The Book of Behavior Change Rik Crutzen & Gjalt-Jorn Ygram Peters 2022-04-05 2 Contents 5 I Theory 9 1 Understanding human behavior 11 1. 11 2 Changing human behavior 13 2.1 ELPs: Evolutionary Learning Processes .2 BCP: Behavior Change Principles. 13 II Practice 15 3 The behavior change toolbox 17 3.2 The causal-structural chain .3 Operational tools: software. 20 4 Identifying determinants 33 5 Identifying sub-determinants 35 5.1 MAP spreadsheet set-up .2 Using the MAP.
36 3 4 CONTENTS 6 Selecting determinants 39 6.2 CIBER: Confidence Interval-Based Estimation of Relevance. 44 7 Identifying Behavior Change Principles 59 8 Selecting Behavior Change Principles 61 9 Tying it all together 63 9.1 The ABCD matrix .2 The Acyclic Behavior Change Diagram .4 Creating an ABCD. 69 10 Zooming out 75 III Appendices and references 77 11 Glossary and Chrestomathy 79 11.1 Conceptually organized glossary .2 Alphabetically organized glossary. 81 12 References 83 ## Warning in knitr::include_graphics(here::here("img", "bbc-cover.png")): It is ## highly recommended to use relative paths for images.
You had absolute paths: "/ ## builds/a-bc/bbc/img/bbc-cover.png" 5 6 CONTENTS The Book of Behavior Change is an Open Access book that helps with the development of effective behavior change interventions as well as doing research into behavior change. Unlike for example Intervention Mapping, this book does not provide a complete protocol, instead focusing on identi- fying what to target, and how to target it, to maximize intervention effectiveness. Please be aware that this is a “living” book. This means that it will be updated over time and certain parts might CONTENTS 7 be changed, extended or shortened.
If you would like to cite this book, you can use this reference: Crutzen, R. (2019) The Book of Behavior Change (1st Ed. 3570967 8 CONTENTS Part I Theory 9 Chapter 1 Understanding human behavior If you are reading this book, chances are you’re already well aware of some of the many reasons to want to change human behavior. (Obesity, substance use, exercise, etc etc, references, burden of disease, prevention, money, etc etc) We define human behavior here as sequences of human muscle movement.
Such motor activity originates in the motor cortex, and the firing patterns of motor neurons are determined by firing patterns of other neurons. Any change in human behavior, therefore, requires changing the firing patterns of these neurons that together make up the human brain. The human brain consists of roughly 90 billion of such neurons, and each is connected to on average 7000 other neurons. Directly targeting a subset of such neurons and connections is not feasible.
However, these firing patterns can be targeted in a different way.2 Pragmatic nihilism 11 12 CHAPTER 1. UNDERSTANDING HUMAN BEHAVIOR Figure 1.1: A bit of psychology represented using the ‘spreading activation metaphor’. Chapter 2 Changing human behavior 2.1 ELPs: Evolutionary Learning Processes 2.2 BCP: Behavior Change Principles 13 14 CHAPTER 2. CHANGING HUMAN BEHAVIOR Part II Practice 15 Chapter 3 The behavior change toolbox Some behaviors are easy to change, some are hard to change.
Behavior change interventions are generally only required for the behaviors that are hard to change. Therefore, usually, those processes are complicated. It is easy, common even, to be overwhelmed by the multitude of things that need to be carefully mapped out in order to optimize the probability of an intervention being effective. Therefore, a number of tools have been developed to support this process.
Because of the complexity of the task, many of these tools are conceptual tools, that help to keep track of all the information that needs to be collected and organised. Other tools are more operational, providing an interface to conceptual tools or to analyses. In this chapter, we will discuss a number of tools, specifically the following tools: • Core processes help leveraging theory and organising empirical evidence and expertise • DCTs and the repository at https://PsyCoRe.one help with consistent definitions and use of (sub-)determinants; • COMPLECS specifications help with the needs assessment; • MAP specifications help listing all potentially relevant aspects and organising them into sub- determinants; • CIBER plots and Determinant Selection Tables help selecting determinants and sub- determinants • ABCDs help securing causal-structural chains 3.2 The causal-structural chain The causal-structural chain is a conceptual tool that expresses one potential partial avenue to behavior change. Recall that all human behavior is caused elsewhere in the brain (Chapter 1), and changes in a brain in response to stimuli in one’s environment are called learning (Chapter 2).
THE BEHAVIOR CHANGE TOOLBOX The causal-structural chain expresses the assumptions about which parts of the brain cause the behavior, and what can be done to influence those parts of the brain. In other words, it expresses the causal (what influences what) and structural (what consists of what) assumptions underlying a bit of an intervention. These assumptions are divided into three sections that together contain the seven links of the chain. These sections are behavior, psychology, and change.
The behavior section contains two links. The ultimate link is the target behavior of a given inter- vention. Target behaviors are generally formulated on a very general level, such as “exercise” or “condom use”. As such, they consist of sub-behaviors.
These sub-behaviors can be, for example, for exercise, “registering at a gym” and “scheduling gym visits”, or for condom use, “buying condoms” and “negotiating condom use”. These are distinguished from the overarching target behavior be- cause the relevant determinants of these sub-behaviors can be different: for example, the reasons why people do or do not buy condoms can be very different from the reasons why they do or do not carry condoms or why they do or do not negotiate condom use with a sexual partner. These two links form the ‘behavior’ section of the causal-structural chain, and because the sub-behaviors together form the target behavior, their relationship is structural. As discussed in Chapter 1, all (sub-)behavior is necessarily caused by people’s psychology.
