health and wellbeing, safety, productivity, living independently) Lifestage/demographic (e.g, young people, adolescence, retirement). Specificity is important because the influences on behaviour differ and change strategies should be tailored accordingly.  For example, the influences of exercise among children are different from the influences of exercise among older adults, and a behaviour change intervention for children would be different from one for older adults.  A key competency of behaviour change practitioners is an awareness of behaviours that affect people. May involve other core competencies such as the ability to assess people's needs and interpret relevant data on local or national needs and characteristics, and understanding local policy and demographics. To identify the important behaviours that affect people, behaviour change practitioners can use a range of sources such as Observation Personal report (from e.g., people, carers, key stakeholders) Empirical research/scientific knowledge (e.g., about the links between behaviours and outcomes) Theories and frameworks Surveillance.

Behaviour Change Practitioner Competencies Awareness of behaviours that adversely affect people, and benefits of prevention and management Able to assess people's needs and interpret relevant data on local or national needs and characteristics Understand local policy and demographics Understand factors that may affect behaviour, including psychological, social, cultural and economic factors Select, design, implement and evaluate appropriate evidencebased interventions Recognise the specific behaviour change techniques used in change interventions Know how an intervention works (mechanism of action) Address inequalities by tailoring interventions to people's specific needs, including cultural, social and economic factors Understand how to access, and how to direct and refer people to, specialist support services   Individual-level Approaches Aim to understand/change an individual’s knowledge, awareness, motivation, intentions, skills related to behaviour Understand consequences of behaviour Feel positive about benefits of changing behaviour Recognise how social relationships and contexts affect behavior Plan change over time Plan explicit coping strategies e.g., individual/group counselling, support groups Organisational-level Approaches Aim to understand/change the norms, processes and structures of the organisation to understand/change behaviour of people linked with that organisation Supportive social networks and relationships for behaviour Opportunities for behaviour Promote access to financial and material resources for behaviour e.g., school nutrition programs, workplace antibullying policies, onsite health and safety rules Population-level Approaches Aim to understand/change large numbers of people via awareness and the context of the behaviour local and national advertising and mass media fiscal interventions legislative interventions  environmental restructuring should be consistent with individual and community approaches e.g., TV advertising (e.g., don’t drink and drive), national bowel screening program, bike hire scheme and paths, speeding fines, cigarette taxes, nutritional labelling requirements, covid19 restrictions My Behaviour Change Work Understanding behaviour Studies of behaviour patterns & influences (preferences, attitudes, knowledge, etc) Logan Council Survey Physical activity participation and use/perceptions of council facilities HABITAT 10y study of physical activity and individual (e.g., attitudes), social (e.g., support) and area level (e.g., neighbourhood design) influences Changing Behaviour Supervised training, behavioural counselling, and self monitoring with smart devices to promote healthy lifestyles among adults with chronic conditions (mental illness, diabetes, arterial disease, arthritis) Impact of flexible work on recreational activity and occupational sedentariness National behavioural guidelines

Week 2

Changing behaviour in individuals, organisations, and populations requires an understanding of the influences on behaviour.  These influences can then be targeted in interventions. A core competency of behaviour change practitioners is, therefore, understanding factors that may affect behaviour, including psychological, social, cultural and economic factors. This understanding may involve other core competencies such as the ability to assess people's needs and interpret relevant data on local or national needs and characteristics, and understanding local policy and demographics.   Your self directed online learning activities for this topic include Key concepts about behavioural influences A reflection activity and mini lecture on the multiple levels of behavioural influences An interactive activity about types of research designs which can be used to identify behavioural influences A mini lecture, required reading, and interactive activity on a theoretical framework which can be used to identify behaviour influences By the end of this topic you should be able to Explain what a behavioural influence is and common methods to identify influences Describe and differentiate down stream, mid stream and upstream behavioural influences, including: behavioural; psychological; social; and physical, economic, policy and cultural environmental factors Differentiate six types of research designs which can be used to identify behavioural influences Describe and use the Theoertical Domains Framework

What are Behavioural Influences? An "influence" is an element or factor with the capacity to have an effect on behaviour. This effect may increase (i.e. a positive association) or decrease (i.e. an inverse or negative association) the behaviour. Behavioural influences may have a direct or indirect effect on behaviour. A direct effect is when an influence impacts on a behaviour without any intervening factors. e.g., My positive attitudes about exercise have a direct effect on my doing exercise. An indirect effect is when an influence impacts on a behaviour via an intervening factor. e.g., The presence of street lights in my local area makes me feel safe, and feeling safe makes it more likely for me to walk at night.  The streetlights do not directly impact my behaviour, but do so indirectly via my perceptions of safety.  There are a range of terms for behavioural influences. Examples include correlates, covariates, determinants, mediators, moderators, predisposing factors, precipitating factors, perpetuating factors, reinforcers, barriers, enablers, risks factors etc.  Each of these terms is used to describe a specific type of relationship with behaviour, which may reflect eg., timing, type of evidence, type of statistical analyses used to identify the influence, direct/indirect impact etc. For the purposes of 3018PSY, we will use the generic term "influence". Importantly, an influence is not necessarily a cause of a behaviour.  An influence may increase/decrease the likelihood of the behaviour, but it does not necessarily make the behaviour occur/not occur.

An "influence" is an element or factor with the capacity to have an effect on behaviour. This effect may increase (i.e. a positive association) or decrease (i.e. an inverse or negative association) the behaviour There are a range of terms for behavioural influences Examples include correlates, covariates, determinants, mediators, moderators, predisposing factors, precipitating factors, perpetuating factors, reinforcers, barriers, enablers, risks factors etc.  Each of these terms is used to describe a specific type of relationship with behaviour, which may reflect eg., timing, type of evidence, type of statistical analyses used to identify the influence, direct/indirect impact etc. For the purposes of 3018PSY, we will use the generic term "influence". Importantly, an influence is not necessarily a cause of a behaviour.  An influence may increase/decrease the likelihood of the behaviour, but it does not necessarily make the behaviour occur/not occur. Levels of influence Downstream (Micro level) Biological and physiological factors Age Gender Genetics Hormones Health Physical functioning Midstream (Intermediate level) Behavioural attributes Complexity Demand/Effort Variety Novelty/Habit Skill required Time required Resources required Psychological factors Confidence Knowledge Attitudes Optimism Coping Beliefs capabilities control competence Outcome expectancies benefits risks Self esteem Goals & values Commitment Motivation Emotions fatigue stress mood fear enjoyment Coping Social factors Social Support Emotional Material Informational Network Sources Family Friends/Peers Professionals Other Group norms and cohesion Leadership Role models Social pressure Organisational climate Supervision Conflict Comparisons Social identity Care responsibilities Companionship Stigma Upstream (Macro level) Physical environment Resources Infrastructure Availability Accessibility Aesthetics Because I live here, it’s very easy for me to go walking by the river, there is a walking and a cycle path that is convenient, and I use that to come home from work. There’s nothing to do around here unless you enjoy going to the pub or bingo. When you got no transport, what you got to do is wait two hours for the bus and then get a train. Economic environment  Costs Education Employment Occupation Prestige Working conditions Income Housing and area of residence Eg: I was working in the school environment so I had free access to the gym and pool anytime. We don’t have enough clubs for ladies only and even if there is, it is expensive. Before was cheaper but now double the price. We have ladies’ clubs but it’s expensive. [sic] A lot of the back problems actually came from weakened core muscles, so we paid for gym memberships for those people. We’re subsidizing the enrolment for Global Corporate Challenge this year, so that means people don’t have to pay full price. It’s not been seen as a priority, because of the cost of it Political environment Health Welfare Housing Transport Taxation Legal Safety Organisational Professional Practice Policies influences: Eg: NSW Dept Education Sport and Physical Activity Policy Students participate in a minimum of 150 minutes of planned moderate with some vigorous physical activity across the school week. This time includes planned weekly sport. Schools are also encouraged to provide Year 11 and 12 students weekly access to a minimum of 150 minutes of moderate with some vigorous physical activity and sport. Sets the direction for the provision of sport, recreation and physical activity that support the diverse community to be active in Logan Creating spaces that provide positive physical activity benefits Parks Strategy Access and Inclusion Plan for People Living with Disability Sport and Recreation Infrastructure Discussion paper Statement of Intent: Cycle Network Infrastructure Implementation Plan Cultural environment Belief systems Practices Values Norms Roles/boundaries Eg: Families think differently to us and maybe sometimes when you are slim they ask why are you going to exercise – they don’t want you to be more slim so they prevent you from doing anything. Like my friend is not allowed to do exercise because she is slim – her family will not allow her. Doing exercise disagrees with the Emirati culture – the parents are not used to letting the girls go out to do walking. Some parents think that you are a girl and you should learn the kitchen work and you don’t do exercise – this is from the culture. Because it is too hot we cannot go outside and do exercise especially because we are wearing abaya and shayla it is very hot for all weather Sometimes there is that attitude that if you’re not seen to be at your desk then you’re not doing anything. When we built the office, we put in showers in both wash rooms so that would be available to encourage people to cycle to work or whatever it is that they want to do. If your manager exercises and is active and promotes it in the workplace, you will tend to start doing the same things, because it’ll make it okay, it’ll be all right for you to do those things. I think leadership’s a big part of it, your leader’s got to be seen to be out doing this stuff. I think it’s got to be led from the top and I think the blokes have got to trust you. The workers have got to trust you and it can’t be, “Ah I’m telling you what to do,” sort of thing, it’s just got to be led by example without too much telling them and then they just pick up and start doing

