Improving health and wellbeing:

A guide to using behavioural

science in policy and practice
Authors: Professor Robert West and Ashley Gould
 Step-by-step Important
Framework for Principles of
guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Improving health and wellbeing: a guide to using behavioural science in policy and practice

Authors:
Professor Robert West, Professor Emeritus, University College London
Ashley Gould, Programme Director, Behavioural Science Unit, Public Health Wales

Contact details:
Behavioural Science Unit, Policy and International Health, WHO Collaborating Centre on Investment for Health & Well-being
Public Health Wales.
Email: [email protected]
Website: www.phwwhocc.co.uk/teams/behavioural-science-unit/
Twitter: @BSU_PHW

Behavioural Science Unit:

The Public Health Wales Behavioural Science Unit was launched in May 2022 to provide specialist expertise on behavioural science, and develop the application of
it, to improve health & wellbeing in Wales. The Unit is part of the World Health Organisation (WHO) Collaborating Centre on Investment in Health
and Wellbeing.

For further information, or support around the application of behavioural science to improve and protect health and wellbeing in Wales please get in touch.

Mae’r ddogfen hon ar gael yn Gymraeg / This document is available in Welsh

Some tools in this guide have been previously published, and are owned by others. Their content has been translated, with retention of some of the originally
published language and design.

ISBN: 978-1-83766-104-6
© 2022 Public Health Wales NHS Trust.
Material contained in this document may be reproduced under the terms of the Open Government Licence (OGL)
www.nationalarchives.gov.uk/doc/open-government-licence/version/3/
provided it is done so accurately and is not used in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.
Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.

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 Step-by-step Important
Framework for Principles of
guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Contents
1. Summary 7.7 Intervention delivery
7.8 Stage 6: Implementing, disseminating and evaluating the intervention
2. Background
8. Important principles in intervention development
3. Scope
8.1 Do a literature review
4. Aims 8.2 Do not re-invent the wheel
8.3 Be prepared to adapt
5. A framework for incorporating behavioural science into decision-making
8.4 Cast the net wide
5.1 Making use of behavioural science expertise
8.5 Use topic-specific experts

6. Principles of behavioural science 8.6 Involve key-stakeholders

6.1 Understanding behaviour: the COM-B Model 8.7 Carry out pilot testing

6.1.1 Capability 8.8 Always evaluate

6.1.2 Opportunity
9. Conclusions
6.1.3 Motivation
6.1.4 How C O M interact 10. References
6.2 Behaviours are part of an interacting system
11. Appendix A: Formal process for applying reporting APEASE
7. Step-by-step guide to intervention development assessment

7.1 Using the APEASE criteria to make decisions

12. Appendix B: Quiz on principles for developing behaviour change
7.2 Stage 1: Deciding on target population(s) and behaviour(s) interventions
7.3 Stage 2: Conducting a behavioural diagnosis
13. Appendix C: Intervention development quality checklist
7.4 Stage 3: Selecting intervention types
7.5 Stage 4: Selecting implementation options
7.6 Stage 5: Building the intervention Interactive PDF
7.6.1 Intervention content Navigate the document, by section or
7.6.2 The NEAR-AFAR framework page, by using the top nav bar or arrows

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 Step-by-step Important
Framework for Principles of
guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

1. Summary
Aims of the guide What is Behavioural Science? tools, resources, and behavioural science expertise as
required.
This document aims to provide policy makers and Behavioural science is the scientific study of behaviour –
practitioners in public health, healthcare and the what enables it, what prevents it, and how best to elicit
Basic principles of behavioural science
wider Welsh public service with guidance on the use of and maintain it. It involves collecting and analysing data,
behavioural science to help them reach their objectives. synthesising evidence, building models and theories For someone to enact a particular behaviour at any given
The guide focuses on behaviours in a range of policy areas, to predict behaviour, and developing and evaluating moment they must have the capability to do it (e.g., the
that directly or indirectly influence human health and interventions to influence it. knowledge and skills), the opportunity to do it (e.g., the
wellbeing, including substance use, diet, physical exercise, time and resources and a conducive social environment),
injury prevention, behaviours that affect environmental Why use behavioural science? and they must be more motivated to do it than
sustainability, and antisocial behaviours and pro-social anything else they might be doing. This understanding
Behavioural science is becoming widely applied in the public
behaviours. is captured in the COM-B (Capability, Opportunity,
and commercial sectors. In the public sector it is being used
Motivation, Behaviour) model which provides a unifying,
to optimise policies, services, and communications. Relying
transdisciplinary framework for other models and
on common sense to predict how people will react has
theories in behavioural science. It can be generalised
led in the past to costly failures. There are now numerous
to understand and predict the behaviour of groups,
examples of how behavioural science has led to effective
organisations and whole populations.
policymaking, service development and communications.

An important practical use of behavioural science is to

Who should use behavioural science?
develop effective behaviour change interventions. In
Most decisions in policy, service or communications doing so it is crucial not to jump in with such interventions
development are made by people who are not behavioural prematurely, but to adopt a systematic method to arrive
science experts, and they do not need to be. The important at ones that stand a good chance of meeting their
thing is for these policymakers and practitioners to objectives.
recognise when behavioural science might be deployed
to add value to their efforts, and the first step to take in
making that happen. To enable this, it is useful to have:
an understanding of the basic principles of behavioural
science, system-level enablement, and access to relevant

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
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behavioural science science
development development

A first step in developing behaviour change interventions is to understand who

needs to do what, when and for how long in order to achieve one’s objectives: i.e., to
decide on the target behaviour(s) and target group(s).

Then we need to understand how to ensure that a) each target group has the necessary
abilities to perform the behaviour(s), that b) their physical and social environment
supports the behaviour, and that c) they are more motivated to enact the desired
behaviour than anything else. The process of developing this understanding is called
behavioural diagnosis and it can be achieved using the Capability-Opportunity-
Motivation-Behaviour (COM-B) Model. To achieve this, we draw (as far as time and
resources permit) on literature reviews, primary research, evaluations of previous
interventions, and stakeholder engagement.

Next, we must decide what the best approach to achieving this is, selecting one
or more approaches from a menu of evidence-based options (intervention types):
education, persuasion, incentivisation, coercion, training, restriction, environmental
restructuring, modelling or enablement. Each of these has strengths and limitations
and is more appropriate in some situations than others.

We can then decide on how to implement these with a blend of policy options:
providing a service or developing a product, mounting a communications or
marketing campaign, legislating, producing regulations short of legislation,
developing guidelines, using fiscal measures, and/or using environmental or social
planning mechanisms. As with the intervention types, each implementation option
will be more appropriate in some cases than others and usually more than one of
them is needed.

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

The behavioural diagnosis using the COM-B model, followed by selection of

intervention types and then implementation options, is captured graphically in
what is known as ‘The Behaviour Change Wheel’. The wheel provides a simple visual
reminder of the options available as one works out from the hub (in green) to the
rim (in grey).

These steps create the overall vision of a behaviour change strategy. This is then
used to build the intervention: i.e., to turn the vision into a concrete reality rather
like engineers and builders translate an architect’s vision into a functioning building.
This includes selecting from a menu of specific Behaviour Change Techniques (BCTs)
and deciding on appropriate modes of delivery, who should deliver the intervention
(the intervention source) and the delivery schedule. Then the precise details of the
intervention can be crafted.

Finally, the intervention needs to be implemented, disseminated, and evaluated.

Throughout the development and implementation process, it is not enough just to
consider whether in principle it will have the desired impact, particularly in the target-
audience/population segment of concern. All the way through the process, from the
initial ideas to the finished intervention, we must pay attention to a wide range of
considerations, from the perspective of the target-audience/ population segment.
These are set out in the APEASE criteria: acceptability, practicability, effectiveness,
affordability, spill-over effects, and equity.
While the sequence set out above follows a logical order, it is usually necessary to
revert to previous stages many times as we hit obstacles in the chosen approach or
new data or opportunities become available.

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Intervention development scenarios

The above principles can be used in any intervention development scenario: building an intervention from scratch, applying an existing intervention to a new context, improving an existing
intervention, or selecting from interventions that are being proposed. In every case the behavioural diagnosis and the APEASE criteria should inform the decisions being made about the
options available.

Principles to apply during the development process

Applying the following principles will increase the chances of developing interventions that meet your objectives:

Pilot test interventions before investing in full-

Wherever possible work from an intervention Involve experts in the scale implementation and be prepared to revisit
that has already been demonstrated to be behaviour of interest the basic premise of an intervention if required.
effective in a similar context, but do not assume whenever possible.
that an intervention that has worked in one
context will perform equally well (without
adaptation) in a new context.

Evaluate interventions and intervention

components throughout development
and after implementation, using
Involve key stakeholders in the
the best methods that are practicable
development process, including
Do not be blinkered into using a particular and affordable.
target groups and people who
implementation option (e.g., a communications
Start with a review of the scientific may have to deliver it.
campaign or legislation) just because it seems
literature to identify specific factors
most obvious. Similarly avoid the easily-adopted
potentially influencing the behaviour(s)
assumption that increasing knowledge (through
of interest, in the target-audience and
instruction or education) will lead to change.
possible intervention approaches.

