Felix Greaves, Deputy Director, Science and Strategic Information at Public Health England, is the keynote speaker on day two of the Centres for Behaviour Change (CBC) conference. He steps back and forth across the stage, twirling a traditional British ‘bowler hat’ talking about the intersection between academia and civil service: “Standards”, he goes on to say, “are essential”. And this statement was a pervasive theme in the conference itself.
This is the fifth annual CBC conference, held in London and organised by the University College London (UCL) Centre for Behaviour Change in collaboration with the UCL Institute for Digital Health.
The theme of the conference is “Behaviour Change for Health: Digital and other Innovative Methods”. As CBC director Professor Susan Michie pointed out in her welcome, this is the first year that there were more attendees from industry than from academia resulting in an exciting cross-sector melting pot with over 300 delegates across academia, industry and third sector. It was our third year attending and is a perennial favourite of ours because it sits at the intersection of so many important topics: advanced academic behavioural science, digital media, and healthcare.
In an action-packed two days, presentations covered a wide range of topics, but to us two over-arching important themes emerged:
As alluded to in Dr. Greaves’ keynote, several presentations underscored the importance of keeping high standards. Standards for underpinning theory, standards for analysis, standards for intervention fidelity. In this age of fast-moving digital technology and ‘behavioural science’ as a buzz word, it’s easy to see how people rush to apply the concepts without enough consideration of standards. There were several examples of ‘behaviour change interventions’ that were rolled out based on a ‘good idea’ but not designed in accordance with known standards.
• One favourite of mine was from Denis Fikretoglu from McGill University, who described a mental health intervention that had been rolled out within the Canadian military. However, their randomised controlled trial study subsequently showed that the programme actually didn’t deliver any benefit to participants. It transpired that the programme had just been rolled out because the military wanted to do something about mental health but failed to think about the design and delivery of the programme in enough detail at the design stage. . Lack of psychological input and inconsistency in programme delivery meant that all the time and investment did not deliver benefit to troops.
• Conversely, a successful example of holding high standards came from a very moving presentation from Corrina Safeio at the communications agency Pegasus, who described a campaign to help increase interventions by members of the public to help stop suicidal people on train platforms. In this case, they started with clear standards, using behaviour change modelling with the COM-B model (one of our favourites) to address the barriers to intervening and designing their campaign around interventions recommended by evidence. Thus, they were able to create a campaign that actually saves lives, modelling to the general public how making small talk on train platforms can help recognise someone who is having a temporary suicidal impulse.
For us, this underscores the importance of bringing robust behavioural science to our commercial clients; we heavily invest in in-house expertise to deliver deep and rigorous behavioural science applications. This ensures that we’re enabling our clients to be truly evidence-based from the ground up when they’re creating and testing ideas aimed at behaviour change, so they’re holding their interventions to higher standards equipped to succeed in the real world.
2) Really smart technology
It’s often said that just because you can do something with technology, it doesn’t mean you should. Two keynotes that bookended the conference paid homage to this fact: the opening keynote from Dr. Jennifer Turgiss at Johnson & Johnson and the closing keynote from Dr Sherry Pagoto of University of Connecticut. Dr. Turgiss started the conference by describing how at J&J they work backwards: start from the organisational level outcomes, back to individual outcome, individual behaviour, and then to the techniques to change that behaviour, to help ensure that their digital interventions are designed based on need with a specific outcome attached, rather than creating digital tech based on what’s possible from a technology perspective. Dr Pagoto is a social media expert and spent most of her presentation talking about attempts to form communities on social media that support health behaviour change like weight loss: she described how technological ‘features’ of apps, like auto-sharing of weight loss or exercise, actually inhibits community formation because they’re so clearly automated.
• A presentation from Sander Hermsen from HU University of Applied Sciences Utrecht detailed a clever, randomised, controlled trial looking at the most effective way to slow down eating. He created a ‘smart fork’, designed based on validated behavioural interventions around monitoring (when people are watching you, you behave better), tracking (when you know what you’re doing over time you change your behaviour), and immediate feedback (when you get timely notification you are more likely to adjust behaviour). The fork monitored the speed at which participants ate.
For several months, that’s all it did, but then he tested various interventions, where participants were able to see their own eating speed on a digital interface, and/or a ‘vibrotactile’ intervention where the fork vibrated to indicate participants were eating too quickly. Having the technology of the intervention emerge from the science of behaviour change in this way, meant that all the interventions created lasting change and (small) weight loss benefits.
• Another intervention, presented within a poster from Florence Nwankwo at Nottingham Trent University, was looking to increase physical activity among children. Based on an insight that a driver of inactivity was screen time, her group designed a “nudgebox” – a device where you had to exercise to gain access to screen time. Again, the success of the intervention can be traced to the origins of the intervention in habit creation theory and insight about human behaviour, rather than technology for technology’s sake.
And we were delighted to see this as a prominent theme. In our work assessing digital technology, we are always conscious of the danger that technological interventions are designed based on a novel technological capability, rather than a human need (from ‘the lab’ instead of ‘the heart’), and value the role for behavioural frameworks to assess and refine these technologies which has helped many clients avoid costly mistakes.
Another delightful conference, another chance to exchange ideas with old friends and new contacts among multidisciplinary professionals across industry and academia. We walked away with a head full of ideas, a pocket full of business cards, and a notebook full of notes. Looking forward to continuing our pursuit of high standards and smart technology at the intersection of these two critical areas in the industry.
By Katy Irving, Founder of HRW Shift (Behavioural Science expert team)