Case study: A detailed descriptive account of an individual or group about the influence and the behaviour Prospective longitudinal study:  Assessment is done with the same people on multiple occasions. This may examine the relationship between the influence at one point in time and the behaviour at a future point in time, or how changes in the influence and behaviour coincide over time. Case control retrospective study:  Differentiates between people who do the behaviour and those who do not, and assessment looks back in time to compare exposure to the influence. Experimental study:  A specific type of longitudinal study where participants are randomised to groups which are manipulated to receive different levels of the influence.  Behaviour is assessed before and after the manipulation to determine possible changes over time, and compared between the groups Quasi experimental study: A specific type of longitudinal study where different groups of people are exposed to different levels of the influence, but without randomisation. Behaviour is assessed before and after the exposure to determine possible change over time, and compared betwen the groups Ecological study:  Assesses levels of the influence and behaviour in a defined group/area, but not in the same people

The Theoretical Domains Framework

The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers. The collaboration aimed to provide a comprehensive, theory-informed approach to identify influences of behaviour. The TDF is a framework rather than a theory; it provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour. The TDF is an integrated theoretical framework synthesised from 128 theoretical constructs from 33 theories. Although the domains cover the physical and social environment, the majority relate to individual motivation and capability factors. The revised version of TDF, with 14 domains covering 84 theoretical constructs, is referred to as TDF(v2).   Knowledge Skills Skills Awareness of existence of something Beliefs about capabilities Ability or proficiency acquired through practice Beliefs about consequences Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use Consequences Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation Optimism Confidence that things will happen for the best, desired goals will be attained Reinforcement Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus Intentions A conscious decision to perform a behaviour or a resolve to act in a certain way Goal Memory, Attention and Decision Processes Emotions Social/professional role and identity Social influences Environmental context and resources Behavioural regulation   Transtheoretical Model Stages of Change Precontemplation Unaware of the problem Contemplation Aware of the problem and of the desired behaviour change Preparation Intends to take action Action Practices the desired behaviour Maintenance Works to sustain the behaviour change

Goals: Mental representations of outcomes or end states that an individual wants to achieve Memory, retention, decisions: Ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives Emotions: A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event Professional identity/role: Coherent set of behaviours and displayed personal qualities of an individual in a social or work setting Social Influence: Interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours Context resources: Circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour Regulation: Aimed at managing or changing objectively observed or measured actions TDF Weakness: Does not explain or indicate causality about influences (a list, not an explanation of how to change) Heavy bias towards individual-level factors (what of upstream?) TDF Strengths Framework encompasses range of influences across theories Relevant to range of contexts Use for planning, evaluation and implementation or to synthesise evidence Change interventions based on theory are more effective than those without   Examples in module  

Week 3

An "influence" is an element or factor with the capacity to have an effect on behaviour. This effect may increase (i.e. a positive association) or decrease (i.e. an inverse or negative association) the behaviour There are a range of terms for behavioural influences Examples include correlates, covariates, determinants, mediators, moderators, predisposing factors, precipitating factors, perpetuating factors, reinforcers, barriers, enablers, risks factors etc.  Each of these terms is used to describe a specific type of relationship with behaviour, which may reflect eg., timing, type of evidence, type of statistical analyses used to identify the influence, direct/indirect impact etc. For the purposes of 3018PSY, we will use the generic term "influence". Importantly, an influence is not necessarily a cause of a behaviour.  An influence may increase/decrease the likelihood of the behaviour, but it does not necessarily make the behaviour occur/not occur. Levels of influence Downstream (Micro level) Biological and physiological factors Age Gender Genetics Hormones Health Physical functioning Midstream (Intermediate level) Behavioural attributes Complexity Demand/Effort Variety Novelty/Habit Skill required Time required Resources required Psychological factors Confidence Knowledge Attitudes Optimism Coping Beliefs capabilities control competence Outcome expectancies benefits risks Self esteem Goals & values Commitment Motivation Emotions fatigue stress mood fear enjoyment Coping Social factors Social Support Emotional Material Informational Network Sources Family Friends/Peers Professionals Other Group norms and cohesion Leadership Role models Social pressure Organisational climate Supervision Conflict Comparisons Social identity Care responsibilities Companionship Stigma Upstream (Macro level) Physical environment Economic environment Political environment Cultural environment

Assessing Behavioural Nonadherence Define the required behaviour Collect related information on behavioural performance Collect related information on behavioural performance frequency, duration, standard etc Subjective methods (self report) survey, interview, diary, rating scale Objective methods physiological measures, monitors, records Person/professional burden, bias, cost, acceptability, accuracy, utility, viability, intrusiveness Determine rate Behaviour done in time period /Expected behaviour in time period X 100% Define adherence criterion  >? % Partial adherence?

Underperformance: i.e. not doing a behaviour enough or at all  e.g., doing no exercise during the week, or doing exercise once/week, when it is recommended to exercise three times/week Overperformance i.e. doing too much of a behaviour e.g., doing exercise at a higher intensity or frequency, or with heavier weights, than what was recommended Incomplete performance  i.e. not doing all of the behaviour e.g., doing the recommeded exercise program, but without the included warm up and cool down Different performance i.e., doing the behaviour in a different way e.g., doing aerobic instead of muscle strengthening exercise, doing exercise in a leaning instead of straight posture, as recommended   intentional nonadherence is when the person is aware that he/she is not doing the behaviour as recommended nonintentional nonadherence is when the person is unaware that he/she is not doing the behaviour as recommended   Understanding non adherance One and two are personal motivational ability, "Do I want to? Can I do it?" Three and four are the peer pressure, the social pressure that's all around us. And sources five and six are the structural motivation, like incentives and rewards, or the environment itself.   Non adherence TDF Self Regulation: The required behaviour was not a habit for you, or you did not have a plan to do it Skills: You were not actually capable of doing the required behaviour, had insufficient practice, or were not good at it Knowledge: You did not understand what was required Social/Professional identity: The required behaviour did not fit well with how you see yourself, or was outside your work role Optimism: You were confident that things would work out well regardless Social Influences: Other people discouraged you, made it difficult, or did not help you to do the required behaviour Capability Beliefs: You were not confident to do the required behaviour, thought you did not have what it took to do it, or had low self esteem Social influences: You were not impressed with the person advocating for the required behaviour Reinforcement: There was no or little reward/return in doing the required behaviour Environmental Context: A critical event made it difficult to do the required behaviour Environmental Context (Person X Environment): A critical event made it difficult to do the required behaviour

The COM-B Model Psychological model for explaining individual-level volitional human behaviour Intended to reflect range of potential change mechanisms Starting point to consider how to change behaviour   Behaviour = Capability Psychological capacity to do the behaviour Understand Nonadherence Poor/incorrect knowledge Poor recall Distraction/poor focus Poor planning Poor judgement Promote Adherence Provide/shape knowledge Feedback on understanding Develop planning skills Physical capacity to do the behaviour Understand Nonadherence Poor physical functioning Promote Adherence Physical training Physical aids Motivation Reflective processes that activate or inhibit behaviour Understand Nonadherence Low confidence/esteem Undesirable outcome expectancies Beliefs of low need/value Promoting Adherence Information on salient consequences Improve confidence Identify value Automatic processes that activate or inhibit behaviour Understand Nonadherence No cues for action  Unhelpful mood state (eg anxious, depression) Other/no habit Promoting Adherence Cues for action Habit formation/reversal Opportunity Physical factors outside the individual that enable or hinder the behaviour Understand Nonadherence Low resources Low accessibility/availability High cost Environmental stressors Limited opportunities Promote Adherence Resources Accessibility/Availability Affordability Provide opportunities Restructuring: reduce barriers Social factors outside the individual that enable or hinder the behaviour Understanding Nonadherence Stigma Cultural beliefs Religious beliefs Promote Adherence Reduce stigma Positive norms

Motivation: a process that drives and directs behaviour, dimensions of amount and quality Adherence: Adherence is a dynamic behavioural process to be managed against a variety of other factors (life, people, situation)

Week 4

RE-AIM Framework Reach Effectiveness Adoption Implementation Maintenance   Reach (individual) Who takes part: The absolute number, proportion, and representativeness of individuals who are willing to participate in the intervention NOTE: This may not be the same people for ultimate change Outcomes: Planned Unplanned Effective: The impact of an intervention on important outcomes, including primary/secondary measures, and potential negative effects Adoption (organisational) Gatekeepers: Settings/organisations which provide the intervention Adoption: The absolute number, proportion, and representativeness of settings and intervention agents (who provide the program) Relative Advantage Better than what it replaces Compatibility Fits intended audience Complexity Easy to use Observability Results observable and easily measured Social impact Minimal disruption on social environment Reversibility Easily reversed or discontinued Communicability Clearly and easily understood Time required Minimal time investment Risk and uncertainty Minimal risk and uncertainty Commitment Effective use with modest investment Modifiability Possible to adapt, update and modify over time

Implementation What is done At the individual level, participants’ use of the intervention strategies. At the organizational level, the fidelity to the various elements of an intervention protocol, including consistency of delivery, time and cost of the intervention Maintenance What is the sustainability At the individual level, the long-term effects of a program on participant outcomes. At the organizational level, the extent to which a program becomes institutionalized or part of routine organizational practices and policies

RE-AIM for planning behaviour change: REACH Who is the target? How can we access/engage them? Who are the participants? (users) How can these people be accessed? How can the intervention be promoted? How can participation be assessed? How can the representativeness of participants be assessed? Are there equity issues for participation? How can the underserved be enabled to engage? EFFECTIVENESS How to demonstrate results? (planned and unplanned) How to Demonstrate Results: Outcomes primary (3018PSY: behavioural) secondary unplanned How can these be assessed?  Self report (diaries, Q/re, i/v) Observation Objective (measures) Records ADOPTION Where could use this? (why and why not)  What setting/agency could use the intervention? Rationale : desirable characteristics of setting what is appealing about this intervention TO THE AGENCY? what is not appealing about this intervention TO THE AGENCY? IMPLEMENTATION What will be done? (BCTs for participants, by agencies, resources needed) Key elements of the intervention aim, objectives, functions (Topic 5) what is done? (BCT: Topic 5) how is it done? who does it? when is it done? mode? what organisational/participant resources are needed? MAINTENANCE What will happen in the long term? (participants, agencies) What will happen in the long term? Likelihood of lasting change effects for participants? How could this be assessed? Can the intervention continue to be used by the agency? What infrastructure and resources are needed? Consistency with core business

