Book Review: Beyond Behaviour Change by Spotswood, F. (Ed.)

Post date: 05-Apr-2016 11:51:57

In many ways, the concept of “behaviour change” reminds me of the term, “sport science”. Both are common terms that are often used to identify a set of concepts and practices connected by their ultimate aims but they are both areas that remain contested and even segregated in terms of the practitioners that might identify themselves within the umbrella terms. Just as “sport science” is often used as an umbrella term for disciplines such as biomechanics, physiology and psychology, so the term “behaviour change” is used in fields as varied as sociology, psychology, politics and economics. Speak to the top sport scientists and they will demand an interdisciplinary approach of their staff, and so those interested in behaviour change should also strive to work in what this book terms a transdisciplinary approach, a task that many of the structures and practices of Higher Education do not encourage as easily as we might hope for. This book attempts to bring together a range of experts to examine the nature of behaviour change itself and present their own ideological and theoretical insights into creating meaningful changes across a range of lifestyle behaviours.

It’s just a few years since Michie and colleagues attempted to draw links between the wide range of cognitive behaviour change theories that exist in the field of psychology and it seems logical to try and extend these connections beyond the field of psychology. It's widely accepted that behaviour is based on more than personal cognitions and rational choice making and that social and environmental factors play a vital role and while this book is clearly grounded in the field of sociology it manages to achieve its aim of acknowledging a range of disciplines, offering contradictory viewpoints and considering a variety of influences on behaviour.

Mike Kelly and Alan Maryon-Davis have each contributed excellent chapters, writing separately on the political influence and administrative regulation of behaviour change. There is also a chapter that gives a summary of the role of nudge theory and its use in the implementation of government policy by the Behavioural Insight Team’s Michael Hallsworth and Michael Sanders.

Gerard Hastings and Marisa de Andrade’s chapter on stakeholder marketing and the subversion of public health gives a good introduction to the dark arts of corporate social responsibility and cause-related marketing (for examples in my own areas of interest see Exercise is Medicine, GEBN, UKActive and academic conferences)

Other chapters I enjoyed included Tim Chatterton’s overview and critique of behaviour change theories that discusses how different theories of change might be applied in different circumstances (see the figure below and Chatterton & Wilson, 2014). Denford, Abraham and colleague’s chapter on intervention design and evaluation and Daniel Welch’s contribution on social practice theory were also interesting.

Common themes across the chapters include references to the dual process theory that reminds us that behaviours involve both a reflective more thoughtful component as well as a faster more impulsive element that is built on a range of biases and heuristics, an idea that was given added momentum by Daniel Kahnemann. There is also an underlying tension between the idea of interventions that might address more personal, individual factors and those that are related to the wider ecological environment that the individual exists in. While these are well trodden paths the inclusion of social practice theory neatly bridges the two ends of the continuum and highlights how the actions of many individuals can produce patterns of social behaviour that are regular and predictable and can in turn influence other individuals.

The format of using chapter authors from diverse theoretical and ideological backgrounds creates an experience for the reader that demands engagement with the text and the various arguments of the authors. The inclusion of a range of behaviours that include, but are not limited to transport, diet and environmentalism highlights many similarities between the fields and gives a glimpse into the potential benefits of increased transdisciplinary work. It also hints at how many of these areas might elicit behaviour changes that are complementary to each other such as that of transport. The chapters are not without opinion and have plenty of contemporary reading to turn to beyond this book (see my favourites below); the stop and think boxes and case studies are also good tools for helping students develop higher levels of critical thinking (eg the nature of evidence p91).

In conclusion the editor suggests there are three key actions to take away from this analysis. There is a call for a more culturalist perspective on changing behaviour that shifts the emphasis away from the perceived choice making of the individual to an examination of how that individual exists within broader sociocultural structures. There is also a call for more transdisciplnary research and more work on integrating policy and evidence, a task that quite rightly leads to a neat discussion on the “conundrum of evidence” and how the evidence producing and policy making communities might balance the call for more positivist approaches to evaluation with the benefits of integrating this with more qualitative analysis that captures the breadth and depth of an intervention's impact.

Overall, I enjoyed reading about different areas of human behaviour and how change might be initiated from a range of viewpoints. It's left me wondering how the academic silos can be disrupted more often and how collaboration across behaviours might also be beneficial in creating changes with multiple societal benefits.

