Changing behaviour in a population, a group, or an individual is challenging for many reasons. The Behaviour Change Wheel is the result of a consensus study by more than 30 researchers in health psychology and implementation sciences. After reviewing the literature, they identified 33 theories and 128 constructs. That review and the consensus study formed the basis for a “behavioural change wheel” (BCW) consisting of three concentric circles. The inner circle or hub is the sources of behaviour that cause and maintain it and/or prevent it from changing. The middle circle contains the intervention functions, and the outer circle or rim of the wheel is built on categories of policy (see figure). Top
The hub of the wheel helps us understand the situation by defining the problem, specifying the target behaviour, and identifying what needs to change. The authors use the COM-B model to understand and define the behaviour, where B stands for behaviour, C for capability (both physical and psychological), O for opportunity (both physical and social environment), and M for motivation (reflective and automatic mechanisms). Motivation, capability, and opportunity each influence behaviour in different and synergistic ways. The six subdivisions of the hub are similar, but not identical, to the six sources of influence in Influencer: The New Science of Leading Change,1 i.e., the personal, social, and structural motivations and abilities that affect behaviour and behavioural change. Top
Once the target behaviour has been identified, there is a choice of nine evidence-based intervention functions that make up the middle circle and are aimed at addressing the deficits identified with COM-B. Each is defined and well explained in the book. The outer circle identifies seven policy categories to support the delivery of the intervention functions. Policy categories are the types of decisions that must be made by authorities to support and enact the interventions determined to be effective. The policy categories apply less to behavioural change in the individual and more to changes in an organization or population. Top
The book makes the approach to the BCW model quite practical. Although it might make the novice to behavioural change management gasp at first, a second look will bring an appreciation of the eight logical and well explained steps, each with plenty of examples. Health-related examples include improvement in hospital hygiene practices, use of assessment strategies for cardiovascular disease assessment by general practitioners, habit formation for cystic fibrosis treatment, use of a smart phone app by parents of obese children, evidence-based care of elderly with suspected cognitive impairment in general practice, and intervention to prevent melioidosis in Thailand. With the help of the book’s many worksheets, the reader can ease into developing his or her own project to change behaviour and form new habits. Top
The first four steps (the hub of the wheel in Figure 1) help the reader understand and define the behaviour; the fifth identifies the appropriate intervention (middle circle in the wheel); and step six (the rim) identifies the supportive policy categories. Because these six steps by themselves are not specific enough to lead to action and measurable change, the researchers added two more crucial steps: identification of behavioural change techniques (BCT) and identification of the mode of delivery.
The BCTs, which are evidence-based, are lists of active ingredients within the intervention, designed to change behaviour2; they are observable, replicable, and irreducible components of an intervention and can be used alone or in combination. In other words, the seventh step, BCT identification, supports the delivery of the intervention function(s), as defined in step five using the middle circle of the wheel. The eighth and final step, which supports the sixth step, helps identify how best to deliver the entire package. Top
In summary, this is a good reference source and a book worthy of a spot in your library. Although perhaps overwhelming for the beginner, it contains the most up-to-date evidence available in the literature. The BCW model is structured in such a way that it will provide the best chance for success in changing the behaviour of a population or an organization, although, for changing personal habits, the BCW is less suitable. Purchase of the book includes access to more resources on the BCW website
Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the CJPL and past-president of the Canadian Society of Physician Leaders. He is clinical professor of pediatrics at the University of British Columbia and the University of Alberta and an associate faculty member at the School for Leadership Studies at Royal Roads University in Victoria. He is also on the faculty of the CMA Physician Leadership Institute.