RE-AIM for evaluating behavour change REACH Who participated? (proportion of eligible, representativeness) How many participated? # participants / # eligible x 100 Who participated and were they representative?  characteristics of participants  vs non participants/frame of reference EFFECTIVENESS What were the outcomes? (planned, unplanned)  What were the outcomes? behavioural biologic psychosocial organisational societal satisfaction ADOPTION Where used this? (proportion, representativeness, influences)  How many settings/agencies used the intervention ? % of those aware/invited? Which settings/agencies used the intervention ? characteristics of adopters characteristics of non adopters IMPLEMENTATION What was done? (fidelity, resources used) What was done? (organisational) fidelity (as intended) delivery costs resources used What was done? (individual) participant experiences adherence (Topic 3) participant costs MAINTENANCE What happened in the long term? (participants, agencies) What happened in the long term? Was there sustained change for participants? 6 mo, 12 mo, 24 mo etc Did the adoption setting/agency continue to use the intervention?   Behaviour Change Interventions with High Impact Engage a high proportion of eligible and representative people, especially those most in need Have a positive impact on desired outcomes with minimal adverse impact and adverse unanticipated consequences Are adopted quickly and broadly across relevant settings Are delivered as intended, with high participant adherence (and are cost effective) Have prolonged positive effects and sustained use Limitations: Framework not a theory what not how Reach vs adoption Dimensions not weighted equally Information not always available across all dimensions Strengths: Key components for planning and evaluation Impact is not just change in the primary outcome Considers real world applications Considers individuals and settings Means of standardised reporting

Week 5

Key Concepts The "aim" of an intervention is the overarching statement of intent.  This would typically include a description of the direction of change (i.e, increase, decrease, maintain) specific outcome (which, for 3018PSY, is a behaviour) and if relevant, the associated context (e.g., workplace, school, community, faith-based organisations) and/or demographic (e.g., children, female adolescents, male employees, Indigenous People, people with cancer, older adults, retirees). For example, "The aim of this intervention is to increase exercise among older adults living in retirement villages".  "The aim of this intervention is to decrease occupational sedentary behaviour among office workers" The "objectives" of an intervention are more precise than the aim and reflect the steps necessary to achieve the aim.  Objectives may reflect intervention functions or targetted influences. For example, an intervention which aims to increase exercise among older people may have the objectives to increase knowledge and confidence of how to exercise safely, and increase awareness of age-relevant opportunities for exercise in the local neighbourhood.  An intervention which aims to decrease sedentary behaviour among office workers may have the objectives to increase knowledge of the adverse effects of prolonged sitting, and to restructure workplaces to enable more movement during the day.  Intervention functions: The "function" of a behaviour change intervention describes the overall style of approach to change.  An intervention may have one or multiple functions. In 3018PSY we will consider nine intervention functions Education Education approaches involve increasing knowledge or understanding.  e.g., providing information about the maximum amount of screen time recommended for children. Training Training approaches focus on increasing skills. e.g., having an instructor provide feedback on how to do an exercise program. Persuasion Persuasion approaches use communication to induce positive or negative feelings, or stimulate action. e.g., providing "before" and "after" images of people who complete an exercise program, using testimonials from credible sources Incentivisation ncentivisation approaches create an expectation of a reward. e.g., offering a 10th exercise class for free. Coercion Coercive approaches create an expectation of punishment or cost. e.g., having higher health insurance costs for people who don't exercise Restriction Restriction approaches use rules to reduce the opportunity to do the behaviour, or to increase the behaviour by reducing the opportunity to engage in competing behaviours. e.g., creating family rules which restrict children's screen time per day. Modelling Modelling approaches provide an example for people to aspire to or imitate. e.g., Having a woman lead a women's introduction to bicycling group Environmental Restructuring Environmental restructuring approaches change the physical or social context of the behaviour. e.g., Providing standing desks in a workplace to reduce sitting time, spending less time with those of your friends who criticise exercise Enablement Enablement increases the resources, or reduces barriers, to increase capability for the behaviour. This is BEYOND education, training, or environmental restructuring. e.g., providing people with an activity tracker to monitor exercise The Behaviour Change Technique Taxonomy Behaviour change techniques (BCTs) are the observable, replicable and irreducible components of an intervention, i.e. the proposed mechanisms of change. BCTs are designed to alter or redirect the processes which regulate behaviour. In addition to specifying what BCTs are used, interventionists also need to consider who delivers the BCT (e.g., a peer, expert) the mode of implementation (e.g., in person, online, small groups) other factors such as frequency, duration, sequencing, etc. The Behaviour Change Technique Taxonomy provides an internationally shared language for specifying and developing behaviour change interventions. This can be used for synthesising evidence, implementing effective interventions and testing theory. Having a taxonomy enables intervention development assessment of the mechanisms of action the accumulation of evidence and assessment of generalisability synthesis of evidence faithful implementation of what is effective A hierarchically structured classification system of techniques used in behaviour change interventions Goals and planning goal setting (behaviour, outcome) goal review (behaviour, outcome) action planning problem solving commitment, contracting discrepancy between current behaviour and goal Feedback and monitoring Monitoring others or self behaviour vs outcome Feedback behaviour vs outcome biofeedback ie. step counter Social support practical emotional unspecified ie. facebook Shaping knowledge instruction on how to do information on antecedents reattribution behavioural experiments ie. education poster Natural consequences information on consequences: health, social & environmental, emotional salience of consequences monitoring emotional consequences anticipated regret Comparison of behaviour demonstration social comparison information on others’ approval Associations prompts/cues reduce prompts/cues cue signalling remove reward access remove aversive stimulus satiation exposure associative learning Repetition and substitution  behaviour practice/rehearsal behaviour substitution habit formation habit reversal overcorrection generalisation of target behaviour graded tasks . Comparison of outcomes credible source pros and cons comparative imagining of future ie. member stories Reward and threat Incentives and rewards behaviour, outcome material, social, other self incentives Future punishment ie. reward badges Regulation pharmacological support reduce negative emotions conserve mental resources paradoxical instructions Antecedents restructure environment physical social add objects (to facilitate desired) avoid/reduce exposure to cues distraction body changes Identity identify self as role model framing/reframing incompatible beliefs valued self identity identity with changed behaviour Scheduled consequences behavioural cost Punishment Present, remove reward remove approximation completion situation specific incompatible, alternate behaviour reduce frequency Self belief verbal persuasion about capability mental rehearsal focus on past success self talk Covert learning imaginary punishment, reward vicarious consequences    

Week 6

Types of approaches A person-centred approach  to behavioural counselling involves eliciting, respecting and responding to clients’ wants, needs and preferences.  Major goals are to Elicit and understand the person's perspective  i.e., knowledge, concerns, expectations, needs, feelings, thoughts, preferences Understand the person in their unique psychosocial context Although many professionals believe that they use a person-centred approach, it is often not done to the extent they believe, and many clients report unmet informational and emotional needs Develop a shared understanding of the change process which is concordant with the person's values Person Centered Communication A person-centred approach requires behaviour change practitioners to have the communication skills to: elicit and reflect clients’ thoughts, emotions, preferences, and expectations   recognise, respect and respond to clients’ needs and concerns   individually tailor information about options, benefits, and risks collaborate with clients to develop a plan for action The core components of person centred communication for behaviour change are  Building the relationship Establishing the agenda Eliciting and understanding the client's perspective Responding to concerns Providing information Shared decision making Enabling the desired behaviour Person centred communication therefore includes Task oriented processes  e.g., eliciting and providing information. Affective processes, which are the socioemotional exchanges associated with e.g., building rapport, expressing empathy, addressing clients' concerns. Shared Decision Making A key component of a person centred approach to behaviour change is shared decision making. This is an interactive process of exchanging information and opinions, discussing client preferences and interventionist responsibilities, and mutual agreement on action. Shared decision making is important because people have a perspective that interventionists do not have, in particular regarding psychological and social issues, which can impact on change it can increase use of beneficial options and decrease use of options without clear benefits people's active involvement with the change process increases adherence and positive outcomes of a philosophical right, given the person lives with the consequences of behaviour change decisions e.g., risks , benefits, social reactions ethically, a person has a fundamental right to be involved with the change process Importantly, shared decision making is not just for when decisions are to be made. It involves eliciting preferences and opinions throughout the interaction ensuring the client is well informed about, and understands, e.g., behavioural standards, contributing factors, consequences, options and associated implications providing professional guidance and expert opinion e.g., evidence based information enabling informed decision making enabling change, including empowering the client's autonomy, facilitating support and resources, advocacy and systems assistance

5As Behavioural Counselling: Initial Assess Knowledge (behaviour, links, standard) Current behaviour, impact, context Feelings/thoughts/concerns about and reasons for change Advise Share information: confirm understanding, address misperceptions Clear advice to change with personalised information Agree Shared understanding and commitment Collaborative goal setting Assist BCTs Social, environmental and systems support Interventionist support and encouragement Arrange Resources and referrals Follow up

5As Behavioural Counselling (Follow up) Actual Assess Change in behaviour Change in experiences, feelings, concerns, barriers, enablers Advise Share information: confirm understanding, address misperceptions Advice to continue change (personalised information) Agree Ongoing shared understanding and commitment Collaborative goal review Assist BCTs Social, environmental and systems support Interventionist support and encouragement Arrange Resources and referrals Follow up