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development development

2. Background
Behavioural science has become increasingly used across underlay the failure of people infected with Covid to self-
the board in government (national and local), public health, isolate. This assumption led to threat of fines as a way to
motivate self-isolation. However, it turned out that failure
Behavioural science uses rigorous methods to understand
to self-isolate was in large part a matter of capability (not
Governments, public health, healthcare and wider public and predict behaviour.
knowing the symptoms) and opportunity (not having the
service organisations develop and enact policies. They also
and healthcare. Many parts of the public and commercial financial resources) (3) .
directly commission, deliver and seek to improve services,
sectors have set up behavioural science teams to advise Policymakers and practitioners experience several barriers
and they engage in and commission communications.All
them and, in some cases, to develop interventions to to making effective use of behavioural science. One is
these activities involve influencing the behaviour of people
influence behaviours. However, we still have a long way that they may lack the basic understanding of behavioural
and organisations. They may target behaviour directly, as
to go in exploiting the potential of behavioural science to
in policy activity to reduce excessive alcohol consumption; Jumping to decisions about interventions (policy, services
optimise health and wellbeing. This can be addressed by
to attend a screening or vaccination appointment or to get and communications) without applying behavioural science
increasing understanding of behavioural science and its
more people to switch to active travel, or they may require can lead to costly mistakes and wasted effort.
value in everyday decision-making, developing systems and
changes in behaviour in order to work, as in tackling obesity
processes, and by providing greater access to behavioural science principles. Another is that decisions often have to
or reducing Covid-19 infection rates.
science expertise and resources. be made quickly, without the time or resources needed for a
Behavioural science applies scientific methods to
The use of ‘common-sense’ assumptions about behaviour full analysis of the problem and a carefully crafted solution.
Influencing behaviour is often critically important, either is prevalent but often leads to unsuccessful interventions. A third barrier can be overconfidence in their common
directly or indirectly, to achieving goals to protect and For example, it has been assumed that a major part of the sense understanding of behaviour. Fourthly, they often do
improve health and wider wellbeing. not have ways of working or access to relevant behavioural
Behavioural Science Units are increasingly being set up
science expertise to support the use of behavioural science
understanding and influencing behaviour. It involves in public sector organisations, but most decisions are
gathering data, developing models and theories, and still made using ‘common sense’ assumptions.These units Barriers to making effective use of behavioural science
using these to predict behaviours in specific contexts and provide expertise and resources; they also grow capability include lack of understanding of principles, the need for
population/workforce groups. The disciplines of psychology, and broker engagement with topic experts. rapid decision-making, overconfidence in common sense,
sociology, anthropology, neuroscience, economics and and lack of systems, and processes to access expert support.
reason newly qualified drivers have relatively high traffic
many others all contribute to it. Its data collection methods
accident rates is a lack of driving skills which has led to
include laboratory and field experiments, surveys,
setting up post-licensing education courses. It turns out
naturalistic observation, and interviews. It relies heavily
that motivational factors are probably dominant as causes
on statistical analyses to detect patterns in the data and
of traffic accidents (1) and post-licensing driver education
make inferences. It has contributed to significant advances
programmes focusing on improving driving ability have
in a wide range of areas, including transport safety, public
been found to be ineffective (2). In the Covid-19 pandemic
health and clinical medicine, mental health, environmental
the UK Government assumed that lack of motivation
protection, and law and order.

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Wellbeing of Future
Generations Act
‘Way of Working’
Example of where behavioural science can contribute 3. Scope
• Identifying ways to combat the tendency for people to prioritise immediate This guide focuses on behaviours that directly or indirectly influence human
perceived benefits over longer-term costs.
wellbeing and physical and mental health. These include behaviours that
Long term • Identifying structural changes to social and physical environments that will
undermine health and wellbeing such as tobacco smoking, use of illicit
sustain new behaviour patterns.
drugs, excessive alcohol consumption, sexual harassment and violence.
• Supporting the development of new habits and routines
They also include behaviours that directly promote health and wellbeing
• Identifying how to create a culture in all sectors of society that strongly such as physical activity, eating a balanced diet, getting vaccinated, and
values health and wellbeing.
protecting ourselves and others against infection. Thirdly, they include
• Establishing optimum means of educating and empowering all sectors in
Prevention behaviours that promote environmental sustainability such as reducing
society to behave in ways that maximise health and wellbeing.
our use of fossil fuels and increasing our re-use and recycling of waste.
• Identifying key components of services that support the population in
Fourthly, we include behaviours of health, care and other practitioners
combating unhealthy behaviours.
and policy makers.
• Supporting the development of ‘systems maps’ that show how the
behaviours of different actors (organisations, individuals and groups)
The Wellbeing of Future Generations (WBFG) (Wales) Act sets ambitious
influence each other and important outcomes.
goals for improving wellbeing in Wales, as well as duties, mechanisms and
Integration • Identifying how behaviour change designed to achieved desired outcomes
‘ways of working’ to achieve these goals (4). Achieving improvements in
can have spill over effects, positive and negative, on to other outcomes.
• Supporting decision making in complex interacting systems by providing the social, economic, environmental and cultural wellbeing of Wales relies
tools and models that aid comprehension. heavily on public and practitioner behaviours. Consequently behavioural
science can play an increasingly important role in delivering the wellbeing
• Supporting identification and prioritisation of possible partnerships.
goals. Table 1 provides examples of how behavioural science can
• Identifying barriers and facilitators to effective collaboration.
Collaboration contribute to each of the prescribed ‘ways-of-working’.
• Providing resources and evidence based principles to support effective
collaboration within and across sectors.
Behavioural science can make a significant contribution to public sector
• Identifying and helping to engage key stakeholders. bodies’ ways of working to help achieve the goals of the Wellbeing of
• Providing resources and insights to support effective co-production of Future Generations Act.
Involvement policies, services and interventions.
• Addressing concerns about, and possible counter movements to, beneficial
policies and interventions.

Table 1: Examples of the contribution of behavioural science to the Wellbeing of Future Generations ‘ways of working’

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
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behavioural science science
development development

4. Aims
This guide aims to help policymakers and practitioners make effective use of
behavioural science in their work – to optimise their efforts and increase the likelihood
that policy objectives are realised – so we more often ‘get what we aim for’.

It does this by providing:

a framework for incorporating behavioural

science in decision-making,

a basic understanding of the principles of

behavioural science, and

a step-by-step guide to developing, adapting

or selecting behaviour change interventions.

It also includes tools and resources to help with intervention development and
pointers to appropriate sources of behavioural science expertise.

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

5. A framework for incorporating behavioural

science into decision-making
Depending on the task at hand policymakers and need to go further and in addition to using a structured The Unit provides:
practitioners can use behavioural science in several ways approach use tools and resources of the kind provided in this
1. rapid feedback on products (such as communication
(Table 2). For most routine decisions, it is sufficient to have guide. There will also be occasions when decision-makers
tools, letters, and scripts for service engagement),
a basic grounding in the core principles. For more complex need to involve behavioural science experts. This may be
2. technical assistance and advice to other parts of the
or important decisions/policies/services/communications, on an ad-hoc basis using informal networks or established
organization and wider system,
it is worthwhile taking a more structured approach using groups or teams, and may require commissioning specific
methods described in this guide. Decision-makers may pieces of work, including literature reviews and empirical 3. advice to inform policy design,
research. 4. engagement, advocacy and information to increase
awareness of behavioural science (meetings, events,
Use personal understanding of behavioural
5.1 Making use of behavioural science expertise conferences, briefings, videos, public reports, peer-
science informally
reviewed publications),
The Public Health Wales Behavioural Science Unit (BSU) is a
Structure the problem using formal basic team established in 2022 with the mission of: 5. bespoke behaviour-change projects,
behavioural science principles Providing specialist expertise on behavioural science, 6. capacity-building among stakeholders in applying
and developing the application of it, to improve health & behavioural science (including readiness assessments,
Use written behavioural science tools and wellbeing in Wales. training delivery, webinars, workshops),
resources such as templates and decision aids
7. a developing network connecting policymakers and
Seek ad-hoc behavioural science advice from a practitioners with external experts, and
standing group or team of experts Public Health Wales Behavioural Science Unit 8. assistance with commissioning projects.
The Unit is dedicated to maximising the use of behavioural
Commission behavioural science expertise to Website: phwwhocc.co.uk/teams/behavioural-science-unit
science to benefit the public health and wellbeing,
contribute to decision-making
professional practice, and policy design.
Email: [email protected]
Commission stand-alone behavioural science
advice, reports or research Twitter: @BSU_PHW

Table 2: Ways of using behavioural science in decision-making

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guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
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development development

Figure 1: A framework for using behavioural science expertise

Calls on Public health Wales Produces

Behavioural Science Unit

Uses Provides
Ad hoc advice

Connect to
Policy-maker/ Uses Training and Provides Research/Product
Practitioner Knowledge support development/Reports

Uses Provides
Tools and resources

External experts
Commissions Produces

It is important to use behavioural science approaches and/or expertise as early in the process of intervention
development as possible – so you get the change you aim for. Often expert help is brought in too late.

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guide to principles in
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development development

6. Principles of behavioural science

A basic understanding of behaviour is helpful for developing 6.1.1 Capability
effective behaviour change interventions. This section First, people must have the capability to perform the Physical capability Psychological capability
provides a brief overview of the principles which this guide behaviour. Table 3 shows different aspects of capability.
will return to when it comes to explaining how to develop The COM-B model divides these into physical capability Having the physique needed Awareness of the behaviour
interventions. and psychological capability. For example, they must know for the behaviour and how to perform it
how to do it and often they need to understand why they
6.1 Understanding behaviour: the COM-B Model should do it. They must have the mental skills and resilience
Having the co-ordination, Understanding the
The starting point for developing interventions to to achieve it, and they need the physique and physical skills dexterity and physical skills consequences of the
influence behaviour (behaviour change interventions) is an to be able to do it. needed for the behaviour behaviour

understanding of the causes of behaviour. This guide uses a

framework for understanding behaviour called the COM-B When we are trying to influence the behaviour of groups Having the psychological
of people or whole populations we want to maximise the skills and judgement (e.g.,
Model, whose initials stand for Capability, Opportunity, Having the physical strength
reasoning ability, memory
Motivation and Behaviour (5,6). The model aims to capability of as many people as possible in that group. needed for the behaviour
capacity) needed to perform
provide a framework for incorporating insights from all This may mean tailoring the intervention according to the the behaviour
the behavioural science disciplines, including psychology, pre-existing capabilities of members of that group (e.g.,
sociology, anthropology, economics and neuroscience. As reading ability). Having the sensory abilities Having the mental resilience
such, it is interdisciplinary and was developed as a way of needed for the behaviour to perform the behaviour

integrating the large number of models that have been It will be necessary to focus on different capabilities
proposed. It has become widely adopted in many sectors, depending on the behaviour, setting and target group. For Having the self-regulatory
example, when attempting to promote increased physical Having the physical stamina abilities and techniques
including government, business and healthcare (7).
needed for the behaviour needed to perform the
activity a focus on physical strength and stamina will most
behaviour
The COM-B Model captures the idea that three conditions likely be more important in an aging population than a
must be met for any behaviour to occur on any given population of young adults.
Table 3: Aspects of capability to enact a behaviour
occasion. The core version of COM-B model focuses on an
individual person at a given moment in time, but this can
then be generalised to groups, organisations and whole
populations over periods of time.

