Professor of Health Psychology
The Change Exchange
The University of Manchester, UK
THET Toolkit
This toolkit is for anyone who is exploring health professional practice change with the aim to change or improve practice in antimicrobial stewardship (AMS). It will take you through defining behaviours to be changed, exploring the influences on those behaviours, developing interventions to change behaviour and having conversations with people about changing their practice.
The benefits of taking a behavioural approach start with having a common understanding of what any policy changes mean for them in their day-to-day working lives. In order to change behaviour, we need to understand what might be getting in the way of behaviour change and what might enable people to change. This knowledge then helps to develop interventions to change practice. Finally, health professionals’ knowledge of what to do and how to do it is related to how they feel and to what is going on in their working environment. Starting by understanding these influences on behaviours, can allow us to have meaningful conversations with health workers about change. Bringing people along with us, in a participatory way, is also likely to result in more meaningful and sustained change. Behaviour change interventions are more likely to be successful if they are embedded in good relationships, when people have control over their own practice and when communication is good between all parties.
Professor of Health Psychology
The Change Exchange
The University of Manchester, UK
Professor of Health Professional Education
The Change Exchange
The University of Manchester, UK
Senior Lecturer in Health Psychology
The Change Exchange
Birmingham City University, UK
Lecturer in Health Psychology
The Change Exchange
The University of Stirling, UK
Lecturer in Health Psychology
The Change Exchange
The University of Stirling, UK
Reader in Psychology
The Change Exchange
The University of Stirling, UK
Senior Lecturer in Health Psychology
The Change Exchange
Manchester Metropolitan University, UK
Research Associate
The Change Exchange
The University of Manchester, UK
Lead Antimicrobial Stewardship Pharmacist
Manchester University NHS Foundation Trust, UK
Clinical Senior Lecturer (Hon Consultant in Intensive Care and Respiratory Medicine)
The University of Manchester, UK
Project Lead of Scottish Antimicrobial Prescribing Group
Health Improvement Scotland, UK
Deputy Medical Director (General Practitioner)
Manchester Health and Care Commissioning, UK
Capturing health professional behaviours can add value to a project. Having information about practice at baseline can help projects develop tailored interventions to change practice. Monitoring change in practice can help projects to understand whether and how their work is making a difference.
There are a range of influences on behaviour: those things that influence whether someone does or does not do something. We can usefully summarise these as capability, opportunity and motivation. Exploring the influences on behaviour of people whose behaviour is expected to change to improve AMS is important, because it is helpful to understand ourselves and others when we are trying to change. Exploring influences helps us to understand the wide variety of pressures, barriers and challenges health workers, and the general public, have in relation to improving AMS. This also helps us to move forward with health workers as collaborators.
The more detailed a theory of change is, the more likely we are to understand what needs to change and what works in affecting change. The process of creating a good theory of change starts with stating what we specifically want to result from our intervention (the desired outcomes) and what indicators we can collect of those outcomes. Next, it is important to explore and specify who needs to do what differently and to explore influences on those behaviours. Finally, producing a diagram / document /logic model that is agreed with all stakeholders ensures that everyone agrees what you want to achieve and through which behavioural influences that is to be achieved.
Education and training are the most commonly used interventions to change behaviour in AMS and in health partnerships generally. Here, we will talk about ensuring education and training interventions align with behaviour change theories and evidence. Health partners might want to address the multitude of influences through other kinds of interventions like behaviour change campaigns, or implementing new systems and tools in the healthcare environment.
Sometimes, we can best influence change through having conversations with individuals about changing what they do. Behavioural science is clear that just telling someone what to do is often ineffective in changing behaviour. Someone is more likely to change if they are aware of the new behaviour(s), are motivated to change, make a plan and then have the plan supported with reminders / prompts.
To understand if our interventions are targeting the right behaviours and having an impact, we need to be able to assess / evaluate behaviour. Observation of behaviour is the most reliable way to do this (either in person or through audits e.g. of prescriptions) but when observation is not possible, we can ask people a variety of different types of question to help us understand their behaviours before and after an intervention.
Next module — Who needs to do what differently
