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Health economics and behaviour change: a workshop

Authors of a paper entitled What can health psychologists learn from health economics: from monetary incentives to policy programmes note that they

…believe that health psychologists would benefit from greater familiarisation with the methodologies, theories, and tools of economics”.

I wonder what discourse a research paper examining what health economists could learn from health psychologists or health behaviour change would take; particularly in the area of intervention design and evaluation. Intervention design and evaluation is an area in which multidisciplinary research has become the name of the game! Over the last decade, the intersection of economics and psychology has become even more apparent. The announcement of the 2017 Nobel Memorial Prize for economics, to Richard Thaler, for his groundbreaking work incorporating psychology into economic theory, was a victory not only for the Professor but also for behaviourally-informed policy worldwide.

A workshop

As the Intensive Follow-Up Workshop on Designing Effective Interventions for Health Behaviour Change approaches, I reflect back on the introductory workshop that I attended at the Health Behaviour Change Research Group (HBCRG), NUI Galway. The aim of that workshop was for participants to learn about, and practice using, emerging methods for designing and evaluating behavioural interventions. It was delivered by Dr Molly Byrne, Dr Jenny McSharry and Milou Fredrix.

My background is in health economics. I currently work in a large multidisciplinary team (we call ourselves the CHErIsH team!); a melting pot of health behaviour change, health psychology, public health, health economics and general practice. The different elements of our disciplines are “melting together” into a harmonious common goal of developing an intervention for childhood obesity prevention. I am extremely fortunate to have learnt a lot working with this team. I have been exposed to different methodologies, theories and frameworks in behaviour change and health psychology which has greatly enriched my health economics research thinking. Prior to becoming part of the CHErIsH team, I had little to no experience of working in behaviour change or health psychology. Admittedly throughout my PhD, my thoughts on health behaviour change and psychology models and frameworks wandered from imagining them to be very complex with almost an overload of frameworks and theories – to the other extreme of thinking this area to be a fairly unassuming area of research and that behaviour change could be easily evaluated.

It is safe to say that I left the introductory workshop with the confirmation that behaviour change is a complex area, but that this complexity is OK! The workshop fuelled me with a wealth of knowledge, reassurance and confidence regarding how I might apply behaviour change theoretical models to inform my health economics research. I also left the workshop with a greater understanding of the emerging methods for evaluating behaviour change interventions (which coincidentally I will be doing very shortly).

Whilst this blog post does not cover all of the material outlined in the workshop, below are some nuggets of information that I took home with me.

The big picture

What we do in our behaviours are hugely predictive of morbidity and mortality. Justify the importance of health behaviour in the particular setting that you are researching. This is important in health economic evaluations when we think of health outcomes and how behaviour might impact on these. Or indeed within the less traditional methodologies in health economics such as discrete choice experiments examining individual preferences and behaviour.

When designing a behavioural intervention…

  1. Identify and define the specific behaviour that you are trying to change, this is as good as having a good research question or a good systematic review question. Be aware of the spillover effects that the intervention might have, along with thinking how this intervention might be measured. The more precisely you specify the behaviour, the better!
  2. Understand the psychological theory – why a particular person or group is behaving a certain way in a particular setting. Understand how you can change it.
  3. Specify clearly what the intervention is in your research paper, describe it – clearly. There is a greater need for specificity. There is loose terminology in behaviour change, which often has more complex interventions than biomedical subjects. There is a real need for common language, but try to be clear when describing your intervention. Don’t make it hard on those trying to evaluate it later.

Take home messages

Behaviour change is complex. But, complexity is not a problem once we are aware and acknowledge the complexity that exists.

I previously mentioned that I left the workshop reassured. I was reassured to be reminded by the experts that it is OK not to know exactly what your intervention is going to be or going to look like from the onset.

Last, but by no means least, this workshop provided me with access to the psychological and health behaviour change frameworks. There are in fact 83 theories! Molly and Jenny spoke about “on the ground reality”. So whilst theoretically there are all of these theories, pragmatically the intervention needs to be designed and tested. So a pilot should be about optimising the components of the intervention and testing which components are more feasible.

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