BEHAVIOUR CHANGE AND PUBLIC HEALTH
Individual behaviour patterns affect health. Across populations, these patterns shape
public health and determine health care costs. For example, rising obesity rates have
resulted in increases in type 2 diabetes, coronary heart disease, hypertension,
osteoarthritis and some cancers (Allender et al.,2006; Guh et al., 2009; Whitlock
et al., 2009). Excess weight increases one’s risk of premature death and accounts for
at least 2.8 million premature annual deaths worldwide (World Health Organization,
2013). In the UK in 2013, for example, 61 per cent of adults were overweight or obese
costing the health services an additional £5 billion annually (Department of Health,
2013). By 2050, rising UK obesity levels may result in increased national health costs
of up to £45.5 billion per year (Kushner and Foster, 2000; Butland et al., 2007). Yet
the risk of obesity-related health problems can be substantially reduced with weight
loss of as little as 5 per cent of body weight (Jensen et al., 2014) and reviews suggest
that interventions aiming to generate daily energy deficits can result in clinically
meaningful weight loss (of at least 2–3kg) in the short term (Greaves et al., 2011). So
how can we intervene to change dietary and physical activity patterns to reduce obesity
levels?
In many countries, the age of sexual debut has decreased over time and the range
of sexual activities engaged in by young people has increased leaving young people at
greater risk of sexually transmitted infections (STIs) and young women at risk of
unwanted pregnancies (Mercer et al., 2007). In the US, nearly half of the 19 million
new sexually transmitted infections (STIs) are among young people aged 15–24 years
(Hamilton, Martin, and Ventura, 2014). While, in the UK in 2012, there were more
than 27,800 under-18 conceptions with more than half of these being terminated (The
Office for National Statistics, 2014). Many STIs, such as Chlamydia, may not be
diagnosed in young people but still affect future health and fertility. So how can we
intervene to protect young people from the risk of STIs and unwanted pregnancy?
The examples above are just two global public health challenges calling for behav -
iour change interventions that could change population-level behaviour patterns.
A FRAMEWORK FOR DESIGNING BEHAVIOUR CHANGE
INTERVENTIONS
We know that interventions to support people changing health-related behaviour
patterns can be effective. Increases in physical activity and consumption of healthy
diets, reductions in risky sexual behaviour and in smoking, improved self-care for chronic
conditions and uptake of health screening have all been observed following targeted
interventions (Denford et al., 2015; Greaves et al., 2011). For example, the UK’s National
Institute of Health and Care Excellence (NICE) commissioned a review that included
data from 103 systematic reviews of interventions targeting 1 of 6 behaviours (cigarette
smoking, alcohol consumption, physical activity, healthy eating, drug use and sexual
risk taking). This review found that, although the degree of effectiveness varied bet -
ween populations and intervention characteristics, overall, interventions were found
to be successful in changing behaviour patterns (Jepson et al., 2010 and see also Johnson
et al., 2003).
CHANGING BEHAVIOUR 189