The psychology section, therefore, captures the causes of behavior: psychology is causally linked to behavior. This section has two links as well: sub-determinants and determinants. These represent two more or less arbitrary levels of specificity that can be used to describe parts of the human psychology. Not entirely arbitrary, though.
Sub-determinants are defined as aspects of the human psychology that are sufficiently specific to clearly verbalize or visualize them. They capture specific representations of the world that a person may have, or specific stimulus-response associations, or specific implicit associations. Sub-determinants can be clustered into clusters that contain sub- determinants that are similar (for example, all representations about risks) or or functionally similar (for example, all aspects of a person’s psychology involved in self-monitoring). As such, sub- determinants together form determinants, and so, their relationship is structural.
As discussed in Chapter 2, all psychological changes in response to stimuli are learning. The change section, therefore, captures the causes of learning: change is causally linked to psychology. The change section consists of three links in the causal-structural chain, but the middle link is a bit different in that it represents conditions for the first link. This first link is a behavior change principle (BCP; see Chapter 2) that can change the sub-determinant in the fourth link.
BCPs are general descriptions of procedures that can be followed to engage one or more evolutionary learning processes (ELPs; again, see Chapter 2). Successfully engaging those ELPs is not easy, and doing so required meeting a number of conditions. These conditions for effectiveness are included in the second link. The third link is the specific application of the BCP: the concrete, more or less tangible intervention product that the target population members will interact with.
So, the BCP in the first link is applied in the application in the third link, in a way that satisfied the conditions for effectiveness in the second link. The causal-structural chain is shown in Figure 3. If any of the links of the causal-structural chain is broken, it is very unlikely that the target behavior in the final link will change. Specifically: • If the behavior change principle (BCP) does not engage one or more evolutionary learning principles (ELPs), no learning can occur.
This means that no aspects of the target popula- tion’s psychology can change, which means behavior will stay the same. THE CAUSAL-STRUCTURAL CHAIN 19 Figure 3.1: A visual representation of the causal-structural chain. THE BEHAVIOR CHANGE TOOLBOX • If a BCP’s conditions for effectiveness are not met, it will not successfully engage the under- lying ELPs, which will diminish or eliminate its effectiveness. • Because applications are the specific, tangible intervention components that make up the actual intervention, if an application does not contain a BCP, it cannot change any aspects of the target population’s psychology.
• If an application successfully changes a sub-determinant, but that sub-determinant is not relevant, the targeted behavior will not change. • Given that determinants consist of sub-determinants, the same holds for determinants: for changes in determinants to contribute to behavior change, they must be relevant to the targeted behavior. • If a sub-determinant changes, and therefore, the overarching determinant changes, and there- fore, the associated behavior changes, that change only contributes to change in the ultimate target behavior if that behavior is indeed a sub-behavior of the target behavior. • If the entire chain is intact, ultimately, the target behavior changes.
The causal-structural chain itself is hardly controversial. In fact, it does not do much more than provide a structure for a number of trivial facts. Still, it can be a very useful tool to organise the structural and causal assumptions underlying an intervention. It forms the basis of the Acyclic Behavior Change Diagram (ABCD) matrix and the ABCD itself, that will be discussed in Chapter 9.1 A note about Intervention Mapping vocabulary For those familiar with the Intervention Mapping framework for intervention development, the causal-structural chain will be familiar.
In steps 2 and 3 of IM, the same elements are covered. The vocabulary is slightly different, though. In Intervention Mapping, sub-behaviors are called performance objectives. Sub-determinants are usually formulated according specific rules (i.
using action verbs) and then called change objectives. Behavior change principles are called methods for behavior change.3 Operational tools: software A number of software solutions exist that support the development of behavior change interventions. Two of these will be discussed here, and both are Free/Libre Open Source Software (FLOSS) solutions. This means that they are free to download and install in perpetuity.
The first, Jamovi, is a very userfriendly general-purpose graphical user interface that can be used for a variety of analyses, unlocked through its ecosystem of modules. One of these modules, behaviorchange, contains a set of tools for behavior change researchers and intervention pro- fessionals. This module offers a way to access the basic functionality of a more powerful underlying package. This more powerful package is an R package called behaviorchange.
R is the second software solution. It was originally a statistical programming language, but it is not only open source, but also has a flexible infastructure allowing easy extension with user-contributed 3. OPERATIONAL TOOLS: SOFTWARE 21 packages. Therefore, R is quickly becoming a multipurpose scientific toolkit, and one of its tools is the behaviorchange package.
When using R, most people use RStudio, a so-called integrated development environment. It has many features that make using R much more userfriendly and efficient. In this book, where we refer to using R, we actually mean using R through RStudio. Like Jamovi and R, RStudio is also FLOSS.
You can download jamovi from https://www. To use the behaviorchange module, you will require at least version 1. Once jamovi is installed, start it and click the button with the big plus to browse the jamovi Library (see Figure 3. Look for the behaviorchange module and install it as shown in Figure 3.1 Supplied behaviorchange datasets The behaviorchange module comes with a number of datasets, which you can access through jamovi’s data library.