Upskilling Dietitians in Behaviour Change Techniques: Effectiveness and Process Evaluation

Overview

• Introduction:

  • Hayley Breare is a PhD candidate and research assistant at ATAP Tutor.

  • Her research interests include behaviour change, health professionals (pharmacists, dietitians), and optimising professional development.

• Presentation Outline:

  • What is behaviour change?

  • The Study.

  • Evaluation.

  • Preliminary findings.

  • Future directions.

The Need for Behavior Change

• Health Recommendations: Many Australians do not meet the recommended guidelines for:

  • Fruit and vegetable consumption.

  • Physical activity.

  • Smoking and alcohol consumption.

• Role of Health Professionals:

  • Health professionals play an important role in promoting healthy behavior change

  • However, much of their training focuses on education rather than behavior change techniques.

• Increased knowledge vs Behavior change: Increased knowledge # Change in behaviour $(Arlinghaus \& Johnston, 2018)$

COM-B Model

• The COM-B model is used to understand behaviour in terms of:

  • Capability

  • Motivation

  • Opportunity

  • These three factors interact to influence behaviour $(Michie et al., 2011)$

Behaviour Change Techniques (BCTs)

• Definition: An active component of an intervention designed to change behaviour $(Michie et al 2014, p.145, Pearson et al., 2018)$.

Health Professionals and Behavior Change

• Current training:

  • Focuses on education

• Barriers:

  • Time.

  • Role expectations.

  • Perceived response from patients.

  • Lack of training/knowledge.

• Dietitians:

  • Expressed a need for further training in health behaviour change $(Heath et al., 2015; Hussein et al., 2021; Keyworth et al., 2019; Rapoport \& Perry, 2000)$

Dietitians and Their Role

• Essential Role: Dietitians play an essential role in delivering nutrition and dietary advice.

• Personalised Support: They tailor personal support to improve health and wellbeing.

• Varied Training: Training in behaviour change science varies in depth and breadth across universities $(Rigby et al., 2021)$.

The Study: Objectives

• Aim: The study aims to:

  • Develop and evaluate the effectiveness of two 2-hour behaviour change workshops.

  • Assess impact on behaviour (frequency/use of BCTs).

  • Improve COM-B factors.

  • Determine acceptability and feasibility for dietitians.

Workshop Development

• Observation of a dietitian in practice.

• Piloted materials with a group of dietitians (formally & informally).

• Develop materials in consultation with behaviour change researchers and dietitians.

The Intervention

• Goal Setting

  • Specific

  • Measurable

  • Achievable

  • Realistic

  • Timely

• HABITS

  • Stage 1: Understand the behaviour

    1. Define the problem in behavioural terms

    2. Select target behaviour.

    3. Specify the target behaviour

    4. Identify what needs to change

  • Stage 2: Identify intervention options

    1. Intervention functions

    2. Policy categories

  • Stage 3: Identify content and implementation

    1. Behaviour change techniques

    2. Mode of delivery

• Index

  • BCTs have been grouped into domains based on how they work.

    • Goals & planning

    • Feedback & monitoring

    • Social support

    • Shaping knowledge

    • Natural consequences

    • Comparison of behaviour

    • Associations & Antecedents

    • Repetition & substitution

    • Comparison of outcomes

    • Reward & threat

    • Regulation

    • Identity

    • Self belief

    • Covert learning

• Capability

• Motivation

• Opportunity

  • $(Michie et al., 2008, Michie et al., 2011)$

Research Design

• Pre-Post.

• Participants expressed interest to participate.

• Timeline:

  • Baseline Survey (Pre).

  • Behaviour change workshops.

  • Post Workshop Survey (Post).

  • Follow up Survey (3 months).

• Exit interviews.

Recruitment

• Dietitians Australia.

• Share plate facebook.

• WA Primary Health Alliance.

• hnPERTH SOUTH.

• SOUTH PERTH.

• COUNTRY WA.

• Curtin University.

• Diabetes special interest groups.

The Evaluation Process

• Three online surveys (Likert scales and open-ended question).

• Timeline: Baseline, post-workshops & 3 month follow up.

• Measures:

  • COM-B Scale.

  • Knowledge.

  • Confidence.

  • Behaviour.

  • Acceptability scale (only post-workshop).

• Survey for non-completers who withdrew from study.

• Interviews after 3 month follow up.

• Quantitative & Qualitative methods.

Why Mixed Methods Design?

• Unknown?

Participants

• Baseline Data:

  • Of those who completed the baseline $(N = 117)$.

  • 94% Female, Mean age = 36 $(SD = 10)$.

  • Almost half (50%) worked in private practice.

• Workshops:

  • Delivered 21 workshops (small groups).

• Mode of Workshop (108 completed the workshops):

  • Online $(n =48)$.

  • Both workshops as recordings $(n = 24)$.

  • Hybrid $(n = 36)$.

Workshop Activities

• Dietitians shared experiences using various techniques:

  • Restructuring the environment (e.g., meal spaces).

  • Self-monitoring (e.g., recording what goes well/doesn’t go well).

  • Pros and cons list (e.g., mini experiments).

  • Goal setting (e.g., clinical and nonclinical outcomes).

Behavior Change Techniques (BCT) Use

• Commonly Used Techniques (Pre-Workshops):

  • Goal setting (97%).

  • Problem solving (89%).

  • Action planning (75%).

• Frequency of Use:

  • 38% always or most of the time.

  • 25% half the time.

  • 37% Never or sometimes.

Behavior Change Over Time

• Significant effect of time for both behaviours (p <.001).

