Changing Health Behaviours

There has been much talk recently about Behaviour Change.  This is, in part I think, due to the realisation that health care alone does not determine health, it influences it, but not nearly as much as we thought. These pie charts from The King's Fund show estimates of how much (or little) health care contributes to overall health.  Click here & scroll down to see the images more clearly.

The first pie chart suggests that health behaviour patterns may contribute to overall health by 40%, compared to health care at 15% (McGiniss et al 2002).  It's information like this that has brought techniques that facilitate changes in behaviour into sharp focus.

I really like this infographic from Evans Health Lab, it summarises some of the key ways in which we already encourage healthy behaviours.  It highlights the fact that it's usually clusters of behaviour that we are targeting and it advocates an individual, intuitive and tacit approach.

Earlier this year NICE published guidance on Behaviour Change,  I've mentioned in previous blog posts that I think physios are natural facilitators of behaviour change but I think that to date our approaches have been intuitive.  The NICE guidelines clearly state the importance of engaging with behaviour change strategies but this needs to be done in a way that is recognised outside of physiotherapy practice.

This week Quality Watch published their report "Allied health professional.  Can we measure quality of care?" the authors of the report acknowledge the need for AHPs in view of the ageing population and the increasing numbers of people with long-term conditions.  However, they also acknowledge that the contribution made by AHPs is often "hidden, overlooked or potentially undervalued" this is something I can relate to and it makes our services vulnerable.  We simply have to be able to demonstrate that we are effective and that our contributions count but this is no longer limited to treatment of the presenting complaint.  We have the opportunity to be recognised a key "deliverers" of public health priorities and we have the opportunity to establish ourselves as an integral part of the public health workforce.

With this in mind, rather than taking an intuitive approach to changing behaviour we may need to formalise what we do so that it is very clear to other people (managers, commissioners etc) exactly what we are doing.  I think that for this to happen we probably need to do some or all of the following;

1. Clinical staff need training in this area and need supporting in their practise.
2. Decide the scope of our remit, we can't change everything, which health behaviours are we going to target.  The four biggies are smoking, alcohol, activity and nutrition, we need a strategy and I can't help feeling that focusing on Physical Activity would be the sensible option for physiotherapists.
3. Decide which approach works best in our clinical environment, one size does not fit all, does your service lend itself to very brief interventions or to high intensity interventions?
4. Develop a consistent approach.
5. Record what we do.
6. Collate our records, at an individual level, a team level a departmental level and a national level.
7. Evaluate what we are doing.
8. Tell the world!

We need to be canny about this, we need to be able to demonstrate our activity and effectiveness in a universal language.  We can't change our practice suddenly or dramatically, there are HUGE constraints on our time & resources, but we can subtly shift the way in which we deliver behaviour change interventions to ensure that we are ticking the right boxes and getting the recognition we need and deserve.