By Dr Liz Jenkinson, Senior Lecturer in Health Psychology and Co-chair of the UWE Bristol Healthy University Group
There has never been a greater focus on health and wellbeing in our day to day lives. From health behaviours which slow the spread of the covid-19 pandemic, to those which will help protect our wellbeing and mental health at this difficult time, many of us are trying to change our health behaviours for the better.
However, decades of insights from the field of health psychology and behavioural science suggests that even if we begin new health promoting behaviours, these can be hard to maintain, particularly in the long term. We also know that starting new healthy behaviours at times of stress can be really challenging.
We may be more likely to engage in behaviours that provide instant rewards but long term negative health impacts, such as drinking more alcohol and more often, eating less healthily, staying up late and sleeping in, and too much sedentary screen time.
Couple this with obvious barriers such as greater childcare responsibilities, longer working hours for many and curtailed income for some, sedentary jobs without the usual commuting time, and health behaviours can be even more challenging to shift, even with good intentions.
My discipline, Health Psychology seeks to understand psychological processes in health, illness and health care (Johnson 1994). At UWE Bristol, we are a hub for the teaching and training of Health Psychologists and in March 2020, I joined a consortium of 155 health psychologists and trainees called the Health Psychology Exchange seeking to support the NHS, public health professionals and wider health organisations in designing evidence-based guidance and support using health psychology and behavioural science.
One very pressing task was to help health officials to support the public in promoting and maintaining health behaviours during Covid-19 and I was asked to join the British Psychological Society Behavioural Science and Disease Prevention Health Behaviours sub-group.
I recruited a group of our talented Professional Doctorate in Health Psychology trainees and we set to work. I led the sleep hygiene stream, bringing together experts in the field to consider existing evidence, and we collectively worked across topics areas.
Our roadmaps
The ‘roadmaps’ we developed focus on six health behaviours using psychologically-informed behaviour change approaches:
• Physical activity
• Sedentary behaviour
• Eating behaviour
• Stopping smoking
• Alcohol consumption
• Sleep hygiene
The roadmaps utilise a model of understanding health behaviour called the COM-B model (Michie, Stralen and West 2011). This model suggests that we need to consider capability, opportunity and motivation when seeking to promote behaviour. For example, whilst many of us will be very capable (e.g. the knowledge, skill, ability and strength) and motivated to act in a given way (e.g. positive attitudes and emotions towards the behaviour, confidence and intention to perform it), we may not have the opportunity to do so.
This model goes beyond previous ideas about health behaviour which focus squarely on what predicts the intention to do something, and instead places equal importance on how capable we feel, and the opportunities to engage in the behaviour offered by health promoting environments (are the tools or resources I need available and easy to access, is it hard to carry out the behaviour?) and social norms and support.
So, if we want to increase the chances of carrying out a behaviour, we need to ensure people feel capable; that they feel motivated to engage; and that the physical and social environment offers that opportunity at the right time.
We are starting to see this being applied to a range of behaviours such as hand hygiene, where opportunity to hand wash and sanitise is now more widely provided in all settings, socially accepted and visible, leading those who feel capable of maintaining good hand hygiene and motivated to do so, translate this into a successful behaviour.
Our guidance applies these notions to everyday health behaviours, and we hope to see similar rollout and support from health officials and organisations.
Upon recent release, they have been welcomed across the UK by Public Health Teams and health organisations, and we are excited to see how they are implemented. Recent feedback to the team that, “the work here is done”, was music to our ears.
This was exactly what we hoped to achieve – to support already very busy teams to design useful psychologically-informed policy and practice in order to quickly respond to the emerging public health challenges posed by Covid-19.
Prof. Angel Chater, Chair of the Division of Health Psychology who leads the BPS COVID-19 Behavioural Science and Disease Prevention taskforce stated, “Dr Liz Jenkinson and her team of Professional Doctorate Health Psychology Trainees at UWE Bristol have made an incredible contribution to providing insight into the application of health psychology approaches during this pandemic”
What next?
The success of the new roadmaps has led to the team working on a further set with the British Psychological Society Behavioural Science and Disease Prevention Group around access to healthcare, adherence to medication and opioid prescribing.
The team I lead here at UWE Bristol are also engaged in wider work as part of the Health Psychology Exchange, including rapid reviews of the effectiveness of public health messaging in epidemics and pandemics in fostering pivotal health behaviour outcomes such as vaccination behaviour.
Health Psychology has never been more relevant. Our profession has so much to contribute to the collective cause of responding to the challenges of Covid-19. I feel privileged to be able to lead the UWE Bristol Health Psychology contribution to the Health Psychology Exchange and Behavioural Science and Disease Prevention group as an expert in the field.
As new challenges emerge, we intend to keep at it and ensure that health psychology insights continue to help shape policy and practice to save lives.