Understanding the Process of Behaviour Change

The project is Nelli Hankonen's Academy Research Fellowship (2015-20).


This study addresses health-related behaviours that may prevent chronic physical and mental ill-health. The lack of engagement in four key health behaviours – eating fruits and vegetables, engaging in physical activity (PA), not smoking, and using alcohol moderately – is related to fourfold risk of death compared to performing these behaviours. By changes in eating and PA, the onset of type 2 diabetes can be prevented or delayed by 58% in people with a heightened risk. Mental well-being can be fostered by several emotional self-management skills, e.g. mindfulness. Such behaviours have marked effects on human well-being and societal costs.

Preventing both chronic diseases and the spread of many infectious diseases is possible through changing people’s behaviour. Changes in eating habits, physical activity (PA) and hand hygiene are essentially about people’s voluntary behaviour. To bring about the motivation to change and to support sustained efforts to carry out behaviour change, theoretical understanding is important: the more comprehensively behavioural science theory is used in intervention design, the better the intervention outcomes.

However, many interventions tend to have mainly short-term effects, e.g. the effects of school-based programs to promote physical activity tend to disappear over a longer follow-up. Indeed, a scientific understanding of how to most effectively help people change behaviours is still developing.

A key limitation of the current literature is that often only outcome evaluations are performed: They simply reveal whether the intervention had an effect on behaviour, but shed no light into the underlying mechanisms – why or why not behaviour change occurred. To open the “black box” of complex interventions evaluated in trials, process evaluations are recommended. Recent years have seen an increasing amount of useful models proposed for this purpose. Process evaluations enable drawing conclusions of effective components of interventions and reasons for inefficacy of the program.

Process evaluations are vital to tackle problems of translating research evidence into practice and policy. This study aims to identify effective components of health behaviour interventions, and understand processes underlying behaviour change. Four theory-based intervention studies will serve as case studies to enable research into processes underlying behaviour change, with objectively measured behaviour (and health outcomes) as a major strength. The interventions include a lifestyle change intervention for people with type 2 diabetes in primary care (ADDITION-Plus), a classroom intervention targeting mindfulness and stress management skills among school children (Healthy Learning Mind, TOM), a military-based intervention to improve hand hygiene behaviours (VirusFight), and a school-based intervention to promote physical activity (Let’s Move It, LMI).

Healthy Learning Mind

Marguerite Beattie's PhD project is linked with the Healthy Learning Mind process evaluation, investigating the determinants of uptake of mindfulness and relaxation practice.

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