Week 7

Core Characteristics of Groups Using groups for behaviour change involves delivering strategies to a collection of people with some common characteristics or purpose. Groups can be used for a range of behaviour change functions including skills development, knowledge transfer, modelling, and enablement. Two main reasons for using groups for behaviour change interventions are that groups may be more cost effective than individual approaches, and intra group interactions and processes can generate change in ways that self delivered or individual interventions cannot e.g., via social modelling, social norms. Use the flip cards below to identify seven core characteristics of small groups which can enable behaviour change. A common purpose This fosters social identification within the group such that members self identify and are seen by others to be group members Pro-group perceptions Promote adoption of values and strengthens members' motivation to achieve group goals Shared values and norms Internalisation of group values and norms creates collective perceptions and shapes behaviour inside and outside the group Group structure Members are assigned or develop different roles and relationships that channel interactions within the group Interdependence Members become dependent on each other and act collectively on the basis of common perceptions of group purpose, norms and structure Group cohesion and climate Groups that are attractive to members become more unified and so more readily influence members’ beliefs and values and encourage common motivations and behaviours Disclosure and feedback Self disclosure can promote social validation and generate trust, which in turn can facilitate the receipt and acceptance of (helpful and challenging) feedback Group Development Group development refers to internal group processes that determine how group members relate to each other over time. This focuses on the group as a whole. These processes can change in a single group session and are likely to develop over multiple group sessions. The general consensus is that groups proceed through an initial period of ambiguity and insecurity leading to a period of frustration and tensions which, if resolved, lead to consensus and norm formation, which in turn allows harmonious interdependent work. Five stages of group development have been proposed (Tuckman), and can be used by behaviour change practitioners to consider specific group management tasks across the lifespan of the group. Text:  Forming Storming Norming Performing Adjourning Group Features Questioning, seeking understanding Ambiguity, confusion Variable commitment Getting to know members Formal, cautious interactions Differences emerge Conflict, resistance, tension, frustration Variable, reactive participation Power/leadership struggles, competition Independence among members Agreement and consensus Shared values Empathy, tolerance, support Clarity of roles and responsibilities Accepted leadership Confidence Goal/achievement focus Interdependence of members Cohesive and cooperative action Self directed actions are consistent with group purpose Suggestions to optimise performance Constructive negotiation Task completion Recognition/celebration of achievements and efforts Emotional reactions to separation (positive, anger, anxiety) Disengagement Group Facilitation/Management Understand members' expectations, interests Facilitate clarity, direction, purpose, processes Establish sense of belonging, motivation Engender trust Reduce ambiguity, detachment, artificiality Explore and respect differences Start defining agreements Promote engagement across members Assess needs   Confirm consensual processes Enable negotiation Facilitate leadership Balance relationship and task processes Recognise efforts and achievements Promote flexibility Continuous improvements   Enable independence of members Establish support networks outside (vs. inside) the group Establish personal responsibility(vs group accountability)

Group dynamics Dynamic Group Processes & Properties Dynamic Group Processes Bind the group together and enable pursuit of group goals. These processes distinguish interactions in groups from interactions among a collection of indviduals. They are dynamic in that they fluctuate during the group's development. Group Processes Social identification Acknowledgement of group membership & identification with other group members When salient & valued: enables group norms and standards to shape individual goals and actions Undesirable individual consequences if identified group is not valued Behaviour change groups need to nurture social identification Group cohesion Group members value membership and want to remain members Cohesive groups shape members’ beliefs and evaluations Facilitated by group attractiveness, perceived benefits consistent with members’ aspirations Behaviour change groups need to incentivise membership: similar member characteristics, group goals/activities, positive climate Group norms Expectations/standards that direct members’ interpretations of events, beliefs and behaviours Shape, consolidate, make salient specific beliefs, attitudes, intentions May be developed by agreement with ground rules or when leaders exemplify and approve of values and behaviours Groups evaluate members based on conformity to norms and may reject those who deviate Behaviour change group leaders may preset norms via ground rules Group roles and statuses Provide guidance on own and others’ behaviour Formally or informally prescribed Group building roles contribute to group development and increase group trust, attractiveness, cohesion Task/performance oriented roles progress group core business Can include non functional roles Behaviour change group leaders need to manage nonfunctional patterns Group climate Members’ involvement, trust, empathy, warmth, acceptance Influenced by group attractiveness, cohesion, identification, norms, operation of social power Implications for e.g., self disclosure, feedback, confidence, change Behaviour Change Group Design What is the basis for social identification? What strategies will be used to develop group social identification, cohesion, norms and positive climate? What facilitation methods will be used to manage group roles, including disruptive roles and informal leadership? Social and Personal Change Processes in Groups Social and Individual Change Processes are the mechanisms by which small groups can promote behaviour change. Social change processes facilitate change via the structure, functions and interactions within the group. Individual-level (or personal) change processes facilitate change via intra-individual mechanisms of group members. Social Change Processes Social comparison Social facilitation Social learning Social power & influence Social support Individual Change Processes Individual cognitive change Individual skill development Self disclosure, feedback & challenge Social Change Processes: Social Comparison Continuous self evaluation based on comparisons with others May be powerful among members of valued groups Small modifiable discrepancies can promote motivation, learning to improve Large/unmodifiable discrepancies may promote rejection Prefer groups homogenous In optimally functioning groups BOTH upward and downward comparisons can promote motivation and change Group leaders may facilitate social comparisons among group members Social Change Processes: Social Facilitation Enhancement or impairment in individual performance in the presence of others Can enhance well learnt skills, habits and behaviours Can disrupt/undermine less established or complex actions Behaviour change group leaders need to consider difficulty of tasks done in groups and impact of others

Social and Personal Change Processes in Groups Social Change Processes: Social Learning Modelling: Providing an example of behaviour Imitation: Repetition/simulation of behaviour Requires attention, memory, reproduction capacity Fostered by observed rewards, credible & high status role models, models with who we identify Facilitated via verbal instruction and practice opportunities Behaviour change group leaders can be models, encourage modelling and imitation, ensure required skills for imitation, optimise social comparisons (appropriate models) Social Change Processes: Social Power & Influence Capacity to exert influence over others Shaped by status, group attraction, social identification, cohesion Compliance: response to others’ control of rewards & punishment Identification: agreement and imitation to enhance self evaluation and rewarding relationships Internalisation: acceptance of beliefs and values as one’s own Reward power: control over rewards Coercive power: control over punishments Legitimate power: acceptance of established social order Referent power: identification with the person (strongest?) Expert power: recognised superiority What is the power of the group leader: similarity, expertise? Social Change Processes: Social Support Provision of psychological or material assistance May enhance coping, mitigate stress responses Informational: advice & instruction Appraisal: assists with self evaluations Emotional: empathy, care, regards Instrumental: practical/material aid Benefits more likely with quality relationships, trusted provider, reciprocation Effective support more likely in groups with high cohesion, social identification, positive climate, supportive norms Constant support may undermine self evaluations, esteem, & efficacy especially if the provider has a judgement role What is the role of the behaviour change group leader wrt social support? Behaviour Change Group Design and Evaluation How are social comparison processes managed so they are positive? How does the presence of others impact members’ performance How does the presenc What can be/is demonstrated and practiced in the group to provide opportunities for social learning and modelling? How can the group leader/facilitator increase their potential for positive influence? How can the group leader/facilitator increase their potential for positive influence? What types of social support should be facilitated and how? What types of social support should be facilitated and how? Individual Change Processes Cognitive Change Attention, memory Attitude change Motivation Making & breaking habits Skill Development Learning new skills and behaviours Generic e.g., goal setting & review, action planning, monitoring, seek support, use cues/prompts Group specific Self Disclosure, Feedback & Challenge Interactive patterns of self disclosure, social validation, feedback and challenge promote personal change Risks negative judgement Gains of social affirmation, “universality” validation Responses to disclosure enable self reflection/awareness Others’ perceptions and reactions clarifies personal social impact Effective feedback which promotes change recipient identifies with and likes provider recipient motivated to listen directly addresses desired change describes behaviour and provider’s feelings  challenges recipient later stages of group development Behaviour Change Group Design & Evaluation What cognitive change can be facilitated in group members? i.e. knowledge, attitudes, beliefs, motivation, habit W What (generic and purpose specific) skills can be/are developed among group members? How can/is a trusting climate be established to promote disclosure and feedback? How can/is a trusting climate be established to promote disclosure and feedback? How are norms of disclosure, feedback and validation established? What feedback can/does the facilitator provide and is this done effectively? How is self disclosure, feedback and challenge managed in the group? Group Design & Operating Parameters Group Design and Operating Parameters can facilitate or constrain group development and social/individual change processes. This includes size and composition,leadership processes, facilitator characteristics, and group/interaction management Group purpose Interdependence of goals Fosters social identification and cohesion, and provides a basis for positive group climate Behaviour change group leaders can establish clear group purpose and (realistic) group expectations Group composition & size Shapes social identification and development of group cohesion Balance of homogeneity and heterogeneity among members Group characteristics & function change by size. Optimise number of members Behaviour change designers need to optimise number and type of group members Leadership processes Balance goal achievement (task-related) functions and group dynamics and relationships (group building/socioemotional) functions Facilitator requirements and leadership style depends on group purpose, members’ skills/needs, and group composition Peer vs professional group leader, or both, dependent on group purpose and proposed change mechanisms Behaviour change group leaders need topic expertise and group management skills Facilitator characteristics Effectiveness based on training and personal characteristics Credibility, acceptance Likeability, attractiveness Topic relevant expertise Good interpersonal skills Group management skills Members can identify with Facilitators need relevant content and skills training Group & interaction management Create a safe environment Engage group members in others’ learning/experiences Explore group members’ relationships to core content Ensure group interactions stay on agreed content and related activities Combine new information with experiential learning: “learn by doing” Encourage engagement and responsibility for learning Manage communication patterns mediated pyramid or non hierarchical Facilitate optimal group development ie. constructive conflict, norms Behaviour Change Design & Evaluation  