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development development

6.1.2 Opportunity It is all too easy to overlook the physical and social Table 4 has an entry for the ‘linguistic and conceptual
environment when trying to understand behaviour and to framework’ which needs explaining. It is a recognition that
In addition, the person must have the opportunity to
focus exclusively on the people whose behaviour we are the labels we give to things are extremely important in how
perform the behaviour (Table 4). The COM-B Model divides
trying to change. In social psychology there is a term for this we behave. For example, if we label ‘addiction’ as a disorder
opportunity into what it calls physical opportunity and
undue focus on individuals: ‘the fundamental attribution we behave differently in relation to it from how we would
social opportunity. Physical opportunity relates to time and
error’. It is a pervasive tendency when judging why people respond if we label it a ‘lifestyle choice’. As social animals
the objects, materials and spaces in the world we inhabit.
do things to assume that it is because of something special we recognise the importance of labels and spend a great
Social opportunity relates to the people, groups and
about them, rather than something in their environment. deal of time and effort debating them. In the ‘addiction’
organisations with whom we interact, directly or indirectly.
For example, we tend to overemphasise individual traits example, labelling it as a disorder provides an opportunity
when trying to understand why people overeat or fail to for those with the condition to be entitled to receive
Physical opportunity Social opportunity exercise. This is not to say that individual traits are not medical treatment and resources to be deployed in public
important, but rather to point out that these are shaped health budgets to prevent it.
Having enough time to Social support for the by, and interact with, the person’s environment; and often
enact the behaviour behaviour the best way to reshape the behaviour is to change the There are many examples of the benefits of focusing on
Having access to the environment. opportunity to promote a desired behaviour when this is
resources needed for the not the obvious thing to do. A good example in healthcare
Social norms and formal
behaviour (e.g., money, Social norms play a particularly important role in our is providing GPs with ‘post-it’ pad for their desks to remind
rules relating to the
equipment, materials,
behaviour behaviour. They set the boundaries within which we them to provide brief advice on stopping smoking to their
infrastructure, service
provision) exercise our choices and they condition our perceptions patients. A randomised trial found that this increased the
and thinking. Norms may be explicit, for example embodied rate at which brief advice was offered to smokers without
Having access to spaces and
Social cues that prompt the in a set of rules of conduct in an organisation or society. shifting their attitudes (8).
locations needed for the
behaviour Very often they are implicit: tacitly accepted by members
behaviour
of a society or social group. Understanding the role of
A linguistic and conceptual
Having physical cues that implicit social norms is crucial to understanding behaviour.
framework that is
prompt the behaviour
supportive of the behaviour For example, there are many occasions in which explicit
rules say one thing (e.g., wearing protective clothing in a
hazardous environment) but ‘custom and practice’ conflict
with this. People in those settings will typically follow the
implicit norms which then leads them to be personally
blamed if things go wrong.

Table 4: Aspects of opportunity

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development development

6.1.3 Motivation times it is not so obvious. For example, someone may not A third important insight into motivation is that our
consciously decide each day to go to work by car or by train reflective motivation does not have a direct influence on our
Motivation is the third pillar of behaviour in the COM-B
because they are following a set routine. But the possibility behaviour; it has to work through our automatic motivation.
model. For any behaviour to be enacted people must
of the other option is still there and always has to be Thus, it does not matter what we think we should do unless
be more motivated to perform that behaviour than any
considered when understanding their behaviour. Thus, it this leads us to feel that we want or need to do it; and it
potentially competing behaviours (5). They must want
may mean that to get someone to switch from car to train does not matter what we want or feel unless this creates an
or need to perform the behaviour more than anything
we have to bring the alternative option to the table, and impulse to act or inhibits us from acting.
else they might be doing at the time; or it must be such
encourage a reflective decision-making process, ultimately
a strongly ingrained habit or instinct that it overpowers
leading to using the train becoming the routine. This is a principle that has been understood for centuries
everything else.
and is important to the development of effective behaviour
A second important insight when understanding motivation change interventions. For example, an intervention may be
Table 5 shows the different aspects of motivation. The
is that it must always be analysed ‘in the moment’. For highly effective at persuading a group of smokers that it
COM-B Model divides motivation into reflective motivation
example, it does not matter what a person wanted a would be better for them if they were to stop, but unless
and automatic motivation. Reflective motivation involves
week ago, a day ago, an hour ago or even a minute ago. it led to them actually feeling that they wanted to stop it
our conscious thought processes: planning, making
What matters is what they want ‘now’. The reason this is would not trigger a quit attempt (9). Then once they have
evaluative judgement, and deciding what we should be
so important is that many behaviour change interventions started a quit attempt, their desire to stop would not be
doing. Automatic motivation involves our feelings of
fail because they do not anticipate the situations the target enough to keep them from relapsing if they experience
desire, our habits and our instincts.
population will be in that will drive their behaviour in the an overwhelming impulse to smoke possibly compounded
moment. For example, a person may decide as a New with a lowering of their inhibitions as a result of stress or
Motivation is always about prioritisation. Sometimes this
Year’s resolution not to drink alcohol during the month of alcohol (10).
is obvious, as when a person is actively deciding whether
January. But if at 6.35pm on 3rd January that person is in
to travel somewhere by car or on public transport. Other
a bar and offered a glass of wine and the desire to drink This does not mean that conscious planning and decision
it is greater than the resolve not to drink alcohol, the making are unimportant, only that we cannot stop there
Reflective motivation Automatic motivation offer will be accepted. At that moment a range of factors when attempting to understand or predict behaviour. We
will be coming into play that were not present when the have to understand how they lead to desires and then to
Forming, remembering and resolution was made: perhaps having had a stressful day impulses and inhibitory processes; and crucially we need to
Emotions and drives
enacting plans at work, convivial company, or the enticing prospect of a consider what other sources of desires and impulses they
particular favourite type of drink. may be competing with. Figure 2 shows this schematically
Making evaluative Feelings of desire (wants
judgements and needs) based on the PRIME Theory of motivation (5,11).

Making conscious decisions Habits and instincts Behaviour change interventions must anticipate situations
that the target group is likely to encounter and find ways of
shaping their motivation at that precise moment.
Table 5: Aspects of motivation

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Plans are our self-conscious intentions to do things, perhaps in

the immediate future or perhaps minutes, hours, days, weeks
or even years ahead. We form plans as a result of evaluating
a course of action as something worth doing. When the time
Plans
comes to implement a plan we need something to trigger
our memory of it – this might be an external stimulus or an
internal cue.

Evaluations are our conscious beliefs about what is good or

Evaluations
bad, right or wrong, useful for harmful, or ethical or unethical.
They stem from what people tell us, what we work out for
Emotions, drives, perceptions
ourselves, our experiences, our desires, and our plans. External Enviroment
and memories

The influence of desires on evaluations (‘wishful thinking’) Desires

cannot be overstated; it is well established that people to a
very large extent believe what we want or need to believe
irrespective of the evidence. When attempting to influence
behaviour, persuading people of uncomfortable truths is
particularly difficult. It is natural to present what appear to Immediate impulses
and inhibitory process
be incontrovertible arguments and evidence, but this will
typically only work if there is no strong emotional need pulling
in the opposite direction. In those cases, a different route to
behaviour change will often be needed.
Behaviour
Other important biases that affect our evaluations include
‘confirmation bias’ (a bias towards focusing on evidence
that supports a pre-existing belief), overconfidence, ‘loss
versus gain framing’ (a tendency to judge outcomes that are
expressed as avoiding losses as more important than when
the same outcomes are expressed as making gains), and Figure 2: How parts of the human motivational system interact
‘egocentric bias’ (a tendency to base judgements on one’s
own experience rather than more objective evidence) (12).

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Desires are subjective feelings of wants and needs. They and plans. If you can create an intervention that directly chances of successful quitting (14). Similar process can be
involve feelings of anticipated pleasure or satisfaction in influences immediate impulses or inhibitory processes, seen at work with diverse behaviours including sporting
the case of wants, and anticipated relief from, or avoidance it has a much shorter route to behaviour than one that activities, active travel, careful driving and waste recycling.
of, mental or physical discomfort in the case of needs. relies on someone forming a plan which then has to be
For example, feeling uncomfortable and frustrated when remembered and still be thought to be a good idea and 6.1.4 How capability, opportunity, motivation and
travelling on a slow and crowded bus will lead us to feel create a desire to enact it and then lease to impulses or behaviour interact
a subjective need to avoid that mode of transport in the inhibitory processes. This could be by training a habit
Figure 3 shows how capability, opportunity and motivation
future. In contrast, the feeling of comfort, personal space, or creating an environment that automatically triggers
influence behaviour and also how capability, opportunity
enjoying a good sound system, and prestige from driving existing habits.
and motivation influence each other. We can increase a
an expensive car may lead us to wanting to use that mode
person’s motivation to do something by increasing their
of transport in the future. Desires can also stem from However, very often the only practicable way to change
capability or their opportunity. For example, having a
evaluations (wanting things that we have worked out seem behaviour is through getting people to make conscious
degree of skill in playing a sport will generally lead a person
like a good idea), drives states such as hunger, positive and plans. Then we need to make them easily recalled and
to be more motivated to play that sport. Increasing ease
negative sensations and emotions. They are an important emotionally engaging so that they trigger strong desires
of access to recycling facilities will generally increase a
source of impulses and inhibitory processes. and impulses or inhibitory processes when required,
person’s motivation to recycle their waste.
often in the face of strong motivations arising from the
Our immediate impulses and inhibitory processes consist immediate environment. An obvious example is the case of
Enacting a behaviour can change motivation to do it again
of the neural activity that ultimate control all our behaviour trying to stop smoking. The ‘plan’ is not to smoke, and this
or the capability or opportunity to do it. For example,
– not just what we call impulsive behaviour. They can stem has to generate a strong enough desire not to smoke and
repeating a behaviour can help develop a habit that
from desires – for example, feeling that we need to smoke strong enough inhibitory processes to prevent smoking in
strengthens motivation to enact it again. Enacting a
a cigarette will generate an impulse to smoke while a the face of powerful urges.
behaviour can improve a person’s capability. For example,
desire to remain abstinent will generate an inhibitory force
practising cycling will generally increase cycling skill.
against this. Impulses can also be generated directly by our This classic conflict between plans and desires and
Enacting a behaviour can also change the opportunity to
environment, as happens with instinctive behaviours and impulses stemming from the immediate environment is
enact it again. For example, exercising in a social group may
habits. Ultimately our behaviours are determined by which well studied in behavioural science and many techniques
help strengthen the group coherence thereby increasing
of the impulses and inhibitory processes are the strongest have been developed to address it. One of these is to give
the social opportunity to continue to exercise.
at a given moment. more emotional strength to plans by linking them to core
aspects of a person’s ‘identity’ (13). How we see ourselves
It is worth paying close attention to the many ways in which can be an extremely powerful driver of behaviour, leading
emotions can influence all the parts of this system. For us to achieve great things or in some cases terrible things.
example, a high level of fear can interfere with complex To continue the example of smoking cessation, developing
thought processes needed to arrive at sensible evaluations a positive self-image as a non-smoker can increase the

