Kicking Bad Habits

If the NHS is to live up to the rhetoric and truly become a ‘health service’ rather than a ‘sickness service’, it needs to invest much more in promoting healthy lifestyles.

The final report from the Kicking Bad Habits programme, Commissioning and behaviour change, includes recommendations for primary care trusts (PCTs) and other service commissioners on how best to encourage peole to adopt healthier behaviours. Our findings cover four broad areas where change is needed.

Reliable data 

PCTs and other commissioners need reliable data on local needs so that they can understand who should be targeted with which interventions. They may need to strengthen their skills and capabilities in a number of areas, including data collection and analysis, to get a clearer picture of the needs and behaviours of their local populations.

• Geodemographic data (profiling people according to where they live) and social marketing (commercial marketing techniques employed to promote socially desirable outcomes) should be used together with knowledge gained from local health professionals such as GPs.
• Social marketing can be used to identify appropriate interventions for target groups. Social marketing skills and the ability to design effective behaviour change interventions should be developed in-house across different departments.

Multi-component programmes 

Evidence suggests that effective behaviour change programmes usually have more than one component. For instance, providing information on its own does not lead people to change their behaviour; it has much greater impact when it is part of a wide range of activities that promote healthier choices.

• Messages and information should be tailored to specific groups and backed up by financial or other incentives or individual support. Where possible, programmes should use new technologies to ensure that their interventions are cost effective.
• Incentives need to be carefully designed and implemented. They are likely to be most effective when used as one element of a multi-component programme that addresses the range of factors (individual, social and economic) that influence people’s lifestyle choices.
• Messages should be aimed at particular target groups. They should come from a trusted source and ultimately should aim to influence social norms.
• People often respond well to personalised support. NHS staff in both primary care and acute settings should take advantage of opportunities to give patients advice about their lifestyles.

Strengthen the evidence base 

At the moment there is a limited evidence base about what behaviour change interventions work and for which groups. Existing programmes should be fully evaluated and the results shared as widely as possible in order to strengthen the evidence base for the future. Funding should include a requirement to evaluate impact.

 Future evaluations should:

• include behavioural outcome measures where possible
• assess impact over the longer term by finding out if the behaviour change was sustained after the intervention finished
• collect information on cost-effectiveness
• include a control group.

Embed health promotion across national policies 

If the NHS is to truly change from a service that treats people when they are ill to one that promotes good health, the policy environment needs to facilitate this shift. Health promotion needs to be an integral part of national policies, commissioning priorities, care pathways, standards and performance indicators, and staff and service contracts.

• PCT commissioners and policy-makers have a key role to play in ensuring that the vision of the NHS as a true ‘health’ service is realised. But all elements of health policy have to work towards this vision. The report includes a chapter on how a number of key policies – for example, world class commissioning, engaging with new service providers, patient choice – help or hinder behaviour change interventions.
• The NHS and strategic health authorities need to take a lead in sharing information and best practice so that successful interventions for tackling smoking, alcohol misuse, poor diet and lack of exercise can be rolled out to as many people as possible, as quickly and efficiently as possible.
• Encouraging healthy behaviour should not just be the responsibility of staff working on public health projects. Whenever patients come into contact with a health professional – be it their GP, pharmacist or staff at the local hospital – it represents a chance to get across messages about choosing healthier lifestyles and behaviours.