Week 8

Organisational-level Approaches An organisation is a collective entity – such as a company, an institution, or an association – with a common particular purpose. This could include e.g., workplaces, faith-based groups, professional societies, unions, charities, businesses/corporations, training institutions (schools, universities). Organisational-level approaches aim to understand/change the norms, processes and structures within the organisation to understand/change behaviour of people linked with that organisation. This can include opportunities for the behaviour social networks and relationships within the organisation promoting access to financial and material resources for behaviour For example, an organisational-level approach to understand and change sedentary behaviour could focus on employees' opportunties to reduce sitting time at work the organisational culture and climate for change e.g., do managers support employees to reduce sitting time or is that considered disruptive to productivity and criticised? employees' access to resources to change sitting time e.g., standing desks, computer/sitting pad prompts, tip sheets providing education sessions for employees, and posters in the workplace, to highlight the problems associated with prolonged sitting time and the benefits of change providing services such as behavioural counselling to assist employees to change sedentary behaviour identifying champions in the workplace to model opportunities and support staff to sit less in the workplace providing rewards to staff who demonstrate the significant change Importantly, an organisational approach can be used to change individual level influences on behaviour (i.e. knowledge, capability beliefs, skills) if the organisation is the unit of action.  However, an individual approach cannot change organisational influences on behaviour. For example, an organisational-level approach to understand and change sedentary behaviour could focus on Fundamental needs & goals Management Expand the business Increase market share Control costs Increase profits Improve quality Enhance reputation Satisfy shareholders Employees Job security Salary/benefits Career development Recognition Empowerment Better working conditions Being part of something new and exciting Key features of an organisation Collection of people pursing collective goals Management structure – Formal authority People have specific roles, responsibilities Differences in status, power, duties Open systems – influence and are influenced by the environment Remuneration (or other reward/incentive) Regulation and compliance Organisations rely on the EOR Employee-Organisation Relationship Exchange relationship between the employee and employer, including Psychological contracts Perceived organisational support Leader member exchange Organisational Structure Organisational structure defines how job tasks are: Formally divided Grouped Coordinated Six key elements need to be considered Work specialisation Departmentalisation Chain of command Span of control Centralisation and decentralisation Formalisation What is Organisational Change ? Change Cycle

Diagnosis What needs to change? Before you decide what to do, need to know what is actually going on now. Misdiagnosis can lead to a lot of mistakes! ‘Treat causes not merely symptoms’, Brockner & James, 2008 Number of tools you can use to perform diagnosis Work Driving Behaviour Change Diagnosis- What behaviour needs to change? Determine what driving behaviour is currently occurring? What is the desired behaviour? Why is the undesired behaviour (unsafe driving) occurring? Planning How can change occur? Establish a compelling vision for why change needs to occur. Move change to group and then individual level – cascading nature of change. How can change be sustained and institutionalised. Using ‘drivers of change’ to facilitate change. ‘Change drivers are events, activities or behaviours that facilitate the implementation of change’, WhelanBerry & Somerville, 2010. Work Driving Behaviour Change Planning How can the change occur? How can we sustain the change? Drivers of change Accepted change vision – Employees must buy into vision and agree that it is positive for the organisation. Leaders’ change related actions – Supporting the change through their commitment. Change related communication – Building understanding for why change is needed, vision and strategy to achieve vision. Change related training – Understanding of the change and what it embodies. Employee participation – Involved in the planning of the implementation. Aligned human resource management practices – Individual adopting change and sustaining momentum. Aligned structure and control processes – Moving and sustaining momentum for change. Employees are often encouraged to change… The way work is undertaken Performance Teamwork Leadership Communication Motivation Extra-role behaviours Safety Plus many others…incivility, bullying, ‘green’ behaviours, stress management, resistance to change. What about the work driving setting? Some potential strategies and their limitations in the work driving setting Incentivising employees to engage or refrain from engaging a certain behaviour. Changing organisational cultural norms to elicit behaviour change. Creating new policies or adopting practices to encourage behaviour change. Punishing employees for engaging in or not engaging in certain behaviours. Kotter’s Eight Step Plan 1. Establish a sense of urgency by creating compelling reasons as to why the change needs to occur 2. Form a coalition with enough power to lead the charge 3. Create a new vision to direct the charge and strategies for achieving the vision 4. Communicate the vision through the organisation 5. Empower others to act on the vision by removing barriers to change and encourage risk taking and creative problem solving 6. Plan, create and reward short term wins that move the organisation toward the new vision 7. Consolidate improvements reassess changes and make necessary adjustments 8. Reinforce the changes by demonstrating the relationship between new behaviours and organisational success Kotter’s Eight Step Plan –Applied to Work Driving 1. Establish a sense of urgency by creating compelling reasons as to why the change needs to occur 2. Form a coalition with enough power to lead the charge 3. Create a new vision to direct the charge and strategies for achieving the vision 4. Communicate the vision through the organisation 5. Empower others to act on the vision by removing barriers to change and encourage risk taking and creative problem solving 6. Plan, create and reward short term wins that move the organisation toward the new vision 7. Consolidate improvements reassess changes and make necessary adjustments 8. Reinforce the changes by demonstrating the relationship between new behaviours and organisational success Behaviour Change in Organisations Resistance to Change Reactions to change Resistance to change An individual or group engaging in acts intended to block or disrupt management’s attempt to introduce change. Three dimensions to RTC Cognitive dimension – Belief whether change is positive or negative Emotional dimension – Emotional response toward change Intentionality – Support for change or oppose change  Antecedents: Change content and change process as well as individual differences. Organisations can be ‘proactive’ by… 1. Ensuring Justice Procedural justice Is the process fair? Interactive justice Was I told what was going on in a clear and timely way? Was I treated by my leader with respect, sensitivity and honesty? Distributive justice Did I receive a fair outcome? 2. Cultivating a climate of change (and not a climate of cynicism) Change: Putting in place organisational policies, practices and procedures that support, encourage and value organisational change activities (Charbonnier-Voirin et al., 2010). Group-level change climate moderates the individual-level relationship between leadership style and follower outcomes (Du & Choi, 2013). Cynicism: Extreme pessimism and scepticism about the organisation’s ability to change (Andersson, 1996). Consultation – consult with employees to encourage them to be involved in parts of the decision making and change process Road Safety Worldwide World wide estimates since the introduction of combustion engine: Over 18 Million people have died Over 750 000 road related deaths per year 23 million injuries & disablements per year Estimated that one road fatality and 50 injuries occur each minute, worldwide. Is Driving for Work a Dangerous Activity? 2003-2016 3414 workers lost their lives at work 2/3 of worker fatalities involved vehicles Falling from height 14% 92% are male Have you ever thought of these as unsafe driving habits? Eating while driving Using a mobile phone while driving Driving while tired and failing to pull over Driving while under time pressure and rushing to make an appointment Not familiarizing yourself with a different vehicle Bending the speed limit “just a little bit” Take a moment and think about whether you do any of these when you drive Openness to change Support for change Readiness for change Commitment to change Context of Work Driving

Influences on Driver Behaviour

Behaviour Change Model Require different types of support Stages of Change Theory (Prochanska, DiClemente & Norcross, 1992) Text: Concept Definition Application Pre-contemplation See no problem with current bhvr, no intention to change Raise awareness Contemplation Aware of a problem, thinking about overcoming it within 6 months Discuss how change is made Preparation Intend to act within 30 days, may have made small changes Make specific plans through contracting Action Modifying bhvr or environ to overcome a problem Assist with problem solving, provide social support Maintenance Preventing relapse, can last from about 6mths to 5yrs Assist with preventing relapse

Barriers to Change Past negative experiences Past positive experiences (never had a crash) Belief that change = unnecessary extra work Existence of a ‘Them against us’ mentality Autocratic decision making Short term employment contracts Employee perceptions that decision makers do not understand work needs Change fatigue Risk tolerance and complacency Cost Potential loss of client rapport Geographical diversity Time - staff already have high workloads WRRS not treated as seriously as other areas of WH&S Facilitators of change Staff and management are cooperative Road safety is discussed at OH&S meetings History of road safety awareness campaigns Perception that org is committed to safety Awareness of work-related road risks Management support Culture of accountability Good existing communication process Evaluation How can we evaluate the success of otherwise? What are we going to measure?  How are we going to measure it? How can we be assured the change in behavior is from our strategies versus something else?

Four major future challenges in organisations and transport that will require change agents (and therefore expertise, experience, and scientist practitioners) 1. Electric Vehicles Managing the Change Process Phase in Phase out Economic Impact Managing Transition (Old vs New) Travel Range Limitations & Range Anxiety Anxiety Laissez-Fair Approach Revised Work Schedules Who's responsibility for charging? Safety Issues  Economic benefits vs costs Grid overload? 2. Autonomous Vehicles 3. Mobile Phones & Distraction 4. Mobility Resistance to Organisational-level Change Organisational-level behaviour change may be met with resistance from individuals within the organisation.  Individuals and groups may passively resist change or actively try to undermine it.  This may reflect  e.g.,  a belief of losing something of value not/mis understanding about change implications perceptions of more costs than benefits resulting from change a lack of trust in the organisation/change agents low tolerance for change, or a fear of not being able to meet the requirements of the change e.g., new skills  Organisational-level Responses to Resistance to Organisational-level Change There is a range of organisational-level responses to individuals' resistance to organisational change.   Organisations may underestimate the variety of ways to positively influence people's reactions to organisational change.  Understanding situational indicators and relative advantages and disadvantages can inform choice of response strategies.  Situational factors to be considered when planning a response also include the amount and type of resistance anticipated: more resistance may require more "slow" responses the position of the change instigators relative to those resisting change e.g., trust, power: instigators with low power may need more "slow" responses, and instigators with high power can use more "quick" approaches Two common mistakes in organisational responses to resistance are responding in a disjointed and unplanned way, and using only one response regardless of the situation. who has relevant data for desigining change and the energy for implementing change: change needing information/committment may need more "slow" responses the stakes involved e.g., crises, consequences of no change/resistance: high adverse stakes may need "quick" response Text:  Approach Involves Common Use Advantages Disadvantages Education & Communication Providing information before and during the change about the logic and process for change When there is inadequate or inaccurate information or understanding If persuaded, people may help with change implementation May be time consuming and effortful if large numbers of people involved Requires a good relationship between resistors and change initiators Participation & Involvement Involving potential resistors in aspects of designing and implementing change Where the change initiators do not have all the information needed to design change Commitment from the resistors is needed, and resistors have considerable power to resist change Can promote commitment to implementing change Can result in relevant information they have will be integrated into the change plan May be time consuming Participators may design inappropriate change Facilitation & Support Assisting people during the change process e.g., training, time off, listening Where people are resisting because of adjustment problems Useful when fear/anxiety underlie resistance May be time consuming, expensive and unsuccessful Negotiation & Agreement Offering incentives to active/potential resistors When people will clearly “lose” in the change, and those people have considerable power to resist change/ May be relatively easy Can trigger other people to also negotiate for gains Potential for blackmail/coercion Manipulation + Co-option Selective use of information, resources, and structuring of events When other tactics will not work or are too expensive Can be relatively quick and inexpensive to gain specific support May resolve issue when other strategies not successful Can be problematic if people feel manipulated People may use benefits against the organisation or inappropriately May create inequities Can undermine trust relationship Explicit & Implicit Coercion Forcing acceptance of change via threat (e.g., loss of benefits) or removal (e.g., transfer, dismissal) When speed is essential, change is unpopular, change initiators have considerable power Can be quick and overcome any kind of resistance Can be risky if it engenders anger towards the change initiators