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6.2 Behaviours are part of an interacting system Therefore, when planning an intervention to influence a behaviour it is important to assess
what other behaviours the target group is engaging in and whether they are supportive
Behaviours do not occur in isolation. It is crucial to pay attention to how different behaviours
of, or conflict with, the behaviour we are trying to promote. It is also important to think
compete with or facilitate each other by changing the capability, opportunity or motivation
about what other behaviours can be added to the target group’s repertoire to support the
to engage in other behaviours (Figure 4). When trying to stop smoking, for example, using
desired change and avoid adding ones that will be mutually undermining.
nicotine replacement therapy supports cessation by increasing the capability to stop and
avoiding smoking cues can support smoking cessation by changing opportunity. Conversely,
Appendix B provides a brief self-assessment quiz to confirm how well the principles set
drinking alcohol can undermine smoking cessation by reducing capability and/or motivation.
out in this section have been understood.

Capability Capability

Motivation Behaviour Other Behaviour Motivation Target Behaviour

Opportunity Opportunity

Figure 3: The COM-B Model Figure 4: Influence of other behaviours on target behaviour – the extended COM-B Model

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7. Step-by-step guide to intervention development

There are numerous models and frameworks for managing projects
and creating interventions of different kinds, not necessarily to do Identify a problem
with behaviour. Figure 5 aims to distil the most relevant of these or opportunity
into a simple top level model. It notes that any project begins with a
problem or opportunity. This leads to a project to develop or adapt
Needs
an intervention, which in turn leads to implementation in some improvement Develop or adapt
form, then should lead to some form of evaluation. The project
an intervention
may be abandoned during development or after implementation if
it looks as though it is failing or it is judged that there is no further
need. All stages of the project should be documented and reported
in some way to key stakeholders and possibly the wider community. Implement or continue Report and
The evaluation of the project may lead to its continuation or lead to with the intervention disseminate
refinement or redevelopment and this process will often lead to a
cycle of development. Good as is

Evaluate the
In relation to the problem or opportunity a ‘public health approach’
intervention
can add value - early consideration of the epidemiology (the burden
of disease, risks and trends) and/or purely the potential gain
(quantification of the impact of the change in behaviour and the Not worth continuing
number of individuals being targeted) can help with prioritisation, with or no further need
scope and definition.
Not worth continuing
This guide focuses on the pink and yellow boxes: developing, Adandon or terminate with or no further need
implementing and evaluating behavioural interventions. the intervention
Developing an intervention that aims to influence behaviour
involves several stages. Figure 6 shows them as following a logical
order but in many cases we need to go back to previous stages Figure 5: Overview of the process for developing
interventions, not just behavioural interventions
because we encounter obstacles to the path we have chosen or
new information has come to light.

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It is also often the case that we are not starting from scratch. Table 6 lists a range of starting best and finally how to improve or update an intervention that has already been running.
points for intervention development that are commonly encountered. At the top is the case
of starting with a blank sheet, where decisions have to be made about what behaviours Whatever the starting point, it is worth applying all the stages in the development process,
in what target groups will be most useful to target. Then we have problems where the even if retrospectively. For example, even if it has been determined that a social marketing
behaviour and target group have already been defined. After this we have cases where a campaign should be run to improve blood donation, it is worth considering whether this is
decision has already been made about the kind of activity that the intervention will involve, the right approach or whether such a campaign might be usefully supplemented by other
for example where a communications team has been charged with developing a social approaches.
marketing campaign. Then we have the task of deciding which of a range of proposals is

Starting point Examples

Developing an intervention
• Developing a new weight management programme in secondary schools
from scratch to address a
• Developing an intervention strategy to reduce carbon use at home
policy objective

Intervening with a known • Reducing tobacco smoking prevalence in pregnant women

behaviour and target group • Increasing engagement with the bowel screening programme among those over 58.

• Development of a social marketing campaign to promote Covid-19 vaccination uptake

Applying a pre-determined
• Development and dissemination of guidelines to reduce unnecessary antibiotic
intervention strategy
prescribing

• Selecting from active travel interventions (i.e., relating to cycling (provision, skills, safety),
Selecting from a range of
or travel planning support, or active commuting.
proposed interventions
• Commissioning addiction treatment services

Updating an existing • Improving the effectiveness of driver training in teenagers

intervention • Improving letters encouraging people to donate blood

Table 6: Possible starting points for intervention development

Figure 6: Stages in development of behaviour change interventions

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7.1 Using the APEASE criteria to make decisions

Criterion Description Example of use
At every stage in the intervention development process,
decisions have to be made. The APEASE criteria provide
a framework for doing so, and thereby strengthening the How far is what is proposed
acceptable to important
intervention. Table 7 shows the criteria and examples of Legislation to completely ban the sale of tobacco may not be
Acceptability stakeholders, e.g., the target
their use. acceptable to most smokers.
group, those delivering the
intervention, funders?
It is worth emphasising that APEASE can and should be
How far is what is proposed
applied whenever a decision has to be made at any stage able to be implemented at A mobile digital application to support dietary improvement
in the intervention process, whether it is deciding whom Practicability the required scale, with the may run into difficulties of data usage and access on the part
to target, what behaviour(s) to target, whether it is better required quality for as long of users and be difficult to maintain.
as will be required?
to focus on capability, opportunity or motivation, what
intervention type(s) to adopt, what implementation How far will what is
option(s) to adopt or the details of the intervention. proposed achieve the policy Will focusing on increasing physical activity achieve significant
Effectiveness
objectives and provide value weight loss among school children?
for money?
APEASE can be applied informally in which case it there
would be merit in using a simple checklist to ensure that
How far can what is Can a social marketing campaign to promote recycling in
all the criteria had been considered, or users can use it
Affordability proposed be achieved within a local authority be undertaken within the budget of the
as the basis for a structured decision-making process as an available budget? communications department?
shown in Appendix A.

What effects, good or

bad, will what is proposed Will legislating to make Covid-19 vaccination compulsory for
Spill over effects
have beyond the target healthcare staff lead to staff shortages?
behaviour?

Will focusing on promoting attempts to stop smoking

What impact will what is
increase health inequities given that people from more
Equity proposed have on health and
disadvantaged backgrounds find it harder to stop when
social inequities?
they try?

Table 7: The APEASE criteria for decision making in intervention development

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7.2 Stage 1: Deciding on target population(s) and

behaviour(s)
In order to decide whom to target and what behaviours to
focus on, it is often useful to create what is known as a ‘systems
map’. Systems maps chart causal pathways in an interacting
system. Figure 7 shows a systems map of causal pathways in
preventing and responding to Covid-19 (15).

In this example, the nodes represent variables that can be

increased or decreased in value and the arrows represent
influences that can be either positive or negative between
pairs of nodes. Public performance of protective behaviours,
frequency and effectiveness of environmental cleaning and
frequency of interpersonal contact are identified by the
authors as potentially important behaviours to target. The
map identifies in yellow what is called a ‘causal loop’ linking
number of infectious people with risk of transmission per
personal contact and transmission events. This lies at the
heart of the systems map and provides a basis for identifying
key behaviours to target.

The systems map should generate a list of potential target

behaviours and actors (people or organisations) that can
assessed using the APEASE criteria in order to decide which of
these to focus on. This can usefully be accompanied by a brief
description of the reasons for the choice structured according
to the APEASE criteria (Appendix A).

It is essential to consider all the APEASE criteria. For example,

evidence tells us that combining exercise and dietary
Figure 7: Systems map for preventing and responding to Covid-19 (15)

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behaviours in important in achieving weight loss (16) while

COM-B targets Questions
exercise programmes are typically acceptable, affordable,
practicable, equitable and have positive spill-over effects on 1. How aware are they of the behaviour and precisely what constitutes it?
mental and physical health. Improving equity is an important 2. How well do they know how to do it?
consideration that is often overlooked. It has been noted
3. How well do they understand the benefits of doing it or costs of not doing it?
that advertising bans, smoking bans in workplaces, removing
4. How confident are they that they can do it?
barriers to smoking cessation therapies, and increasing Capability
5. How far do they have the cognitive, perceptual and psychomotor skills to do it?
the cost of cigarettes all have the potential to reduce
socioeconomic inequalities in smoking but many European 6. How far do they have ability to make judgements needed to do it?
countries are not adequately considering improving equity 7. How far do they have the self-regulatory capacity for it?
in their tobacco control policies (17). 8. How far do they have the physical strength and stamina for it?