References worth reading taken from the various chapters.

What works in behaviour change…

Jepson, R. G., Harris, F. M., Platt, S., & Tannahill, C. (2010). The effectiveness of interventions to change six health behaviours: a review of reviews. BMC public health, 10(1), 1.

Johnson, B. T., Scott-Sheldon, L. A., & Carey, M. P. (2010). Meta-synthesis of health behavior change meta-analyses. American journal of public health, 100(11), 2193-2198.

Fear doesn't always work...

Milne, S., Sheeran, P., & Orbell, S. (2000). Prediction and intervention in health‐related behavior: A meta‐analytic review of protection motivation theory. Journal of Applied Social Psychology, 30(1), 106-143.

Dual process theory...

Rothman, A. J., Sheeran, P., & Wood, W. (2009). Reflective and automatic processes in the initiation and maintenance of dietary change. Annals of Behavioral Medicine, 38(1), 4-17.

Strack, F., & Deutsch, R. (2004). Reflective and impulsive determinants of social behavior. Personality and social psychology review, 8(3), 220-247.

Cohen, D. A., & Babey, S. H. (2012). Contextual influences on eating behaviours: heuristic processing and dietary choices. Obesity Reviews, 13(9), 766-779.

Choosing and using a range of theories...

Tortolero, S. R., Markham, C. M., Parcel, G. S., Peters, R. J., Escobar-Chaves, S. L., Basen-Engquist, K., & Lewis, H. L. (2005). Using intervention mapping to adapt an effective HIV, sexually transmitted disease, and pregnancy prevention program for high-risk minority youth. Health Promotion Practice, 6(3), 286-298.

Chatterton, T., & Wilson, C. (2014). The ‘Four Dimensions of Behaviour’ framework: a tool for characterising behaviours to help design better interventions. Transportation Planning and Technology, 37(1), 38-61.

Social Practice Theory…

Blue, S., Shove, E., Carmona, C., & Kelly, M. P. (2016). Theories of practice and public health: understanding (un) healthy practices. Critical Public Health, 26(1), 36-50.

Maller, C. J. (2015). Understanding health through social practices: performance and materiality in everyday life. Sociology of health & illness, 37(1), 52-66.

Spotswood, F., Chatterton, T., Tapp, A., & Williams, D. (2015). Analysing cycling as a social practice: An empirical grounding for behaviour change. Transportation research part F: traffic psychology and behaviour, 29, 22-33.


Cohn, S., Clinch, M., Bunn, C., & Stronge, P. (2013). Entangled complexity: why complex interventions are just not complicated enough. Journal of health services research & policy, 18(1), 40-43.

Livingood, W. C., Allegrante, J. P., Airhihenbuwa, C. O., Clark, N. M., Windsor, R. C., Zimmerman, M. A., & Green, L. W. (2011). Applied social and behavioral science to address complex health problems. American journal of preventive medicine, 41(5), 525-531.

Best, A., & Saul, J. E. (2011). Systems thinking: a different window on the world of implementation and global exchange of behavioral medicine evidence. Translational behavioral medicine, 1(2), 361-363.

Grant, A., Treweek, S., Dreischulte, T., Foy, R., & Guthrie, B. (2013). Process evaluations for cluster-randomised trials of complex interventions: a proposed framework for design and reporting. Trials, 14(1), 15.

Using evidence to develop policy...

Oliver, K., Innvar, S., Lorenc, T., Woodman, J., & Thomas, J. (2014). A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC health services research, 14(1), 1.

Stevens, A. (2011). Telling policy stories: an ethnographic study of the use of evidence in policy-making in the UK. Journal of Social Policy, 40(02), 237-255.

Nutley, S., Powell, A., & Davies, H. (2013). What counts as good evidence? provocation paper for the alliance for useful evidence. London: Alliance for Useful Evidence.

Montgomery, P., Underhill, K., Gardner, F., Operario, D., & Mayo-Wilson, E. (2013). The Oxford Implementation Index: a new tool for incorporating implementation data into systematic reviews and meta-analyses. Journal of clinical epidemiology, 66(8), 874-882.