Week 9

Your self directed online learning activities for this topic include Key concept information about the population-based approach Key concept information about ecological models of behaviour A mini lecture and video examples about targetting the information environment Key concept information, an activity, and a video example about targetting the physical environment A mini lecture about targetting the economic and policy environment The required reading and a related quiz on settings-based approaches Key concept information, a video and an interactive activity about upstream social determinants of behaviour  By the end of this topic you should be able to Describe and differentiate the population-based approach to changing behaviour, including relative strengths and limitations Describe the key principles of ecological models of behaviour Appraise the information environment to change behaviour Appraise the physical environment to change behaviour Appraise the economic and policy environment to change behaviour Appraise settings-based approaches to changing behaviour, including schools, workplaces and the community, as well as relative advantages and challenges, and evaluation Explain and appraise upstream social determinants to change behaviour, and their relevance to issues of social justice and equity

Week 9

- See objectives

Population-based Approaches In Topic 1 we discussed that individual approaches aim to motivate and support people to understand the consequences of behaviour, feel positive about the benefits of behaviour change, recognise how social factors and physical contexts affect behaviour, and plan change and explicit coping strategies.  This can include changing aspects of the social and physical environment, BUT only that specifically relate to that person (i.e, changing that person's social networks and/or environment). Individual approaches have some specific advantages and limitations. Individual approaches are advantageous in that they allow for interventions to be tailored to the person and their specific needs are relationship based with that person The limitations of individual approaches however, are that they require identification and active engagement of people in need have limited reach (i.e., the number and proportion of people involved) can risk individual blaming and stigmatisation  de-emphasise contextual factors, which can be important influences on behaviour have the potential to produce a large magnitude of change Population-based approaches aim to improve aspects of the setting and culture that support the desired behaviour, reduce barriers to the desired behaviour, and/or increase barriers to undesired behaviour.  Examples of population-based strategies include introducing programs/services restructuring the physical environment enabling access to opportunities or providing behaviour relevant resources use of mass information fiscal strategies policies and regulation Such strategies can be implemented within different contexts including education settings, workplaces, service settings, and the wider community.  Population based approaches also have some specific advantages and limitations. Population-based approaches are advantageous in that they may not require active identification or engagement of people have large reach (i.e., the number and proportion of people involved) The limitations of population-level approaches however, are that they may     be "paternalistic" and compromise individual autonomy  be seen as not personally salient to people in need be complex, and require extensive planning, committment, (financial, materials, personnel) resources, coordination, stakeholder liaison have a high level of uncertainty have a low level of control over intervention activities require a long time for implementation and change move beyond individual blaming for behaviour have the potential for radical and powerful change acknowledge upstream influences on behaviour  

Ecological Models of Behaviour Population based approaches to understanding and changing behaviour are consistent with ecological models of behaviour. Ecological models of behaviour focus on the inter-relationships between people and their physical and sociocultural environment  differ from many other models of behaviour in that they acknowledge the broader environment and policy as influences on behaviour Use the flip cards below to understand the five core principles of ecological models. can incorporate constructs from other theories and models that focus on individual, social, and organisational influences on behaviour Multiple levels of influence Factors at multiple levels - including intra-personal, interpersonal, organisational, community, policy levels - can influence behaviour. The relative influence may vary by behaviour and context.  Sociocultural and physical influences may apply to more than one level (e.g., organisational and community). Environmental contexts are significant influences on behaviour Behaviours may be predicted more accurately from the situations people are in, than from their individual characteristics.  Behaviour settings - the physical and social situations in which behaviour occurs - can promote and/or restrict behaviour.  Contexts can shape or restrain individual and interpersonal influences on behaviour. Influences on behaviour interact across levels Influences work together to impact behaviour. e.g., attitudes may influence reactions to environmental cues and opportunities, social support may be influenced by knowledge/skill. Ecological models should be behaviour specific Ecological models are most useful when they are tailored to a specific behaviour.  Environmental and policy influences are often behaviourally specific.  e.g., the availability of exercise equipment in local parks has little relevance for healthy eating, free vaccinations has little relevance for exercise.  Multi-level interventions should be most effective for behaviour change As there are multi-level influences on behaviour, multi-level interventions should be more effective than single level interventions.  e.g., educational/persuasion interventions may be unsuccessful if there are not environmental opportunities to do the behaviour, environmental opportunities may not be used if people have insufficient knowledge/skill. Targetting the Information Environment Population based approaches to behaviour change may target the information environment. This includes sources of information and education that are relevant to understanding and influencing the desired behaviour. Education   Required standard Consequences Benefits of change Clarify misperceptions Highlight salience Direct to sources of information or resources Specific related events Persuasion Prompt desirable behaviour Generate emotional arousal Sensitive to influences Increase awareness of norms Stimulate communication Advocate Increase awareness of issue Increase awareness of point of view Create favourable attitudes Validate and legitimise behaviour Generate mood Behaviour Change Techniques Feedback on behavior/outcomes Instruction on how to perform behaviour Information on antecedents of behavior Information on others’ approval Credible source Information on pros and cons of behaviour Information on consequences of behaviour (health, emotional, social, environmental) Salience Verbal persuasion about capability Information cues/prompts Information on support

Information Environment: Communication Options Limited Reach Pamphlets, brochures Information sheets/booklets Newsletters Point of action information Posters Marketing collateral: Tshirts, stickers DVDs Mass Reach Television Radio Newspapers Magazines Internet Social media Mass Media Advertising Publicity Edutainment Civic journalism Information Environment: Choosing Among Communication Options Cost Reach Effectiveness Time Message complexity Availability Acceptability and appeal to target audience Control over content and delivery Credibility Information Environment: Communication Options When to use Mass Media Want wide exposure Urgent time frame Desire public discussion Main goal is awareness Media authorities are on side Information Environment Cues and Prompts

Information Environment Shaping Knowledge Information Environment Interventions Persuasion: Information on Antecedents Information Environment Interventions Persuasion: Information on Consequences Information Environment Instruction How to Perform BehaviourInformation Environment: Restriction and Coercion Information Environment: Restriction and Coercion Economic Environment Rewards, Enablement Coercion Targetting the Physical Environment Population-based approaches may target the physical environment. This includes the presence, characteristics, and location of facilities and resources relevant to the behaviour, and may focus on availability, accessibility, functionality, structure and quality. There are different components of the physical environment which may be targetted in population based interventions. the natural environment     e.g., green space, open space, weather the built environment     e.g., buildings, structures, lighting settings     e.g., schools, workplaces, recreation spaces housing/community design     e.g., multiple occupancy dwellings, connectivity, mixed purpose development exposure    e.g., pollution, sanitation physical barriers     e.g., constraints to access aesthetics     e.g., cleanliness, attractiveness

Targetting the Economic and Policy Environment Population-based approaches may target the economic or policy environment. This includes costs, procedures, rules and regulations relevant to the behaviour. Economic Environment Costs/Affordability relevant to behaviour Taxes Fines Discounts Subsidies  Rebates Financial Rewards **Behaviour related** Economic Environment Coercion

Policy Environment Policies, procedures, rules, regulations relevant to behavior National, state, local Organisational/setting

Settings-based Approaches Population-based strategies that target the information, physical, economic or policy envirornment can be implemented in specific contexts such as education settings (e.g., schools, universities), workplaces, service settings (e.g., GP practices, hospitals), and the wider community. Upstream Social Determinants Population-based approaches may target the "upstream" social determinants of behaviour.  Upstream social determinants refer to the conditions and circumstances in which people are born, grow up, learn, work, play and live relative to others. Upstream social determinants reflect the distribution of power, wealth and resources. Interventions targetting these determinants are, therefore, particularly relevant to issues of equity and social justice. Behaviour change interventions addressing these determinants may target equity in e.g., education, (material and physical) access to opportunities/services/resources, transportation needs, personal safety, sociocultural norms, environmental quality, and communication barriers to enable the desired behaviour.