9. How far is it considered ‘normal’ within their social environment?

Even when it appears to be obvious what behaviour(s) to
10. How far are there formal rules stipulating the behaviour?
focus on and whom to target, it is often worth pausing to
11. How much support do they have in their social networks to do it?
consider whether this is indeed the case so we more often
get what we aim for. For example, when trying to improve 12. How many prompts, cues and reminders for them to do it are they exposed to?
Opportunity
hand hygiene of clinical staff, there may be merit in widening 13. How well can they afford it?
the scope of the intervention to informing and empowering 14. How far do they have access to resources or equipment that facilitate or enable it?
patients to monitor and check if they experience bad 15. How far do they have the time to do it?
practice on the part of clinical staff (18). 16. How easily do they have access to places where they can do it?

17. How worthwhile do they think it is?

7.3 Stage 2: Conducting a behavioural diagnosis
18. How much enjoyment or satisfaction do they expect to get from it?
Once the target behaviour(s) and target group(s) have been
19. How far does is it provoked by an emotion or a drive state?
identified comes the task of determining what changes in
20. How far do they expect it to reduce any mental or physical discomfort?
capability, opportunity and motivation to focus on. Table Motivation
8, expands COM-B into questions that can be used as a 21. How well does it fit with their self-identity?

checklist to answer this question. In a sense, promoting 22. How strong is their intention to do it?
behaviours is like opening a combination lock (which creates 23. How far is it a habit or routine?
a natural pun with COM-Bination!) – everything must line up 24. How strong a priority is it over other things they could be doing?
for the behaviour to occur.
Table 8: Questions that can be applied in order to arrive at a behavioural diagnosis

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Not all the questions will be relevant in all contexts. For Wherever the answer to a diagnostic question is broadly
example, many behaviours we wish to promote are not negative, we must decide whether to target the problem
demanding in terms of physical or mental skills so we could area directly or indirectly. For example, if our target group
take the answer to that question for granted. However, we does not generally believe the behaviour to be worthwhile,
must be careful before making these assumptions as the we may be best focusing on getting them to understanding
target audience might find this question highly relevant. why it is important in terms that they can understand, and
For example, older people or people with disabilities may countering false information coming from other sources.
not have physical capabilities that we policy makers and Similarly, if they do not feel a strong enough desire to do
practitioners may take for granted, and disabilities may be it, it may be better to address the norms in their social
hidden. environment than to try to tackle their lack of motivation
directly.
Most people respond to their situations and environments in
a way that makes sense to them, but not necessarily to us. The APEASE criteria are important in deciding what COM-B
components to target. For example, when attempting to
When we want to understand what factors underlie not change a health behaviour such as calorie intake, shifting
engaging in a particular behaviour, we are looking for their self-identity to someone who cares deeply about
negative responses to the questions in Table 7; but in their health could have positive spill-over effects for other
addition we may be looking for positive responses to behaviours. Thus, once a candidate list of COM-B targets
questions that frame not doing something as a behaviour. has been identified it is worth taking each of these through
For example, when it comes to stopping smoking as the APEASE evaluation to decide which ones to focus on.
a behaviour, we can ask how far the target audience
understand the benefits of stopping smoking and the self- 7.4 Stage 3: Selecting intervention types
regulatory capacity needed to do it?
Once we have decided what COM-B targets to focus on,
we can begin to develop our intervention strategy. Very
The questions in Table 7 are expressed in very general terms.
often the broad type of intervention we should adopt will
For a given behaviour it makes sense to convert them into
follow naturally from the COM-B targets. Table 9 lists the
more specific versions in order to identify potential COM-B
broad intervention types available, and the COM-B targets
targets. For example, if we trying to understand what would
they are generally suitable to addressing. They form the
underlie successfully using public transport more often, we
acronym EPICTREME, or rearranged the name, TIM-PREECE
could translate Question 5 into something like: ‘How far do
who was a famous English actor!
they have the ability to avoid or resist the urge the jump-in-
the-car?’.

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There are often several ways of influencing a COM-B target,

Intervention and as with other stages of intervention development it is
Description Possible COM-B targets
type useful to apply the APEASE criteria when choosing between
them. A few basic principles are worth bearing in mind
Informing, explaining and showing in order to Primarily influencing psychological capability, but
Education during this process.
increase knowledge and understanding. also as a route to changing reflective motivation.

Highlighting, arguing, discussing, proposing, First of all, it is generally wise to ensure that capability
Persuasion requesting, pleading or helping to imagine in Influencing reflective or automatic motivation. and opportunity are in place before targeting motivation
order to influence attractiveness.
directly. One reason for this is that there is no point in
Introducing payment, some other extrinsic motivating people to do things they simply cannot do. A
Incentivisation reward, or an expectation of a desired outcome, Influencing reflective or automatic motivation. second reason is that it can often appear that motivation is
for a behaviour. the barrier to behaviour change when in fact it is secondary
to a perception that the behaviour is difficult or impossible
Introducing a cost or expected negative outcome
Coercion to prevent a behaviour or to induce someone to Influencing reflective and automatic motivation. to achieve. This is captured in behavioural science by the
enact a behaviour. concept of ‘self-efficacy’ (19). If we do not think we can
succeed at something, we are less likely to try. Increasing
Demonstrating, supervising, providing feedback
Increasing psychological capability or automatic the opportunity or capability to perform a behaviour can
Training and supporting practice in order to improve
motivation. often also address the motivational barrier to do so.
mental or physical skills, or build habits.

Creating boundaries around what behaviours are Influencing social opportunity or indirectly Secondly, it is generally better to get people to do things
Restriction
and are not acceptable by setting rules. influencing physical opportunity.
because they want to rather than because they need to.
Introducing, removing or altering objects in However, if you cannot get someone to a position where/
Shaping physical or social opportunity, and
Environmental the physical environment or shaping the social when they want to do something then you may have to
indirectly influencing both capability and
restructuring environment to prompt, facilitate or prevent get them to need to do it. This means that education and
motivation.
behaviours.
persuasion, and measures to make a behaviour easier for
Providing examples of behaviour for people to people are generally to be preferred than providing extrinsic
Modelling Shaping social opportunity.
aspire to or imitate. incentives or using coercion. One reason for this is that
when people are intrinsically motivated to do things they
Providing or improving psychological, social or
Increasing psychological and physical capability,
Enablement physical resources or treatments to support
and indirectly increasing motivation.
enactment of a behaviour.

Table 9: Intervention types matched to COM-B targets

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do not require external monitoring to check that they

are doing it, and they do not try to ‘game the system’ by
Policy option Description Intervention types
doing enough to gain the reward or avoid the cost while
not actually doing what is actually required, or not doing
it well. Creating and Writing instructions and advice and Guidelines serve an education and persuasion role,
disseminating mounting a campaign to get these but they can also help to set norms and provide an
guidelines accepted and put into practice. element of social coercion.
Having said that, sometimes extrinsic rewards can kick-
start a behaviour which then becomes self-motivating.
Using print media, correspondence,
This has been found to be the case with getting children Using
broadcast media and social media to Commonly used for education and persuasion, and to
communications and
to eat healthy foods; if they can be induced to try the present text and images, and in some cases help shape social norms and inform about legislation.
marketing
foods enough times, they can come to like them, and then offering an opportunity for interaction.
want them. In addition, coercion is typically ineffective
or counterproductive for a target group if most of the Providing staff and resources such as Often used to enable behaviour change or support
Providing a service mobile applications to support and enforce regulation. Can be involved in persuasion and
members of that group do not see it as legitimate. It can behaviour change. education.
also help to provide clear boundaries around behaviours
when norms and preferences may not be enough to do so. Using formal planning mechanisms to
Using environmental
create supportive physical and social Most relevant to environmental restructuring.
and social planning
7.5 Stage 4: Selecting policy options environments.

Having decided on the broad types of intervention that are Using fiscal Using financial rules to provide incentives
Most relevant to incentivisation and coercion.
most likely to help achieve our objectives, the next step measures or disincentives.
is to decide on policies to implement these. Sometimes
this is obvious, or is dictated by resources available to us, Creating and applying rules with sanctions
Most relevant for restriction, but can involve creation
for breaking them, short of legislation
but sometimes there is wide latitude and we need to think Enacting regulations of norms, incentivisation and coercion and serve an
or by organisations that do not have the
carefully about the pros and cons of different approaches. educational and persuasive function.
power to legislate.

Table 10 lists the policy options available to agencies, and Mostly used for coercion but can play a useful role
interventions that they may be suitable for. Enacting legislation Enacting and enforcing laws. in setting norms and sometimes in incentivising
behaviours.

Table 10: Policy options and their uses

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The policy options set out in Table 10 are relevant for all agencies/ There are many details to be worked out, and this will often involve a certain amount of pilot work and
entities that have authority to undertake communications and marketing, iterative testing.
legislate, regulate, mount social media campaigns, influence (social and
/or environmental) planning, write guidelines, raises taxes, set fines or If there are existing interventions to draw on that have proven successful in related behaviours and contexts
provide/commission services. it is best to start with these. There is a tendency to want to start afresh rather than build on or purchase
something that has already been developed. But this is a mistake and can be very wasteful. For example,
As with the other stages in the intervention development process, it is new mobile apps targeted at health-harming behaviours are still being developed when there are several
helpful to apply the APEASE criteria to decisions about what policy options already available that have been evaluated. It is better to adopt or improve on these than try to develop a
to use. For example, when going down the route of legislation we need new one – unless one has a highly innovative idea that one wishes to try, or responds directly to ‘new’ insight.
to consider the practicability of enforcement and the extent to which this
enforcement may increase inequalities. It may also have adverse spill-
over effects, for example creating black-markets in goods, or resentment
among large segments of the population. If there is an intervention already in
existence that will do the job, it is
A common mistake with the use of guidelines is to underinvest in their generally best to adapt and test that.

dissemination and promotion. Health professionals in particular are

inundated by guidelines and it is extremely difficult to produce ones that
will cut through. Often a highly targeted communications campaign is
also required with key stakeholder to get engagement and ownership
with guidelines. There also needs to be investment in maintaining the
guidelines and ensuring that they remain salient and relevant. The
behavioural diagnosis, choice of intervention types and of policy options
have been captured in a graphic known as ‘The Behaviour Change Wheel’
(Figure 8). This lists identification of the capability, opportunity and
motivation targets as the hub of a wheel, choice of interventions types
as a middle layer and then of policy options as the rim. This is intended to
provide an aide-memoire for intervention developers.

