Whilst public health researchers and practitioners often focus on population behaviour and behaviour change an alternative approach is to use a practices framework. Practices frameworks view behaviour as one part of an overarching practice. This is useful when trying to understand why communities smoke, drink excessive alcohol, eat an unhealthy diet, are sedentary or unable to maintain a healthy weight. Practices frameworks can also usefully inform intervention development. There is increasing interest within public health in learning more about the utility of practice frameworks.

Practice theorists and scholars consider three inter-related domains: the meaning of a practice (how experience, values and beliefs shape a practice); the people/networks who shape or perform a practice; and the technologies and resources that enable a practice to happen. Take, for example, sedentary behaviour. Viewed as a practice rather than a behaviour, a sedentary lifestyle might be informed by experiences of sport at school or feeling out of place in a gym; having a social network that is also sedentary, with a tendency to dismiss exercise as ‘not for them’; and living in a rural area and on a low income. Taken together, these experiences, beliefs, ‘carriers’ (the people involved in sedentary behaviour) and resources highlight why some people lead sedentary lifestyles. Interventions that are most likely to work will consider all elements of a sedentary practice rather than just focusing on behaviour.

Prof Wendy Wills (Centre for Research in Public Health and Community Care (CRIPACC)) presented a plenary lecture on practice theories within public health at the Hertfordshire Public Health conference; the slides can be viewed here.

Delivery of timely and high quality healthcare is becoming a daunting challenge all over the world. Increased demand for healthcare, spread of epidemics threatening large populations, and reduced funding for healthcare and public health have affected the ability of health providers to cope with demand, protect populations from public health threats, and achieve the required quality of care standards. This under-performance of the health sector is exacerbated by the fact that policy and decision making processes are flawed as they tend to look at health problems in a fragmented way and from a narrow discipline-based perspective without taking in consideration the complexity of health contexts and the interconnections between their elements.

A remedy to this problem is to conceptualise health contexts and problems as “Systems” in which “everything is linked to everything”. This Systems Thinking approach enables a holistic view of health contexts and problems and, by representing these as “Health Systems”, captures the complex web of interconnections and interactions between their elements of the health system. From a methods perspective, the Systems Thinking approach includes qualitative tools to map the structure of the health system and quantitative ones to represent the structure through a mathematically based computer simulation model. Policy interventions aiming at improving the performance of the health system can be rigorously tested and evaluated on the computer model to determine their likely outcomes before they are implementation in the real world. As such, System Thinking approaches offer the required evidence to underpin policy decisions and are a superior alternative to the old approach of “doing something and hoping for the best”, which is no longer viable or acceptable in the modern complex health sector.

Behaviour change research at UH has primarily focused on the field of physical activity to produce translational research knowledge with local and national partners in public health promotion. The aim of this body of work is to produce trans-disciplinary research to embed behavioural science into public health efforts to reduce the burden of unhealthy behaviours in the most disadvantaged communities. Examples of the type of research conducted are given below:

Systematic reviews

We conducted a systematic review and meta-analysis of randomised controlled trials of physical activity and sedentary behaviour interventions for inactive adults. The findings showed that changes in physical activity can be achieved through intervention up to a year after completion and highlighted a number of behaviour change techniques (BCT) that were associated with effectiveness (e.g. Action planning, Instruction on how to perform the behaviour, Prompts/cues, Self-reward). Additional reviews have looked at the most effective BCTs in physical activity interventions for people with dementia and for adolescent and young adult cancer survivors. Identifying effective BCTs helps design effective interventions in the future.

Theory analysis

Previous research has suggested that theory has been used inconsistently, and has rarely been applied to the design, implementation, and evaluation of physical activity interventions. The COM-B model of behaviour suggests that behaviour results from an individual having sufficient Capability, Opportunity, and Motivation. We analysed the content and predictive validity of the COM-B for moderate-to-vigorous physical activity (MVPA). The findings suggested that Capability (habits, action planning, and self-monitoring) and Motivation (intention, self-efficacy, and exercise self-identity) are key in performing regular MVPA.

Public health interventions

The Active Herts programme is a community physical activity programme for inactive adults, with additional cardiovascular disease risk factors and/or mental health issues. Active Herts implements the best BCTs in the intervention materials/delivery and evaluates key drivers of MVPA from the COM-B as secondary outcomes. In two areas programme users are receiving a BCT booklet, regular consultations, a booster phone call, motivational text messages, and signposting to 12 weeks of exercise classes. In another two areas programme users are also receiving 12 weeks of free tailored exercise classes, with optional exercise ‘buddies’ available. An outcome evaluation is assessing changes in physical activity as the primary outcome, and sporting participation, sitting, wellbeing, psychological capability, and reflective motivation as secondary outcomes. A process evaluation is exploring the views of programme users, programme providers, and commissioners about what has worked best and why.

Evaluation projects

We also provide robust evaluation for key partners such as the charity HENRY, who are testing a novel volunteer-led delivery of a programme to improve the behaviour and knowledge of parents and young children around nutrition and physical activity.