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Using behavioural science to improve and protect the health of the nation

Posted by: , and , Posted on: - Categories: Behavioural Insights, Health Improvement, Health Protection

PHE has been leading the way in using behavioural insights to change the behaviour of millions of people to help make us a healthier nation. Whether it’s encouraging smokers to quit, increasing uptake of the NHS Health Check, or reducing the number of inappropriate prescriptions for antibiotics, our work is underpinned by evidence from the behavioural and social sciences concerning why people behave as they do.

What are behavioural insights?

All populations face complex health and wellbeing challenges that stem from multiple biological, psychological and social causes. The rising burden of long-term conditions and health inequalities poses a challenge for all public health systems, which can only be met by addressing the social, cultural and behavioural aspects of health and its determinants.

‘Behavioural insights’ combine findings from fields such as cognitive psychology, behavioural economics, health psychology, sociology, and anthropology to understand human behaviour and decision-making, and also to develop and evaluate behaviour change interventions.

How can behavioural and social sciences contribute to public health?

There is a wealth of evidence that many of the issues that undermine or enhance our health outcomes have structural, social and behavioural determinants. This includes:

  • the environments in which we live, work and play
  • how education, employment, income and access to health care services are distributed
  • our experiences and perceptions of the built and online environments, social behaviour, stigma and discrimination

Therefore, the protection and improvement of the population’s health cannot rely solely on biological and medical models and sciences. The behavioural and social sciences are also required  in a multi-faceted approach to addressing many of the leading public health issues, including infectious and preventable diseases, mental ill health, smoking, poor diet and physical inactivity.

The use of behavioural and social sciences in public health can be traced back a long way. For instance, in 1854, Dr John Snow used geography to map cholera in order to show that the source was a water pump in London’s Soho. However, in recent years, the contributions of behavioural and social sciences to protecting and improving the health of the public have gained more prominence, and PHE’s Behavioural Insights (PHEBI) team have played a leading role in this.

For example, in a series of trials that aimed to increase attendance at the NHS Health Check, PHEBI tested an enhanced invitation letter using behavioural insights and sent primer and reminder texts. The enhanced invitations resulted in improvements of up to 12% in uptake compared to the standard national invitation template letter, at a low cost. PHEBI also produced case studies about the use of weighted remuneration to NHS Health Check providers, to encourage take-up by target groups.

Other letters to which PHEBI has applied behavioural insights include the National Childhood Measurement Programme results letter and flu vaccination letters. An estimated 6 million people per year receive a letter enhanced by PHEBI.

In another trial, which aimed to ‘make the healthier choice the easy choice’, two interventions were designed using behavioural insights to change the visibility and availability of products in hospital vending machines. From the sales data, PHEBI found a 23% decrease in confectionary sales and a 63% increase in water sales, whilst business remained commercially viable. You can read more about this trial in our blog. Behavioural science has also been integrated into NHS guidance on staff health and wellbeing, which you can see here.

PHE’s behavioural scientists are also working to help protect the nation from new and emerging threats to health, such as infectious disease outbreaks and chemical incidents. A sister team to PHEBI, the Emergency Response Department’s Behavioural Science Team (ERD BST), helps PHE understand how people are affected by emergencies and disasters, and how and why their behaviour changes in response to these events. These insights can be used to help us to prepare for and respond to public health incidents.

For example, during the recent nerve agent incident in Salisbury and Amesbury, the ERD BST supported the work of the cross-Government Scientific Advisory Group in Emergencies (SAGE), as responders sought to understand how the local community would be affected by the incident. The team coordinated the deployment of PHE volunteers to work alongside the Police and Local Authority in the community, answering the public’s questions and providing easy access to public health advice. The ERD BST has initiated a number of projects which will help PHE and its partners to understand how best to support the local community in the future.

The behaviour of healthcare professionals has also been influenced through the use of behavioural insights. Prescribing unnecessary antibiotics contributes to antimicrobial resistance, and at least 20% of all antibiotics prescribed in primary care in England are inappropriate. In 2014, the PHEBI team led on a trial to test the effect of sending feedback from the Chief Medical Officer to GPs in almost 1,600 practices with the top 20% prescribing rates. This led to a 3.3% decrease of antibiotic prescribing (73,000 fewer prescriptions), and saved over £92,000 in direct prescribing costs for the public sector alone over the six month trial. This feedback has been delivered every year since and has led to further improvements.

Behavioural insights can also be influential when applied to marketing campaigns. PHE’s Stoptober campaign included insights about social networks, setting clear and specific goals, and moment-to-moment impulse management. Behavioural science also underpins smoking cessation programmes as you can see in the guidance for commissioning local tobacco control interventions here.

A new behavioural and social sciences strategy

The PHEBI team will publish a new strategy – Improving People’s Health: Applying behavioural and social sciences to improve population health and wellbeing in England – later this month. This strategy is being developed collaboratively by a wide range of stakeholders including public health practitioners and academic and professional bodies. As a high level guide, it will aim to ensure that the public health system is able to apply the insights of the behavioural and social sciences to improving and protecting the health and wellbeing of our population.

What’s next?

Behavioural and social sciences will be a prominent subject throughout the PHE annual conference on 11 and 12 September, with multiple sessions including:

  • The conference closing keynote address by Professor Dame Theresa Marteau on the subject of ‘Changing minds about changing behaviour’, which will look into how to facilitate the implementation of interventions that change behaviour benefiting the health of all. Details of this session can be viewed here.
  • The ‘Behavioural and social science in public health: translation of transdisciplinary evidence into outcomes’ session, chaired by PHE’s Director of Health Improvement Professor John Newton. More about this session can be found here.
  • The ‘Artificial intelligence meets behavioural science’ session, presented by Professor Susan Michie from the Centre for Behaviour Change at University College London, will discuss the Human Behaviour Change Project. The presentation abstract can be viewed here.
  • The pre-conference workshop, ‘Responding to major incidents and emergencies: mental health, wellbeing and resilience’ will include contributions from behavioural scientists from PHE’s Emergency Response Department. More information about the workshop can be found here.

There are still a few places available for the second day of PHE’s Annual Conference, taking place on 11-12 September at Warwick University.

For anyone who is unable to attend in person, you can keep up with all the news and online discussions via Twitter, by following @PHE_uk. To join in, use #PHEConf18.

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  1. Comment by Mike Cooke posted on

    I noticed an article in the poor response rate to bowel cancer and wondered if BI could help improve this?

    • Replies to Mike Cooke>

      Comment by Blog Editor posted on

      Hello Mike,

      PHE’s Behavioural Insights (PHEBI) team are currently working with the PHE screening team to conduct a strategic behavioural analysis of healthcare professionals’ behaviours in relation to specific NHS screening programmes: diabetic eye, abdominal aortic aneurysm, bowel, cervical and breast screening programmes. This will summarise the published literature of what drives screening-related behaviours, collate and analyse interventions that are delivered to support healthcare professionals with these behaviours, and provide rigorously-evidenced opportunities for improvement.

      We hope this answers your question.