7.6 Stage 5: Building the intervention

Having decided on an intervention strategy involving the intervention
type(s) (e.g., education and training) and the implementation option(s)
(e.g., guidelines and service delivery), we now have to build the policy. Figure 8: The Behaviour Change Wheel

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7.6.1 Intervention content

Table 11 lists commonly used behaviour change techniques (BCTs) that can be deployed to enact each of the broad intervention types. BCTs can be thought of as the irreducible active
ingredients of interventions.

This list is based on a published taxonomy but uses everyday language to describe the techniques (20). Each of these BCTs will need to be specified in further detail as the intervention is
being built.

Intervention type Behaviour change technique Example

Making people aware of a target behaviour that should be adopted Telling people about local recycling rules and use of local facilities

Making people aware of previously unknown risks of cigarette smoking (e.g., increased risk of
Informing people about the consequences of a target behaviour
blindness)

Equipping people with the background understanding needed for

Teaching novice drivers about minimum braking distances in dry and wet conditions
the target behaviour
Education
Informing people how to enact a target behaviour Explaining how to use face coverings for maximum protection

Informing people about the circumstances when a target behaviour

Notifying people about seasonal flu vaccines
is appropriate

Showing people who are overweight the health benefits they are accruing by changing their
Providing feedback on the effects of a target behaviour
diet and reducing their weight

Prompting commitment to a target behaviour Getting people to make a verbal commitment to move to ‘low or no’ alcohol consumption

Making the consequences of a target behaviour more salient Showing graphic images of car crashes resulting from excessive speed to reduce speeding

Creating associations between a target behaviour or an unwanted Pairing images of someone doing physical activity with images of an attractive lifestyle to
Persuasion
behaviour and stimuli that have emotional or significance promote an increase in physical activity

Showing people how their active commute compares with that of other people to promote
Making social comparisons regarding a target behaviour
active travel

Referring to a report by a professional body to promote adoption of prescribing guidelines

Making reference to an authority supporting a target behaviour
for GPs

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Linking enacting a target behaviour or not enacting an unwanted

Linking being regularly physically active with identity of being a good parent
behaviour to a valued self-identity

Referring to a report by a professional body to promote adoption of prescribing guidelines

Making reference to an authority supporting a target behaviour
for GPs

Highlighting how a target behaviour fits with other beliefs or how an Highlighting how reducing meat consumption fits with beliefs about the desirability of
unwanted behaviour conflicts with them reducing production of greenhouse gases

Framing outcomes of a behaviour in a way that promotes a target Framing smoking cessation in terms of the number of hours of life lost from every day of
behaviour or non enactment of an unwanted behaviour continued smoking
Persuasion (cont...)
Asking someone to enact a target behaviour or not enact an
Respectfully asking users of a service to show respect for those providing the service
unwanted behaviour

Pleading with someone to enact a target behaviour or not enact an

Pleading with people to give money to an emergency appeal
unwanted behaviour

Advising someone to enact a target behaviour or not enact an Advising someone, as someone with expertise or knowledge, not to prepare food for others
unwanted behaviour when suffering with diarrhoea or vomiting

Providing biofeedback to support a target behaviour or non Showing smokers their expired air carbon monoxide concentrations to help motivate smoking
enactment of an unwanted behaviour cessation

Rewarding a target behaviour or non-enactment of an unwanted

Providing pregnant smokers with vouchers for stopping smoking
behaviour
Incentivisation
Prompting self reward for a target behaviour Prompting people to give themselves treats after meeting their alcohol reduction goals

Punishing or threatening to punish an unwanted behaviour or non-

Criminal sanctions for selling illicit drugs
enactment of a target behaviour

Taking away, or threatening to take away, something sought after

Coercion if an un-wanted behaviour is enacted or a target behaviour is not Removing access to grants for companies that fail to develop a green energy use policy
enacted

Increasing the financial cost of an un-wanted behaviour Introducing a charge for disposable plastic bags in shops

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Demonstrating a target behaviour Showing people how to cleanse hands effectively

Breaking down the actions required to enter and exit a road junction safely into the
Breaking down a target behaviour into components
observation and action steps

Getting community pharmacists to practice delivery of brief advice on reaching a healthy

Prompting practice of a target behaviour
weight to improve their skill at doing this
Training
Using dyes to provide feedback on effective hand cleansing by clinical staff, or children in
Providing feedback on performance of a target behaviour
school

Encouraging commuters trying to reduce car use to mentally rehearse their responses when
Prompting mental rehearsal of performance of a target behaviour
it is raining before they leave home

Prompting or supporting repetition of a target behaviour to establish

Promote and give guidance on development of a daily physical activity routine
a routine or habit

Setting up a behavioural contract for a target behaviour or non-

Getting agreement to codes of practice relating to health and safety in the workplace
enactment of an unwanted behaviour
Restriction
Setting up or promoting rules for a target behaviour or non-
Co-producing rules for considering target behaviours when designing a new service
enactment of an unwanted behaviour

Providing prompts or cues for a target behaviour or removing

Placing healthy food items in prominent places in supermarkets
prompts or cues for an unwanted behaviour

Providing material or financial resources for a target behaviour or Ensuring adequate financial support for those who need to self isolate because of
removing them for an unwanted behaviour communicable disease

Increasing physical access to objects or spaces that enable a target

Bringing vaccination facilities closer to people’s homes
Environmental behaviour or decreasing access for unwanted behaviours
restructuring
Increasing the time available for a target behaviour or decrease it for Providing time off work to attend a stop smoking clinic, a screening or vaccination
an unwanted behaviour appointment

Building a social norm around enactment of a target behaviour or

Creating a movement around stopping smoking each October
non-enactment of an unwanted behaviour

Increasing the time or effort needed to enact an unwanted behaviour Reducing the density of alcohol outlets in areas with high rates of alcohol-related problems

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Showing an example of someone enacting a target behaviour to Showing someone with whom a target group identifies getting vaccinated to promote
prompt imitation vaccine uptake
Modelling
Relating an example of someone enacting a target behaviour to Telling people in a target group that someone they admire and respect has reduced their
prompt imitation meat consumption

Building confidence in ability to enact a target behaviour or not enact Getting people to remember previous occasions when they have managed ’low or no’ alcohol
an un-wanted behaviour consumption for an extended period

Promoting effective use of medication to enable a target behaviour

Providing free and easy access to effective stop smoking medicines
or to prevent enactment of an unwanted behaviour

Prompting or aiding effective goal setting for a target behaviour or Prompting parents who are interested in reducing carbon use to set a definite number of
unwanted behaviour days/week when they will walk with their children to school

Prompting or aiding enactment of another behaviour that supports a Providing a decision support tool and providing guidance on use of the tool to aid support
Enablement
target behaviour or aids non-enactment of an unwanted behaviour effective diagnosis and treatment of lower back pain

Providing instruction or support to address barriers for a target

Instruct on how to approach an active commute, when the weather is inclement
behaviour or create barriers for an unwanted behaviour

Supporting development of specific IF THEN plans to avoid drinking alcohol in high-risk

Prompting or aiding effective planning of a target behaviour
situations

Setting up an audit and feedback system for antibiotic prescribing in general practice to
Prompting or supporting self-monitoring of a target behaviour
support appropriate use of antibiotics

Table 11: Commonly used behaviour change techniques

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7.6.2 The NEAR-AFAR framework

It can be daunting to remember and understand how to Delivery medium Mode of delivery Example
apply the large number of behaviour change techniques
available. A simple framework to help make a start on this is
to note that behaviours are more likely to occur when they Interactive websites, computer programs Mobile application to aid reduction in alcohol
Digital applications
are: normal, easy, attractive and routine (NEAR). Conversely, (apps), messaging applications consumption

behaviours are less likely to occur when they are: abnormal,

fraught (in the sense of being difficult to do), aversive, and
involving reflection (having to stop and think) (AFAR). Pre-recorded Videos, blogs, TV, radio and online
TV advertisement to promote waste recycling
dynamic content advertisements

The NEAR framework can be mapped on to the COM-B

model to provide a starting point for intervention design. Of Lectures, seminars, support groups,
course, the intervention developer still needs to translate Live content meetings, interviews, counselling sessions, One-to-one smoking cessation counselling
the broad ideas into a practical intervention to test. advice sessions, press conferences

7.7 Intervention delivery Newspaper advertisements, newspaper Guide to promote effective use of behavioural science
Print media
articles, books, manuals, leaflets, letters in policy making
For many of the behaviour change techniques we have
to make decisions about the ‘mode of delivery’ which is a
medium through which the influence is to be achieved. Table Signage Signs, markings, posters Signs warning of slippery road surface
12 lists commonly used modes of delivery for intervention
developers to choose from.
Package inserts, product or package
Terrain Awareness Warning System in aircraft to
Object design labelling, package design, product design,
It is worth reviewing the list of options and applying APEASE prevent ‘controlled flight into terrain’
product size, product shape
criteria to decisions as to which of them to adopt rather
than automatically going for the one that first springs to
mind. Commonly, several behaviour change techniques and Construction of cycle lanes, oneway walkways,
Infrastructure Construction, destruction, placement
modes of delivery will be required. For example, signage is protective screens
often very important in notifying people of restrictions that
are in place.
Table 12: Commonly used modes of delivery of behaviour change interventions

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When considering modes of delivery we also have to making decisions about a range of So building the intervention involves decisions about the behaviour change techniques and
attributes as listed in Table 13. in many cases the modes of delivery and delivery source. This can still leave a lot of work to
do in specifying and building the intervention but it should provide solid foundations for
it. The final stage of specification and building requires specific expertise in the behaviour
Mode of delivery
Examples of interest. Human behaviour is highly complex and it is usually impossible to derive an
feature
intervention purely from first principles.
• Combining visual and auditory information in video blogs
Sensory modality • Providing haptic cues to warn of stalls in aircraft
• Use of braille for visually impaired readers
Source attribute Description
• Presenting graphs of infection rates
Use of imagery • Graphic health warnings on cigarette packs
How far does the target group trust the source in terms of
• Using video footage to show the impact of global warming Credibility
expertise and honesty?
• Conveying speed limits
Use of text and Likeability How far does the target group like the source?
• Identifying the alcohol content of beverages
numbers
• Writing advertising copy
How far does the source have the knowledge and skills
Expertise
• Prompting questions after delivering brief advice on smoking required to deliver the intervention?
Interactivity • Tailoring app content to the needs and preferences of users
• Prompting group interaction How far can the source be trained to deliver the
Trainability
intervention?
• Giving points for achieving milestones
Gamification • Promoting competition with peers
How far is the source committed to delivering the
• Setting challenges Motivation
intervention as specified?
• Ensuring that text conforms to a maximum reading age
Complexity • Staging the presentation of information How much does it cost to employ the source to deliver the
Cost
• Avoiding use of jargon intervention?