Changes in Capability, Opportunity, and Motivation

• Significant effect of time for all three, capability, motivation (p <.001)

• Opportunity (p <.05)

Acceptability of Workshops

• More than 90% of dietitians $(n = 89)$ found the workshops:

  • Appropriate for the profession.

  • Helpful.

  • Applicable to current practice.

  • Personally relevant.

  • Interesting.

  • Useful.

  • Worthwhile.

• 91% of dietitians $(n = 89)$ were either satisfied or very satisfied with the workshops

3-Month Follow-Up

• Included open text questions:

  • Since the workshops, have you made any changes in practice? (yes/no)

  • If yes, what changes did you make? (open text)

  • If no, why didn’t you make any changes? (open text)

• Invitation to participate in an interview.

Changes in Practice (Yes Responses)

• Reasons For Yes (62%):

  • Specific behaviour change techniques $(n = 46)$.

  • Applying theory $(n = 7)$.

  • Practice changes (e.g., approaches to consults, $(n =8)$).

  • Behaviour change techniques use (e.g., frequency, range, $(n = 7)$).

  • Enhanced self-efficacy (e.g., awareness, confidence, $(n = 5)$).

• Quotes:

  • “I am more mindful of using different behaviour change techniques, rather than focusing on what I have always done.” (Self-efficacy)

  • “Attempted to work on SMART goals, without much success however.” (Practice changes)

  • “Increased discussions on goal setting, problem solving, supports etc, writing down these things to help them with making changes and being able to track the changes made.” (Specific techniques)

Changes in Practice (No Responses)

• Reasons for No (26.3%):

  • Opportunity (workload, leave, limited, $(n = 7)$).

  • Current practice (already doing it, $(n = 9)$).

  • Other (forgot, depth of workshop, $(n = 5)$).

• Quotes:

  • “The workshop highlighted that I was already using these techniques on a daily basis” (Current practice)

  • “I don't have a large patient caseload therefore contact with clients is sporadic and the time to practice and create my own habits using these techniques is limited.” (Opportunity)

  • “Workshop not in enough depth, workload demands.” (Other)

Future Study Directions

• Analysing the exit interviews.

• Further understanding into:

  • Did the workshops fulfill a need for dietitians?

  • Were they useful or helpful as a form of professional development?

  • Implementation and future training (barriers and enablers).

• Guided by COM-B model.

Further Research

• Comparison with a control group.

• Challenges with skill translation.

• Considerations for future research:

  • Other ways to measure behaviour change techniques?

  • Consistent language across disciplines.

Ethical Considerations

• Accessibility.

• Video Recordings.

• Sharing of information during workshops.

• Privacy/confidentiality.

• Unanticipated issues:

  • Modern day issues (generative AI).

Challenges

• Population of interest.

• Barriers that exist for health professionals:

  • How do we reach those who are unmotivated?

• One size doesn’t fit all.

• Need for tailored training across different areas of practice:

  • E.g., community dietitians, hospital dietitians, private practice, food industry etc.

Importance of Program Evaluation

• Did it achieve the desired outcome?

• Understanding barriers and enablers (specifically for health professionals).

• Inform future training for health professionals.

Conclusion

• Workshops were effective and they showcased the importance of behaviour change for dietitians

• Program evaluation is important for future training

• Need for tailored and targeted professional development

• Translation into practice and across other disciplines

• Overview: Hayley Breare's research focuses on behaviour change and professional development for health professionals. The presentation covers behaviour change, a related study, evaluation, findings, and future directions.

• Need for Behavior Change: Many Australians don't meet health guidelines. Health professionals, who primarily focus on education, play a key role in promoting behavior change. Increased knowledge doesn't necessarily translate to behaviour change $(Arlinghaus \&amp; Johnston, 2018)$.

• COM-B Model: This model explains behaviour through Capability, Motivation, and Opportunity, which interact to influence behaviour $(Michie et al., 2011)$.

• BCTs Definition: Behaviour Change Techniques are active components of interventions designed to change behaviour $(Michie et al 2014, p.145, Pearson et al., 2018)$.

• Health Professionals and Behavior Change: Current training focuses on education, but professionals face barriers like time, role expectations, and lack of training. Dietitians, in particular, need further training in behaviour change $(Heath et al., 2015; Hussein et al., 2021; Keyworth et al., 2019; Rapoport \&amp; Perry, 2000)$.

• Dietitians' Role: They provide essential nutrition advice and personalized support. Training in behaviour change science varies across universities $(Rigby et al., 2021)$.

• Study Objectives: The study aims to evaluate the effectiveness of behaviour change workshops, assess their impact via COM-B factors, and determine their acceptability and feasibility.

• Workshop Development: Materials were developed through observations, pilot testing with dietitians, and consultation with researchers.

• The Intervention: Includes Goal Setting (SMART) and HABITS model, which involves understanding the behaviour, identifying intervention options, and specifying content and implementation.

• Research Design: A pre-post design with baseline, post-workshop, and follow-up surveys, plus exit interviews.

• Recruitment: Participants were recruited via Dietitians Australia, social media, health alliances, universities, and special interest groups.

• The Evaluation Process: Three online surveys were used to measure COM-B, knowledge, confidence, behaviour, and acceptability.

• Participants: Baseline data included 117 participants (94% female, mean age 36), with half working in private practice. 21 workshops were delivered.

• Workshop Activities: Dietitians shared experiences with techniques like restructuring environments, self-monitoring, and goal setting.

• BCT Use: Commonly used techniques included goal setting (97%), problem-solving (89%), and action planning (75%).

• Behavior Change Over Time: Significant effect of time for both behaviours (p <.001).

• Changes in Capability, Opportunity, and Motivation: Significant effect of time for all three, capability, motivation (p <.001), Opportunity $$(p <.0