at what intensity by whom will make a difference to health. An intervention will
only contribute to public health if the behaviour changes are sufficient to improve
individuals’ health prospects and are maintained over time. It is equally important to
be clear about whoan intervention will target. For example, an intervention designed
to reduce unwanted teenage pregnancies is unlikely to be optimally effective if it targets
all teenagers because most are not at risk of unwanted pregnancy. Subgroups of people
differ in their cultural backgrounds, their knowledge, motivation and skills. So
imprecise targeting may result in mismatched and ineffective interventions.
The scientific design of any intervention begins with an understanding of the
processes or mechanisms that regulate the system (or systems) we hope to change. To
create a new antibiotic biochemists must first understand and map interactions between
organic molecules and bacteria. Similarly, psychologists need to understand the
processes that regulate behaviour. In previous chapters we have reviewed individual,
intra-personal processes that distinguish between people’s behaviour patterns, including
processes that result in greater or lesser intention or motivation (see Chapters 7 and
8). In addition to these processes, behaviour patterns and behaviour change may be
regulated by inter-personal (between-people) and inter-group processes. For example,
Haslam et al.(2014) studied residents of care homes and compared three conditions,
in which (1) residents formed groups to redesign the home environment; (2) care staff
redesigned the home environment for the residents; and (3) there was no change. These
researchers found that people in the residents-redesign condition had significantly
greater, clinically important increases in cognitive functioning and also increased use
of resident lounges (compared to the other two conditions), indicating that
involvement in the redesign group changed residents’ thinking and behaviour. In this
example, group and organiza tional processes, rather than intra-personal processes, such
as attitudes towards socializing with other residents seem to be critical to intervention
effectiveness (see too Tarrant, Hagger and Farrow, 2011).
Organizational rules, norms and resources may create stress (see Chapter 4) and
impede health behaviour change. They are, therefore, often targeted both in com -
munity interventions and in single-organization worksite interventions. Worksite
interventions may aim to integrate physical activity into employees’ days including
exercise breaks and promotion of walking and stair use or change the availability of
healthy food and/or how food is labelled (Engbers et al., 2005). Worksite interventions
have been found to be effective in increasing physical activity and fitness as well as
promoting weight loss (Proper et al., 2003). Those focusing exclusively on physical
activity (as opposed to general lifestyle changes) and especially those promoting walk -
ing appear to be most effective in promoting employee fitness (Abraham and Graham-
Rowe, 2009; see also Taylor, Conner and Lawton, 2012).
Lack of resources, lack of skills and social norms at community level can also sustain
health-risk behaviours. Consequently, interventions to promote health behaviours may
need to be based in, and engage, communities. This often necessitates meetings and
discussion with local people and organizations. It may also entail persuading local
government to change policies, enforce existing legislation or provide new resources.
In addition, such interventions may utilize local media campaigns and educational
programmes. This work merges health psychology practice with community develop -
ment work. Community development seeks to involve local people in identifying local
assets and needs and facilitating action to create or acquire new resources and/or skills.
CHANGING BEHAVIOUR 193