Is the type of source available in sufficient numbers and

Table 13: Features of modes of delivery Availability can the source be provided with sufficient time to deliver
the intervention as required?
For some BCTs we also have to consider who is delivering it: what we call the intervention
source. Table 14 lists potentially important attributes of intervention sources. Table 14: Attributes of intervention sources

Commonly used sources are health professionals, educators, members of a peer group and
family members.

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7.8 Implementing, disseminating and evaluating

the intervention
Implementing behaviour change interventions can often
be a behaviour-change intervention in itself! It requires a
sound understanding of the capabilities, opportunities and
motivations of key stakeholders who will be involved in
supporting, delivering and promoting it.
Beyond implementation, dissemination is important
for knowledge sharing. The more we can build on the
experience and resources developed by others the more
we can avoid re-inventing wheels and repeating potentially
costly mistakes.

It is widely recognised that behaviour change interventions

need to be evaluated, but usually the budget available for
evaluation is often not sufficient for conclusions about
effectiveness to be drawn with confidence.

However, evaluations need not be costly and often they can

use routinely collected data. Table 15 lists commonly used
evaluation methods and their strengths and limitations.
people of restrictions that are in place.

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Table 15: Commonly used evaluation methods

Evaluation method Description Strengths and limitations

• Under ideal conditions can provide strong evidence that outcomes are due to an
intervention.
Members of the target group are randomly assigned to receive or be • These conditions almost never occur, for example, because of loss to follow up.
Randomised Controlled
offered one or more interventions and one or more comparators and • Expensive and time consuming
Trial (RCT)
outcomes are assessed and compared across the groups. • Only applicable to simple, usually binary, comparisons evaluating intervention packages.
• Often of limited generalisability because of factors such as the need to obtain informed
consent from participants.

• Can identify effects of specific intervention features or components or their

Members of the target group are randomly assigned to receive one combinations.
of a number of interventions that differ from each other in one of • Can under certain conditions be an efficient way of testing intervention components with
Factorial experiment
a number of features, and outcome assess in a way that allows the adequate statistical power.
effects of features and their combinations to be compared. • Similar limitations to RCTs.
• Complex interactions between features are often difficult to interpret.

• Can provide ‘real world’ evidence of intervention effectiveness, especially when using
People or groups who experience an intervention, by choice or objective outcome data.
Quasi experimental
as a result of policy decisions, are compared in terms of outcome • Cannot guarantee that outcomes are not due to factors outside of the intervention that
study
behaviours with those who do not or who experience a comparator. happen to covary with the intervention.
• Can obtain data from large representative samples relatively inexpensively.

• Useful for estimating ‘real world’ effectiveness and picking up effects that might be
delayed or increase or decrease over time.
An extensive sequence of observations or data points taken at • Use of multiple data points allows greater confidence that effects observed were not
regular intervals (e.g., every week) starting well before the start of
Interrupted time series merely a continuation of preexisting trends.
the intervention and continuing for a substantial period after it has
study • Inclusion of covariates can provide a degree of confidence that the effects observed were
started are used to estimate the impact of the intervention taking
account of possible trends that might already be present. not due to con-founding.
• Multiple data points are often not available.
• Cannot rule out influence of confounding factors.

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• Can provide useful ‘real world’ evidence, especially when using objective outcome data.
Data on variables of interest are compared from before to after
Pre-post comparison • Cannot guarantee that apparent effects are not due to something else that changed
an intervention has been implemented or experienced by a target
study during the period of the intervention.
group.
• Can obtain data from large representative samples relatively inexpensively.

• Only useful when outcomes can be evaluated against a predefined benchmark and
therefore better for detecting when an intervention is not performing as hoped for than
providing confidence that it is.
Post-intervention Data on a variable of interest are analysed followed implementation
• Cannot be used to assess effect size.
evaluation study of an intervention.
• Attributing outcomes to the intervention relies on being able to make strong a priori
assumptions about what would have happened in the absence of the intervention.
• Can be very inexpensive, especially if using routinely collected data.

Data are analysed that provide information about how well an • Can provide information on whether an intervention is likely to fail and how an
intervention has been delivered or received, and how far it has had intervention effect may come about.
Process evaluation
an impact on variables that are believed to be on the causal pathway • Cannot provide information on intervention effectiveness.
to an outcome of interest. • Can interfere with the delivery of an intervention.

Opinions are sought about an intervention and its effectiveness from • Can provide useful information about other aspects of an intervention such as
samples that are aimed to be representative of a target populations
Opinion survey acceptability to the target group or those delivering the intervention.
or people who would have insight into the impact on a target
population. • Provides at best weak evidence of intervention effectiveness.

• Can provide useful insights into how people are experiencing an intervention.
People involved in an intervention, including the target population,
Interview study • Can help to understand how an intervention may need to be changed to make it effective.
are interviewed about their experiences.
• Unlikely to provide useful information on intervention effectiveness.

Table 15: Commonly used evaluation methods

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8. Important principles in intervention development

The preceding sections have described stages to go The task in those cases is to examine these closely, identify 8.5 Use topic-specific experts
through when developing behaviour change interventions. their active content and positive features of their modes
Intervention development should always involve topic
They have also alluded in places to important principles of delivery and delivery sources and use a behavioural
experts if possible. Human behaviour is complex and, while
to adopt during this process. This section brings these diagnoses and an APEASE evaluation to determine how they
a general understanding of principles of behaviour change
principles together. can be applied in the current context, or which of a number
is helpful, there is no substitute for expertise in specific
of options to adopt.
areas of interest. Even a thorough search of the research
8.1 Do a literature review
literature conducted by someone unfamiliar with a topic
8.3 Be prepared to adapt
Start with a review of the scientific literature to identify may not be sufficient. This is partly because familiarity
specific factors potentially influencing the behaviour(s) Do not assume that an intervention that has worked in one with a topic is often necessary for effective search and
of interest and possible intervention approaches. Online context will perform equally well without adaptation in a new interpretation of findings and partly because the research
databases (e.g., via NHS e-library); Google Scholar; or context. Human behaviour is highly context dependent and literature often does not fully capture nuances that need
subject-specific journals, are great starting points for so the principle described in 8.2 needs to be accompanied by to be taken into account.
literature reviews and can reveal articles as well as books, a willingness to use behavioural science principles and pilot
book chapters and published reports. If time and resources testing (see below) to determine what changes may need to 8.6 Involve key-stakeholders
permit, it is often worth undertaking a systematic review, be made for an intervention to achieve our objectives in the
The intervention development ‘team’ should, where
but often there are already up-to-date systematic reviews current setting.
possible, include people who will be involved in the delivery
available.
of the intervention and whom the intervention will target.
8.4 Cast the net wide
The term often used for this is ‘co-production’. There are
8.2 Do not re-invent the wheel
Do not be blinkered into using a particular implementation two reasons for this.
Wherever possible start with an intervention that has option (e.g., a social marketing campaign) just because it is
already been demonstrated to be effective in a similar what is most readily available or the one that first springs to One is that behavioural interventions often involve shaping
context. There are so many factors to consider when mind. For example, when we want to stop someone doing choices and habits, and it is ethical to respect people’s rights
developing an intervention the chances being able to work something, often the first thing people think about is to use to make up their own minds about what to do. Sometimes
them all out from scratch in a given situation, and timely coercion through legislation (e.g., fining people for breaking
manner are remote. In the case of many of the behaviours Covid rules). Even if coercion is ultimately what is required
of interest there will already have been a large number there may be better ways of achieving this, for example by
of interventions developed and in some cases these will creating strong social norms leading to social pressure.
have demonstrated effectiveness in a range of contexts.

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it will be necessary to intervene in ways that restrict choices 8.8 Always evaluate
or are unpopular with some of the people who will be
We should evaluate interventions and intervention
affected, but it is an important ethical principle to ensure
components throughout development and after
that we have fully taken their views and preferences into
implementation, using the best methods that are
account.
practicable and affordable, and with a clear focus on
measuring the target behaviour in the target population
Secondly, if we do not engage in co-production, we are
(segment). Evaluation should be integral to all stages
likely to make mistakes. These stem from false assumptions
of intervention development and throughout the life
about factors influencing people’s behaviour and about
of an intervention. Even once an intervention has been
what people find acceptable. We also deny ourselves an
implemented and tested, it is important after a while to
opportunity to glean insights into the situations people
check that it is still delivering its objectives.
find themselves in, which could radically influence the
This evaluation is often challenging and it is common for
choice of intervention strategy or its implementation.
intervention funders not to put enough resource into this.
However, evaluations need not be costly. Often they can
8.7 Carry out pilot testing
use routinely collected data. Table 15 lists commonly used
We should always pilot test interventions or intervention evaluation methods and their strengths and limitations.
components before investing in full-scale implementation,
and we should be prepared to revisit the basic premise of an
intervention if required. In any complex device or system it
is essential to create prototypes and evaluate these before
going into full scale production. It is simply not feasible to
predict the influence of the multitude of factors that can
influence success.

A common mistake is to undertake pilot testing but with

a strong bias toward proceeding. Very often we hear
of behaviour change interventions being described as
‘promising’ when an objective evaluation of the available
data does not support such a view.

