Behaviour change strategies for reducing blood pressure-related disease burden: findings from a global implementation research programme

Abstract

Background: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects.

Methods: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings.

Results: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation.

Conclusions: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.

Fig. 1

The Behaviour Change Wheel [24]. Notes: At the centre of the wheel are the COM-B model components. Capability refers to an individual’s physical and psychological capacity (e.g. comprehension, literacy, reasoning) to engage in the activity concerned. It includes having the necessary knowledge and skills to enact the target behaviour. Motivation refers to brain processes that energise and direct behaviour. Includes automatic processes characterised by habit, emotions and impulses as well as reflective processes involving analytical decision making, making plans and evaluating them. Opportunity refers to the factors that lie outside the individual that make behaviour change possible or prompt it. Can be physical opportunities afforded by the environment in which people live or social opportunity which is affected by the cultural milieu in which we think about things, words we use and concepts that make up our language [24]

Fig. 2

Capability, opportunity and motivation ratings of community members, non-physician health workers and doctors in 15 research projects. + not working with this particular target group. * rating not provided. Notes: (1) Research teams are ordered around the plot by their strategy according to Table 2 and then alphabetically. (2) Each team provided ratings on a 3-point scale (low (inner ring), medium (middle ring) and high (outer ring)) for each of the “actors” with whom they were targeting their interventions. This was done for each of the COM-B components (capability, opportunity and motivation). The more peripheral the location, the higher the rating. (3) Teams provided additional explanatory text providing contextual information for how they arrived at their ratings. Please see the supplemental online files. (4) Several projects are targeting other “actors”, and these are not included in these figures (e.g. for the India triple pill project, ratings are left blank for NPHWs as this project is not engaging with these groups; for the Peru salt project, ratings are left blank for doctors and NPHWs as this project is mainly engaging with the community, community kitchens and retail food outlets.) Please refer to the individual project templates in the supplemental online files to view their ratings for these other actors

Fig. 3

Intervention functions for the 15 research projects using the Behaviour Change Wheel framework

Fig. 4

Policy categories for the 15 research projects using the Behaviour Change Wheel framework