Haynes, L., Goldacre, B., & Torgerson, D. (2012). Test, learn, adapt: developing public policy with randomised controlled trials. Cabinet Office-Behavioural Insights Team.

Other books…

Abraham, C., & Kools, M. (Eds.). (2011). Writing health communication: An evidence-based guide. London: Sage.

Elster, J. (2015). Explaining social behavior: More nuts and bolts for the social sciences. Cambridge University Press.

Jones, R., Pykett, J., & Whitehead, M. (2013). Changing behaviours: on the rise of the psychological state. Edward Elgar Publishing.

Roberto, C. A., & Kawachi, I. (Eds.). (2015). Behavioral Economics and Public Health. Oxford University Press.

Wansink, B. (2014). Slim by Design: Mindless eating solutions for everyday life. Harper Collins Publishers.

Brennan, L., Binney, W., Parker, L., Aleti, T., & Nguyen, D. (Eds.). (2014). Social marketing and behaviour change: models, theory and applications. Edward Elgar Publishing.

Eagle, L., Dahl, S., Hill, S., Bird, S., Spotswood, F., & Tapp, A. (2013). Social marketing. Pearson Education.

Rundle-Thiele, S., Kubacki, K., Leo, C., Arli, D., Carins, J., Dietrich, T. H. O., ... & Szablewska, N. (2013). Social marketing: Current issues and future challenges.

Moss, M. (2013). Salt, sugar, fat: how the food giants hooked us. Random House.

Strengers, Y., & Maller, C. (2014). Social practices, intervention and sustainability: beyond behaviour change. Routledge.

Keller, M., Kiisel, M., & Vihalemm, T. (2015). From Intervention to Social Change: A Guide to Reshaping Everyday Practices. Ashgate Publishing, Ltd..

The rest...

Hollands, G. J., Shemilt, I., Marteau, T. M., Jebb, S. A., Kelly, M. P., Nakamura, R., ... & Ogilvie, D. (2013). Altering micro-environments to change population health behaviour: towards an evidence base for choice architecture interventions. BMC Public Health, 13(1), 1218.

Hollands, G. J., Shemilt, I., Marteau, T. M., Jebb, S. A., Lewis, H. B., Wei, Y., ... & Ogilvie, D. (2015). Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev, 9.

Marteau, T. M., & Hall, P. A. (2013). Breadlines, brains, and behaviour. BMJ, 347, f6750.

Kaplan R, Spittel M, David D (Eds). (2015) Population Health: Behavioral and Social Science Insights. AHRQ Publication No. 15-0002. Rockville, MD: Agency for Healthcare Research and Quality and Office of Behavioral and Social Sciences Research, National Institutes of Health.

Soon, C. S., He, A. H., Bode, S., & Haynes, J. D. (2013). Predicting free choices for abstract intentions. Proceedings of the National Academy of Sciences, 110(15), 6217-6222.

Adriaanse, M. A., Vinkers, C. D., De Ridder, D. T., Hox, J. J., & De Wit, J. B. (2011). Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence.Appetite, 56(1), 183-193.

Barton, H., & Grant, M. (2006). A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126(6), 252-253.

Jochelson, K. (2006). Nanny or steward? The role of government in public health. Public health, 120(12), 1149-1155.

Behavioural Insight Team (2010). Applying behavioural insight to health. London: Cabinet Office.

Levitt, S. D., & List, J. A. (2007). What do laboratory experiments measuring social preferences reveal about the real world?. The journal of economic perspectives, 21(2), 153-174.

Donovan, R. (2011). Social marketing's mythunderstandings. Journal of Social Marketing, 1(1), 8-16.

Hoek, J., & Jones, S. C. (2011). Regulation, public health and social marketing: a behaviour change trinity. Journal of Social Marketing, 1(1), 32-44.

Withall, J., Jago, R., & Fox, K. R. (2012). The effect a of community-based social marketing campaign on recruitment and retention of low-income groups into physical activity programmes-a controlled before-and-after study. BMC public health, 12(1), 1.

Jacobsson, K., & Garsten, C. (2012). Post-political regulation: soft power and post-political visions in global governance. Critical Sociology, 0896920511413942.

Tedstone, A., Targett, V., Allen, R., & England, P. H. (2015). Sugar Reduction: The evidence for action. London. London: Public Health England.