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9. Conclusions
Effective policymaking and service delivery requires an
understanding of behaviour that goes beyond common
sense. Behavioural science is being increasingly used to
help shape policies and develop interventions aimed at
influencing behaviour.

This guide provides a brief introduction to key principles

in behavioural science and a step-by-step process for
developing behaviour change interventions using those
principles. It is not a substitute for in-depth knowledge of a
given topic but a framework for harnessing that knowledge
and optimising the intervention, so we more often ‘get
what we aim for’.

Appendix C provides a checklist to help ensure that all the

key steps and principles in intervention development have
been applied.

It is intended that this guide be updated as required in the

light of users’ experiences and advances in behavioural
science.

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10. References
1. Elander J, West R, French D. Behavioral correlates 7. Michie S, Atkins L, West R. The Behaviour Change Wheel: approach to preventing and responding to COVID-19.
of individual differences in road-traffic crash risk: an A Guide To Designing Interventions [Internet]. Silverback eClinicalMedicine [Internet]. 2020 Apr 1 [cited 2022 Sep
examination of methods and findings. Psychological Publishing; 2014 [cited 2021 Mar 23]. Available from: http:// 22];21. Available from: https://www.thelancet.com/
bulletin. 1993;113(2):279. www.behaviourchangewheel.com/ journals/eclinm/article/PIIS2589-5370(20)30069-9/fulltext
2. Ker K, Roberts IG, Collier T, Beyer FR, Bunn F, Frost C. 8. McEwen A, Preston A, West R. Effect of a GP desktop 16. Shaw KA, Gennat HC, O’Rourke P, Mar CD. Exercise for
Post-licence driver education for the prevention of resource on smoking cessation activities of general overweight or obesity. Cochrane Database of Systematic
road traffic crashes. Cochrane Database of Systematic practitioners. Addiction. 2002 May;97(5):595–7. Reviews [Internet]. 2006 [cited 2022 Sep 22];(4).
Reviews [Internet]. 2003 [cited 2022 Sep 22];(3). 9. Smit ES, Fidler JA, West R. The role of desire, duty and Available from: https://www.cochranelibrary.com/cdsr/
Available from: https://www.cochranelibrary.com/cdsr/ intention in predicting attempts to quit smoking. Addiction. doi/10.1002/14651858.CD003817.pub3/abstract
doi/10.1002/14651858.CD003734/full 2011 Apr;106(4):844–51. 17. Giskes K, Kunst AE, Ariza C, Benach J, Borrell C, Helmert U,
3. Smith LE, Potts HWW, Amlot R, Fear NT, Michie S, Rubin 10. Ussher M, Kakar G, Hajek P, West R. Dependence and et al. Applying an Equity Lens to Tobacco-Control Policies
J. Adherence to the test, trace and isolate system: results motivation to stop smoking as predictors of success of a and Their Uptake in Six Western-European Countries. J
from a time series of 21 nationally representative surveys quit attempt among smokers seeking help to quit. Addictive Public Health Pol. 2007 Jul 1;28(2):261–80.
in the UK (the COVID-19 Rapid Survey of Adherence to Behaviors. 2016;53:175–80. 18. McGuckin M, Govednik J. Patient empowerment and hand
Interventions and Responses [CORSAIR] study). medRxiv. hygiene, 1997–2012. Journal of Hospital Infection. 2013
11. Brown J, West R. Theory of addiction. Wiley-Blackwell; 2013.
2020 Sep 18;2020.09.15.20191957. Jul 1;84(3):191–9.
12. List of cognitive biases. In: Wikipedia [Internet].
4. Well-being of Future Generations (Wales) Act 2015 – The 19. Bandura A. Self-efficacy mechanism in human agency.
2022 [cited 2022 Sep 22]. Available from: https://
Future Generations Commissioner for Wales [Internet]. American Psychologist. 1982;37:122–47.
en.wikipedia.org/w/index.php?title=List_of_cognitive_
[cited 2022 Sep 22]. Available from: https://www.
biases&oldid=1111294304 20. Michie S, Richardson M, Johnston M, Abraham C, Francis
futuregenerations.wales/about-us/future-generations-
13. Oyserman D, Destin M. Identity-Based Motivation: J, Hardeman W, et al. The Behavior Change Technique
act/
Implications for Intervention. The Counseling Psychologist. Taxonomy (v1) of 93 Hierarchically Clustered Techniques:
5. West R, Michie S. A brief introduction to the COM-B Model Building an International Consensus for the Reporting
2010 Oct 1;38(7):1001–43.
of behaviour and the PRIME Theory of motivation. Qeios of Behavior Change Interventions. ann behav med. 2013
14. Tombor I, Shahab L, Brown J, Notley C, West R. Does non-
[Internet]. 2020 Apr 9 [cited 2020 Dec 31]; Available from: Aug;46(1):81–95.
smoker identity following quitting predict long-term
https://www.qeios.com/read/WW04E6.2
abstinence? Evidence from a population survey in England.
6. Michie S, van Stralen MM, West R. The behaviour change
Addictive Behaviors. 2015;45:99–103.
wheel: A new method for characterising and designing
15. Bradley DT, Mansouri MA, Kee F, Garcia LMT. A systems
behaviour change interventions. Implementation Science.
2011 Apr 23;6(1):42.

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Appendix A:
Formal process for applying reporting APEASE assessment
The APEASE criteria are used for assessing: 1) intervention options under consideration,
2) intervention components that have been developed, and 3) full interventions. They were
identified from a review of the intervention evaluation literature.

The information used to make an APEASE assessment can vary, depending on the importance of
the assessment, and the time and resources available. The main options are:

1. Informal analysis
2. Application of theories and models
3. Consultation with experts
4. Literature review
5. Stakeholder engagement
6. Primary research
a. Interviews
a. Focus-groups
a. One-off cross-sectional surveys
a. Repeated cross-sectional surveys
a. Analysis of social media posts
a. Analysis of routinely collected data
a. Laboratory experiments
a. Field experiments, including randomised controlled trials and A-B testing

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Table A1 provides a template for recording the

results of an APEASE assessment. It can be used Option being e.g., Using legislation to raise the age of sale for tobacco products from 18 to 21 in the UK to
considered reduce tobacco smoking prevalence and improve population health
for any important decision that has to be made
and formal evaluation of the full intervention.
Details and justification
The example in the table is hypothetical. Where Criterion Assessment*
(including data sources and relevant findings)
feasible, it would be appropriate to cite relevant
publications or reports that expand on and E.g., High quality surveys show that this policy would be supported by a large majority of
Acceptability 4
support the statements made in the details and the population, including current smokers.
justification section.
E.g., Experience gained from raising the age of sale from 16 to 18 in the UK and from 18
Practicability 3 to 21 in the US shows that this policy can be implemented and enforced with reasonable
If an option being considered or an intervention success.
component or full intervention is judged to be
unsatisfactory on any of the criteria it may not E.g., Evidence from relevant pre-post analyses and quasi experimental studies in several
be necessary to complete the assessment on countries, including the UK, shows that this policy would be expected to reduce the
Effectiveness 4
number of smokers in the UK by approximately 2,000 to 7,000 per year, ultimately saving
other criteria. Alternatively, it may make sense approximately 8,000 to 28,000 Disability Adjusted Life Years each year.
to see whether what is being assessed can be
reformulated or other action can be taken to E.g., Analysis of routinely collected data indicates that the cost of enacting the legislation
remedy a deficit. Affordability 4 and communicating the change to the public would be readily affordable and the cost of
ongoing enforcement would be similar to existing legislation.

E.g., Analysis of routinely collected data, literature review and application of health
Spill-over effects 3 economic models suggests that this policy would probably lead to improved productivity
in the economy and reduce healthcare costs.

E.g., Literature review suggests that this would improve equity by differentially reducing
Equity 3
the number of people from more disadvantaged backgrounds who take up smoking.

E.g., Evidence supports the view that the policy would have a positive impact on smoking
Overall 4 and health, be practicable, acceptable to the public, affordable, have generally positive
spill-over effects and improve equity.

*1=Unsatisfactory, 2=Satisfactory, 3=Good, 4=Excellent

Table A1: Template for recording the results of an APEASE assessment

42
 Step-by-step Important
Framework for Principles of
guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Appendix B:
Quiz on principles for developing behaviour change interventions
Question Where to find the answer (page number in this guide!)

1. In the COM-B model, what are the three pillars of behaviour?

2. In the Behaviour Change Wheel, what are the nine broad types of intervention that can be used to
change behaviour?

3. In the Behaviour Change Wheel, what are the seven policy options available to implement
interventions to change behaviour?

4. What is meant by the term ‘Behaviour Change Technique’?

5. In the NEAR-AFAR framework, what do the initials stand for?

6. What aspects of a person’s capability are potentially important for understanding human
behaviour?

7. What aspects of opportunity to perform a behaviour are potentially important for understand
human behaviour?

8. What components of human motivation are potentially important for understanding human
behaviour?

9. What are the main stages in development of a behaviour change intervention?

10. What is a ‘systems map’ and how can it be used when developing behaviour change interventions?

11. What is meant by the term ‘mode of delivery’ of a behaviour change intervention and what are
some examples?

12. What are the main criteria that should be used when making decisions during the development of
a behaviour change intervention, and evaluating the intervention once it has been implemented?

43
 Step-by-step Important
Framework for Principles of
guide to principles in
Summary Background Scope Aims incorporating behavioural Conclusions References Appendices
intervention intervention
behavioural science science
development development

Appendix C:
Intervention development quality checklist
Question

1. Have the target audience(s) and behaviour(s) been clearly set out?

2. Has a behavioural diagnosis been undertaken to identify key intervention target(s) in terms of
capability, opportunity and motivation?

3. Have intervention type(s) been chosen?

4. Have policy option(s) chosen?

5. Have the appropriate Behaviour Change Techniques been identified?

6. Have the modes of delivery, delivery source and schedules been decided upon?

7. Have the choices in 1 to 6 been made using a review and analysis of theory and evidence and the
APEASE criteria?

8. Have topic experts been involved in the intervention development?

9. Have key stakeholders been fully involved in the intervention development?

10. Has the intervention been pilot tested?

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