Week 10

What are Ethics? Ethics are a set of principles that guide practice  (such as designing and implementing behaviour change interventions) or behaviour. Traditionally, ethics is a branch of philosophy that involves systematising, defending and recommending concepts of “right” and “wrong”, or “good” and “bad".  It involves a conscious and deliberate process of reflection regarding what "should" be done. Ethics are shaped by values, principles and purpose i.e. what is important, desirable, ideal, and for a reason. Values are the things we consider important and desirable (i.e. what is “good)” e.g., compassion, respect, strength, honesty, independence. Principles are propositions that guide the acceptability of actions (i.e. what is “right”). Purpose is the reason for which something is done (i.e. “why”) Ethics are more broad than law, and more reflective than morals.  Laws are a formal system of rules created by a society to regulate action and typically identify an enforceable (e.g., by penalties) standard of behaviour.      Morals are an informal framework of values, principles, beliefs and customs, and may be less conscious than ethics. Paternalistic Approaches A common ethical debate in behaviour change, in particular at the organisational- or population-level, is that of paternalism v. libertarianism. Is it "right" for authorities (such as workplaces or governments) to coerce or restrict behaviour?  What if it is for the person's own good, or to protect others? What about individual rights and undue influence? General Ethical Principles for Interventions Groups, organisations and associations may have a specific set of ethical principles, such as a professional code of conduct.   However, there are also some general ethical principles that can be used to appraise interventions. Autonomy Self determination Independence Freedom of choice Self responsibility Free from manipulation and coercion Informed consent Least coercive Enable empowerment v. paternalism Questions Does the intervention foster choice and enable empowerment? Is there the lowest level of manipulation and coercion? Is there informed consent for engagement Beneficence Producing benefit Adding value For everyone? Sustainable? v. no intervention? Questions What is the potential (evidence?) for gain? What is the sustainability of potential gains? Is the potential for benefit greater than not intervening? Is the potential for benefit greater than the potential for harm? Non maleficence Doing no harm Changing behaviour Understanding behaviour Person v collective Passive others Vulnerable people Questions What is the potential for harm from the intervention? Does the intervention intend to prevent from harm? Social Justice/Equity Fair and impartial distribution of opportunities and privileges No stigmatisation, discrimination, exclusion Publically justifiable  Transparency No exacerbation of inequities Support for vulnerable populations Does not erode social cohesion and identity Inequality vs Inequity Question Could the intervention result in stigmatisation or discrimination? Could some groups be excluded from the intervention? Is the intervention agent publically justified and acting transparently? Are social inequalities exacerbated by the intervention? Are vulnerable groups supported? Does the intervention erode social cohesion or identity? Respect Due regard for feelings, rights, preferences, values Privacy Sensitivity Questions: Does the intervention respect private, personal, sensitive information? Does the intervention respect views from the range of stakeholders? Efficiency/Maximisation Maximised benefit with minimum wasted effort/expenses/resources Questions Is the intervention cost effective? • What are the resource implications of the intervention?    

Ethics of Behaviour Change Design Having identified some generic principles to appraise the ethics of behaviour change interventions, there are also some specific questions that can be asked about intervention design, in terms of the behaviours and influences targeted.  There are also some specific change strategies that may compromise ethical principles. Who decides what are "undesirable" behaviours and “desirable” behaviours? How responsible or “blameable” are people for their own behaviour? How ethical are change strategies of persuasion, manipulation/deception and coercion? If it is unethical to implement unsuccessful interventions, what constitutes "success"? Ethics of Behaviour Change Design What is desirable/undesirable behaviour? Philosophical/Moral Ethics What is the impact/potential gains? Who is affected? Directly Indirectly What are the interests of those affected? Individuals Collectives Are there conflicts of interests? Is behaviour change defensible? What behavioural influences should be targeted for change? Multi-level influences How responsible are people for their own behaviour? How “blameable” are people for their behaviour? What change strategies may compromise ethical principles? Persuasion Communication (verbal, written, visual, other) to induce feelings; stimulate action; acceptance of beliefs, attitudes, values; intentions or actions as advocated More Acceptable Independence of source of persuasion Transparency of persuasion No distortion of facts Overt (v. covert) arguments Not intrusive Facilitates informed decision making More Questionable Vested interest of source of persuasion Source of persuasion controls contingencies May infringe autonomy if involves sensitive assessment or unasked for Authoritative source + pressure to comply + no consideration of interests Results in embarrassment, shame, guilt, offense, vulnerability, powerlessness Manipulation & Deception Deliberate act that successfully influences people by non persuasively altering understanding, and modifying perceptions of options eg information manipulation People are led to what is false: lying, withholding information, misleading exaggeration Intentionally overwhelming with excessive information to induce confusion and reduce understanding provoking or taking advantage of fear, anxiety, pain or other negative affective/cognitive states known to compromise effective information processing presenting information in a way that leads to predictable and misleading inferences Coercion Using power to gain advantage over others, punishing noncompliance, imposing will on others Legislation, fines, costs More Acceptable Minor infringement + major gains To avoid substantial harm Respects other ethical principles e.g., social justice/equity Voluntary consent More Questionable Major infringement + minor gains Secondary adverse impact (eg risk contamination) Vested interest by intervention agent Rewards extrinsic vs intrinsic motivation equity of opportunity transparent eligibility criteria power autonomy secondary effects What is success? Type of change Magnitude of change Extent of change Duration of change Costs of change

Week 11

Meaning of Culture There are many definitions of culture that are distinct depending on the disciplinary tradition, for example; ‘[Culture] is the collective programming of the mind which distinguishes the members of one group or category of people from another.’ (Hofstede, 1994, p. 5) ‘... the set of attitudes, values, beliefs, and behaviors shared by a group of people, but different for each individual, communicated from one generation to the next.’ (Matsumoto, 1996, p 16) ‘the set of distinctive spiritual, material, intellectual and emotional features of society or a social group” that encompasses cultural artefacts such as art and literature, but also more broadly includes lifestyles, ways of living together, value systems, traditions and worldviews’ (UNESCO, 2001). Although there is not a singular definition of culture, these all share core components: Discrete behavioural norms, values, and beliefs shared by individuals within some definable group that are distinct from those shared by other groups. These norms provide ways to realise individual and collective goals, and are often institutionalised in a variety of formal and informal ways. There are ways of transmitting norms to new members, so that the cultural patterns persist over very long periods of time. At the most concise conceptualisation, culture can be understood as the patterns of beliefs and behaviours that are shared and persistent among a group.

Culture Transmission Any group that a person belongs to can have a culture, but not all groups have the same influences on people and their lives. Of importance to psychology are those groups that impact the way people think about and define themselves or those which are transmitted by passing along through generations; and of particular importance the cultures that we learn through the processes of enculturation and socialisation. Socialisation: The process of learning the rules and patterns of behaviour of our culture. Involves deliberate teaching from within a group. Enculturation: The process of internalising and adopting the ways and manners of one’s culture. What does cultural learning influence? ​​​​​​​The things we create The values we have The meanings we make At the most fundamental level, culture influences the way understand the world and our basic assumptions about our reality. The figure outlines how these factors are related to one another and shows how aware we are of their influence on us at each level. At the highest level, culture influences objective culture, or the artefacts and creations of our cultural group that are visible or tangible. We are aware of these influences in that we can see how things are done differently in different cultural groups; e.g., people dress differently, eat different food, and produce different types of art or music. The effects of culture on objective culture are visible, but we often don’t know why things are done in a particular way within a specific cultural group. At the mid level, culture influences subjective culture which comprises of values, or the standards that serve as broad guidelines for social living, and basic assumptions or worldviews. We have a greater level of awareness of values as they impact the way we think, feel, and act, but they are not as visible as objective culture. In fact, cultural values directly influence subjective culture, and serve as the invisible “whys”. At the lowest level, we are often unaware of the ways in which culture influences the meanings that we attach to things in the physical and social world.

CULTURE & BEHAVIOR CHANGE Values What is important to us in life – can exist at many levels At the collective level, cultural values are widely shared, abstract ideas about what is good, right, and desirable. They represent the goals that members of the collective are encouraged to pursue, and they serve to justify actions taken in pursuit of these goals At the individual level, personal values are cognitive representations of the broad goals that motivate the behavior of individuals. Personal values are desirable, trans-situational goals that serve as guiding principles in peoples’ lives that are relatively stable attributes of individuals. They affect people’s choices and actions over time and across situations. Cultural Value Dimensions Without universally applicable frameworks for classifying cultural patterns, we cannot measure differences and similarities Cultural dimensions assess variation between nations as a proxy for culture, treating nations as distinctive units and averaging across people within that nation Cultural dimensions refer to general tendencies that affect behaviour and reflect cultural variability at a national level There are many ways of defining cultural dimensions: Hofstede Schwartz

Dimensions of National Culture

Schwartz’s National Values Embeddedness vs autonomy: Hierarchy vs egalitarianism: Mastery vs harmony:

Schwartz Personal Values

Some key cultural orientations High-low context Polychronic and monochronic time Proxemics Emotional expression Eye contact Peoples of Australia Who are the Peoples of Australia? Indigenous / non Indigenous Australian born / not born in Australia Citizens or permanent residents / Other visa class holders First generation migrants / second or subsequent generation migrants Bicultural or Multicultural / Monocultural Religious or ethnoreligious / non religious English as first language / English as second language Multilingual / monolingual Refugee background / non refugee background Asylum seeker / non asylum seeker

Emic and Etic Approaches Approaches to Culture Emic approach: Investigate phenomena through the perspective of individuals embedded in particular cultural contexts Demands a focus on cultural / group level emergence of experience and avoids simply applying using concepts and measures from other contexts Etic Approach Investigate phenomena through the perspective of universal elements of human experience Demands a system that is equally valid for all cultures and permits the representation of similarities as well as differences Researchers often work with imposed etics meaning that universals of experience are assumed –often by our measures and as a result of research approaches Western psychology itself is a type of emic approach (but this is not often recognised) Indigenous psychologies began as a reaction to the increasing supremacy and dominance of Western models, which did not provide adequate models for understanding human behavior in non-Western contexts Emic and Etic approaches are not mutually exclusive Derived etics should gradually replace imposed etics These are valid cross-culturally and may result in establishing some general principles of human behaviour  Equivalence (or invariance) is key in comparative studies, as it deals with the question of whether measures are the same construct across the cultures

