Changing Behavior

The second chapter outlines what the author calls the “behavior change challenge,” given the perspective adopted, namely, that behavior change is about setting up conditions within which an individuals will naturally learn to perform the desired behavior as a consequence of the modified situation facing them. From this perspective, the challenge is to create new kinds of stimuli (e.g., by modifying the environment) that grab attention, so that they will be properly processed by the brain and, ideally, cause the target behavior (and the outcomes associated with performing that behavior) to be revalued and, thus, become more likley to be performed. However, performance itself can be promoted or facilitated in various ways associated with the situation in which the behavior typically occurs (which the author calls its “behavior setting,” following earlier work in ecological psychology). This constitutes the third type of change facilitation discussed.

What’s Next?

This chapter winds up the book with a brief recap of the argument, and discussion of a couple of developments that could increase the ability of Behavior Centered Design to even more powerfully change behavior: through the application of computerized agent-based models of the settings within which health behaviors take place (to make disruption more predictable) and the ongoing developments in sensor networks for the continuous collection of behavioral data. The chapter concludes with some extensions—or uses of the approach beyond health behaviour change programming (which is the primary application type addressed in the book), such as toward institutional behavior change.

The Program Development Process

Behavior Centerd Design (BCD) follows a mnemonically assisted process of ABCDE (Assess, Build, Create, Deliver, and Evaluate) in which those seeking to change behavior are naturally led through a variety of specific logical moves involving existing data collection, additional data collection, creative development, activities to implement the planned changes, and evaluation of the effectiveness of the campaign or program. An extended example of a public health project is used to illustrate the steps throughout. This chapter introduces the problem of developing programs and an overall picture of how BCD approaches the problem, together with some of the specific tools used at particular points in the process.

Evaluate

Evaluating how well a program has worked—has it actually achieved the goal of changing behavior significantly?—is also highly desirable if the field of behavior change is to advance conceptually and become more effective. For this reason, efforts to evaluate programs should be undertaken, not just for research projects. This chapter provides a discussion of how this can be achieved with scientific rigor. Standard research designs are covered, such as Randomized Controlled Trials, as well as less common models. It is also noted that while evaluating whether the desired outcomes were achieved (such as improved public health indicators), it is equally important to understand how those outcomes arose—was it through the activities of the intervention? Can the observed improvements be assigned to the intended effects (e.g., on how people behave and think)?

Create

This chapter is devoted to a description of a process typically left out of behavior change programming: the step in which an idea is converted through an iterative innovation process into a fully fledged intervention. Quite often interventions in public health, for example, are complex, with many activities and components. Generating the plans for these elements of a promotional campaign or program requires creativity—especially if they are to be surprising and cause the target behavior to be easier to perform and more rewarding. But they are largely based strictly on the ideas of those guiding the project, rather than involving creative professionals, or at least use of a design process to convert knowledge into behavioral insights. The Behavior Centered Design Create process emphasizes use of tools derived from the field of design to guide the identification of powerful insights that can effectively change behavior.

Build

In most cases, programmers don’t have complete knowledge of the behavioral situations they wish to change in some way. There may be a rather abstract sense that many people would like to exercise more or take advantage of breast screening exam services, but little knowledge of what kinds of things would induce people to leave their current patterns of behavior behind, to adopt a new daily routine incorporating exercise, or actually go out to get a mammogram. This chapter outlines numerous ways that programmers can learn the information they need to produce creative campaigns and interventions.

What’s the Problem?

The first chapter sets up the current situation: why is behavior change considered hard, and what do people recommend be done? I present a novel perspective on public health problems, arguing that they all derive from inabilities to learn appropriate responses due to recent changes to the environments in which we live that have occurred through technological evolution. This is a “mismatch” hypothesis common in evolutionary psychology applied to behavior change. Different types of mismatch occur between particular structures of public health problems (as learning problems). This is actually a theory of public health—why certain kinds of health problems arise in the first place.

Deliver

Perhaps the most crucial, but also most overlooked, step in planning behavior change programs is actually implementing it. Often, it is assumed that this will simply happen with great fidelity and reach everyone being targeted. However, logistical problems can abound. Planning in advance can obviously help with minimizing such problems. While the details of such planning will vary according to circumstance, certain goals of the planning process can be identified to guide it. Various ways in which one can monitor implementation and measure aspects of program delivery on the ground are also covered. Identifying process and outcome indicators can be crucial.

Assess

Chapter 5 is an extensive discussion of the first step involved in developing a behavior change program or campaign. This chapter covers the first step, Assess, which is concerned with getting everyone on the same page, and figuring out what is already known about the target behavior. This typically involves a survey of previously conducted research and collecting the opinions of experts, together with as much contextualization to the program context as possible. It can also involve meetings or a workshop to ensure that everyone’s knowledge has been probed and consensus reached, so that the project can move forward efficiently.

Behavior Determination

The third chapter takes a step back to present details about the factors involved in determining behavior (i.e., the influences on what makes current practices happen the way they do), which individuals need to know before they can effectively change them. The discussion is organized commonsensically to ensure that all possible types of causes are covered. Crucial again is the notion of a behavior setting as the suite of proximate causes of behavior, with others being more distal. Having covered the problem of behavior change from two different perspectives, in terms of the process that target individuals must go through in Chapter 2 (Surprise, Revaluation, and Performance) and, in this chapter, what kinds of factors can cause people to go through this process, this part of the book comes to a close.