In order to identify the type or types of intervention that are likely to be effective, it is important to canvass the full range of options available and use a rational system for selecting from among them. This requires a system for characterising interventions that covers all possible intervention types together with a system for matching these features to the behavioural target, the target population, and the context in which the intervention will be delivered. This should be underpinned by a model of behaviour and the factors that influence it.
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Interventions are commonly designed without evidence of having gone through this kind of process, with no formal analysis of either the target behaviour or the theoretically predicted mechanisms of action. They are based on implicit commonsense models of behaviour [6]. Even when one or more models or theories are chosen to guide the intervention, they do not cover the full range of possible influences so exclude potentially important variables. For example, the often used Theory of Planned Behaviour and Health Belief Model do not address the important roles of impulsivity, habit, self-control, associative learning, and emotional processing [7].
It appears that most intervention designers do not use existing frameworks as a basis for developing new interventions or for analysing why some interventions have failed while others have succeeded. One reason for this may be that these frameworks do not meet their needs. In order to choose the interventions likely to be most effective, it makes sense to start with a model of behaviour. This model should capture the range of mechanisms that may be involved in change, including those that are internal (psychological and physical) and those that involve changes to the external environment. In general, insufficient attention appears to be given to analysing the nature of behaviour as the starting point of behaviour change interventions [15], a notable exception being intervention mapping [16]. 'Nature of the behaviour' was identified as one of 12 theoretical domains of influence on implementation-relevant behaviours [9]. Whilst this framework of 12 theoretical domains has proved useful in assessing and intervening with implementation problems [9], the domain of behaviour has remained under-theorised and therefore underused in its application.
There are a number of possible objections to attempting to construct the kind of behavioural model described and link this to intervention types. The most obvious criticism is that the area is too complex and that the constructs too ill-defined to be able to establish a useful, scientifically-based framework. Another is that no framework can address the level of detail required to determine what will or will not be an effective intervention. The response to this is twofold: these are empirical questions and there is already evidence that characterising interventions by behaviour change techniques (BCTs) can be helpful in understanding which interventions are more or less effective [6,17]; and not to embark on this enterprise is to give up on achieving a science of behaviour change before the first hurdle and condemn this field to opinion and fashion.
In addition, the categories should be able to be linked to specific behaviour change mechanisms that in turn can be linked to the model of behaviour. These requirements constitute three criteria of usefulness that can be used to evaluate the framework: comprehensiveness, coherence, and links to an overarching model of behaviour. We limited the criteria to those we considered to form a basis for judging adequacy. There are others, e.g., parsimony, that are desirable features but do not lend themselves to thresholds. Other criteria can be used to evaluate its applicability, e.g., reliability, ease of use, ease of communication, ability to explain outcomes, usefulness for generating new interventions, and ability to predict effectiveness of interventions
We use the term 'model' here in the sense defined in the Oxford English Dictionary: 'a hypothetical description of a complex entity or process.' For the overarching model of behaviour, we started with motivation, defined as: brain processes that energize and direct behaviour) [18]. This is a much broader conceptualisation than appears in many discourses, covering as it does basic drives and 'automatic' processes as well as choice and intention.
Our next step was to consider the minimum number of additional factors needed to account for whether change in the behavioural target would occur, given sufficient motivation. We drew on two sources representing very different traditions: a US consensus meeting of behavioural theorists in 1991 [19], and a principle of US criminal law dating back many centuries. The former identified three factors that were necessary and sufficient prerequisites for the performance of a specified volitional behaviour: the skills necessary to perform the behaviour, a strong intention to perform the behaviour, and no environmental constraints that make it impossible to perform the behaviour. Under US criminal law, in order to prove that someone is guilty of a crime one has to show three things: means or capability, opportunity, and motive. This suggested a potentially elegant way of representing the necessary conditions for a volitional behaviour to occur. The common conclusion from these two separate strands of thought lends confidence to this model of behaviour. We have built on this to add non-volitional mechanisms involved in motivation (e.g., habits) and to conceptualise causal associations between the components in an interacting system.
A given intervention might change one or more components in the behaviour system. The causal links within the system can work to reduce or amplify the effect of particular interventions by leading to changes elsewhere. While this is a model of behaviour, it also provides a basis for designing interventions aimed at behaviour change. Applying this to intervention design, the task would be to consider what the behavioural target would be, and what components of the behaviour system would need to be changed to achieve that.
Several things became apparent when reviewing the frameworks. First of all, it was clear it would be necessary to define terms describing categories of intervention more precisely than is done in everyday language in order to achieve coherence. For example, in everyday language 'education' can include 'training,' but for our purposes it was necessary to distinguish between 'education' and 'training' with the former focusing on imparting knowledge and developing understanding and the latter focusing on development of skills. Similarly we had to differentiate 'training' from 'modelling.' In common parlance, modelling could be a method used in training, but we use the term more specifically to refer to using our propensity to imitate as a motivational device. A third example is the use of the term 'enablement.' In everyday use, this could include most of the other intervention categories, but here refers to forms of enablement that are either more encompassing (as in, for example, 'behavioural support' for smoking cessation) or work through other mechanisms (as in, for example, pharmacological interventions to aid smoking cessation or surgery to enable control of calorie intake). There is not a term in the English language to describe that we intend, so rather than invent a new term we have stayed with 'enablement.'
It must be recognised that there are a near infinite number of ways of classifying interventions and intervention functions. The one arrived at here will no doubt be superseded. But for the present, it has the benefits of having been derived from classifications already available and therefore covering concepts that have previously been considered to be important, and using an overarching model of behaviour to link interventions to potential behavioural targets. The most important test of this framework will be whether it provides a more efficient method of choosing the kinds of intervention that are likely to be appropriate for a given behavioural target in a given context and a given population.
One of the strengths of this framework is that it incorporates context very naturally. There is a general recognition that context is key to the effective design and implementation of interventions, but it remains under-theorised and under-investigated. The 'opportunity' component of the behavioural model is the context, so that behaviour can only be understood in relation to context. Behaviour in context is thus the starting point of intervention design. The behaviour system also has automatic processing at its heart, broadening the understanding of behaviour beyond the more reflective, systematic cognitive processes that have been the focus of much behavioural research in implementation science and health psychology (for example, social cognition models such as the Theory of Planned Behaviour).
Frameworks analysed by criteria of comprehensive coverage, coherence and link to a model of behaviour. Analysis by criteria of comprehensive coverage, coherence and link to a model of behaviour
Participants were also asked to explain their answers in a written elaboration and asked to consider the following prompts: 1) How do you expect social media and digital commentary will evolve in the coming decade? 2) Do you think we will see a widespread demand for technological systems or solutions that encourage more inclusive online interactions? 3) What do you think will happen to free speech? And 4) What might be the consequences for anonymity and privacy?
The majority in this canvassing were sympathetic to those abused or misled in the current online environment while expressing concerns that the most likely solutions will allow governments and big businesses to employ surveillance systems that monitor citizens, suppress free speech and shape discourse via algorithms, allowing those who write the algorithms to sculpt civil debate. 2ff7e9595c
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