Why Culture Matters to Understanding and Changing Behaviour Culture influences the behaviour of individuals and groups, and thus our efforts to change behaviour, in a variety of ways. Below are some key points about behaviour that may influence our ability to conduct efficacious behaviour change interventions. Layers of cultural diversity influence all types of behaviours. Similar values can manifest in different behaviours. Objective culture / observable behaviours are informed by underlying, and often unconscious cultural learning. Our cultural lens influences the way we understand the behaviours of diverse others. Some behaviours are difficult to translate or understand across cultures. Some behaviours are more prevalent and more socially acceptable in some groups than in others. The motivations for engaging or not engaging in behaviours differ across cultural groups.  Our models for behaviour change are often developed and delivered from a specific cultural framework (Westernised) and do not take into consideration that recipients of interventions may have diverse backgrounds and ways of understanding behaviour. Cultural values may influence how some groups interact with practitioners (e.g., avoidance of engagement, deference to authority). Differences in key cultural orientations may result in miscommunication about the intent of interventions and therefore impact on access, uptake, and effectiveness. Cultural Capability & Awareness All individuals are a part of at least one culture.  Culture may be determined by socioeconomic class, age, religion, sexual orientation, ethnicity, disability, nationality, or geographic context.   The growing diversity of our population expands the cultural complexity and variety of people whom behaviour change practitioners encounter. Culturally aware and capable behaviour change practitioners should also understand their own cultural values, preferences, characteristics, and circumstances. They should be aware of their own personal biases and how they compare to, and may affect, the relationship with the client(s).  It is important to be aware of one’s own biases or preconceived notions, as well acknowledging limitations in one’s cultural knowledge.   No individual can learn everything about every culture. However, practitioners can develop skills to collect information and to understand ways in which culture may affect behaviour and change interventions. We can cultivate awareness of diversity and a willingness to honour behaviour change clients and stakeholders.

Week 12

Common Errors in Understanding and Changing Behaviour Common Errors It is just common sense Understanding and changing behaviour is simple and obvious Behaviour results from the interplay of automatic and reflective responses and is located in complex social, political, economic and cultural environments Behaviour can be of interest to profitable industries Understanding behaviour is complex and change requires sustained effort, support & resources It is just about getting the message across Get the packaging of messages right Messaging can be effective but is only one part of a broad multi-level approach Behaviour change needs more than communication Knowledge and information drive behaviour Lack of knowledge/understanding is the problem, and information from expert sources drives change More than knowledge drives behaviour Behaviour is influenced by factors other than knowledge and change needs more than education People act rationally People will be sensible and logical after critical and rational appraisal of the evidence Economic Utility Theory Behaviour is determined by more than a choice of pros v. cons Behaviours are not just the result of reflective processes, and social and environmental factors can cue behaviour People act irrationally People behave thoughtlessly and foolishly Influences on behaviour may not be obvious Persistent behaviours tend to be functional It is possible to predict behaviour accurately It is easy to say how people will behave and react in a given situation Behaviour may not generalise across contexts and time Predicting behaviour and behaviour change is hard, particularly over time Better practice Understand and use evidence and theory for understanding and changing behaviour Be specific: what behaviour by whom, done where Analyse multiple preceding patterns and conditions of behaviour (upstream origins) Differentiate reflective and automatic processes of behaviour Analyse behaviour in its social, physical, economic, political and cultural context Examine the meaning and functionality of behaviour, and precipitating factors Analyse interactions between people, groups, institutions and contexts (and vested interests) Identify mechanisms of change Appraise multi component change options (beyond information and education) Create infrastructure for change - Exam notes on here

Nudging in Behaviour Change One contemporary approach to changing behaviour is "nudging". Nudging involves small changes in the environment which make specific behaviours more likely. This is based on the premis that the behaviour is influenced by automatic responses that require little cognitive engagement and are triggered by cues in the environment. Nudging can also be known as "choice architecture".

Awareness of behaviours that adversely affect people, and benefits of prevention and management In Topic 1 we discussed what "behaviour" is, and the online activity involved identifying examples of behaviours which impact on people for key issues across a range of contexts. In Topic 3 we focused on a specific type of behaviour that adversely affects people - nonadherence. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - You selected a specific behaviour in an area of your interest, and appraised how the behaviour impacted on people, examining individual, interpersonal, organisational, and community levels of impact and the benefits of management. Understand factors that may affect behaviour, including psychological, social, cultural and economic factors In Topic 1 we discussed individual, organisational, and population-based approaches to understanding behaviour. In Topic 2 we differentiated between direct and indirect influences; and discussed downstream, mid stream and upstream factors which may affect behaviour. In Topic 2 we differentiated different types of research designs which can be used to understand factors affecting behaviour. In Topic 2 and Topic 3 we focused on two specific models -Theoretical Domains Framework and COM-B - which can be used to appraise the factors that may affect behaviour. In Topic 3 we applied these models to understand influences on a specific type of behaviour - nonadherence. In Topic 9 we discussed upstream factors which may affect behaviour, such as the information, physical, economic and policy environments, as well as upstream social determinants -the conditions in which people are born, live, play, learn, and work relative to others. In Topic 11 we focused on how culture may affect behaviour. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - involved appraising the multi-level factors that affect a specific behaviour in your area of interest. Select, design, implement and evaluate appropriate evidence-based interventions In Topic 4 we discussed the REAIM framework which can be used to select, design and evaluate interventions. In Topics 5, 6, 7 8 and 9 (i.e. Module 2), we discussed individual, organisational and population (including settings) based approaches to designing and implementing interventions. In Topic 10 we discussed ethical issues associated with selecting, designing and implementing "appropriate" behaviour change interventions. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - involved describing the design, implementation and evaluation of an intervention in your area of interest. Able to assess people's needs and interpret relevant data on local or national needs and characteristics In Topic 6 we discussed a person-centred approach which focuses on eliciting and actively respecting the needs, preferences, and interests of behaviour change clients. In Topic 11 we discussed awareness of personal and client values, preferences, norms and circumstances, as well as cultural values at the personal and national level.   In Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - you may have focused on a specific demographic or context, and considered local and national data, and/or aligned your focus with key local, national or international priorities or policies. Understand local policy and demographics In Topic 2 and Topic 9 we discussed the role of policy in understanding and changing behaviour. In Topic 11 we discussed cultural diversity in Australia, and the online activity involved exploring the demographic diversity of geographical areas of interest to you in Australia. In Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - you may have appraised local policy and demographics related to a behaviour of your interest. Know how an intervention works (mechanism of action) In Topics 1, 6, 8 and 9, we discussed how individual, organisational and population based approaches work to change behaviour.   In Topic 5 we discussed the objectives and functions of interventions, which reflect how an intervention works. In Topic 7 we focussed on how small groups work for behaviour change, including intrapersonal and interpersonal processes. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - involved describing the objectives and function(s) of an intervention in your area of interest. Recognise the specific behaviour change techniques used in change interventions In Topic 5 we discussed the Behaviour Change Technique Taxonomy, which comprises 14 categories of specific change techniques. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - involved describing the specific behaviour change techniques for a proposed intervention in an area of your interest. Address inequalities by tailoring interventions to people's specific needs, including cultural, social and economic factors In Topic 4 we discussed the REAIM model component of "Reach" which includes issues of engaging underserved groups and assessing representativeness of intervention participants.  In Topic 6 we focused on a person-centred approach which tailors interventions to people's needs, preferences, and interests (potentially including cultural, social and economic factors). In Topic 9 we discussed the upstream social determinants of behaviour which reflect the conditions in which people are born, grow, play, learn, work and live relative to others, and how these can contribute to inequities. In Topic 2 and Topic 9 we discussed the economic environment to understand and change behaviour. In Topic 11 we focused on cultural values and implications for understanding and changing behaviour. Assignment 2 - Behaviour Change Intervention and Evaluation Proposal - involved describing how to engage underserved groups and assess representativeness of participants in an intervention in your area of interest.

Behaviour Underpins Multiple Issues Text: Context Issue Behaviour Health Chronic disease Unhealthy eating, inactivity, smoking Organisational Productivity & Performance Absenteeism, safety behaviours Education & Development Social & learning experiences Bullying, school attendance Sport Team Performance Attending team training Clinical Poor Wellbeing Self harm, substance use Counselling Positive relationships Abusive behaviour Forensic Crime, incivility Criminal behaviours recidivism Environment Sustainability of Resources Recycling, littering Professional Ethical practice Intimate relations with clients International Overpopulation Contraceptive practices

What do you need to know: Awareness of behaviours that adversely affect people, and benefits of prevention and management Able to assess people's needs and interpret relevant data on local or national needs and characteristics Understand factors that affect behaviour, including psychological, social, cultural and economic factors Select, design, implement and evaluate appropriate evidence-based interventions Recognise the specific behaviour change techniques used in change interventions Know how an intervention works (mechanism of action) Address health inequalities by tailoring interventions to people's specific needs, including cultural, social and economic factors  understand local policy and demographic Text: Module 1 Understanding Behaviour Module 2 Changing Behaviour Module 3 Big Picture Issues Introduction Planning and evaluating behaviour change interventions Ethical considerations Multi-level influences Behaviour change techniques Cultural considerations Non adherence Behaviour change counselling Reflections & course review Small groups for behaviour change Organisational behaviour change Population-based behaviour change

Understanding & Changing Behaviour Individual approaches Understand/change an individual’s knowledge, awareness, motivation, intentions, skills related to behaviour Organisational approaches Understand/change the norms, processes and structures of the organisation to understand/change behaviour of people linked with that organisation Population approaches Understand/change large numbers of people via awareness and the context of the behaviour

Topic 2 Multi-level Influences on Behaviour Direct & indirect Attributes of behaviour Downstream, midstream, upstream Research designs Case study Cross sectional Ecological Case control Prospective longitudinal Quasi experimental Experimental