Inspiring Behaviour Change 8 March 2018 Who is SWM? We are the - - PowerPoint PPT Presentation

Inspiring Behaviour Change 8 March 2018

Who is SWM?

We are the sustainability adviser for the leaders of the West Midlands. – We were created in 2002 as a not-for-profit company. – Our Board is private sector led and has cross-sector representation. – Our role is to act as a catalyst for change through helping leadership in strategy, delivery and innovation. We catalyse this change by: – Running several events a year for our nine good practice networks, including the – Working closely with our ~60 members, who come from a variety of sectors (from large corporates to small community groups). – Undertaking independent reports, research and consultancy to numerous clients that align with our sustainability priorities. – Monitoring progress against our 2020 vision: “by 2020 businesses and communities are thriving in a West Midlands that is environmentally sustainable and socially just.”

Today’s workshop is run in partnership with:

Aims of today

• Provide delegates with tools to integrate in

behaviour change programmes aimed at sustainable practice.

• Provide good practice case studies to

demonstrate the impact of behaviour change programmes.

• Provide an opportunity for peer-to-peer

networking.

Agenda

Tweet us during today’s event: @SWMtweet

Inspiring Behaviour Change - How do people transform? ‘Inspiring Behaviour Change’

Presentation structure

 Introduction  The integral framework  The vertical map  Tools and applications

The integral map

 Stages  States  Quadrants  Lines  Types

The systemic change iceberg

 Events  Patterns  Structures  Mental models  Life conditions - Nature

System: a collection of parts in dynamic relationship with each other

Mental models emerge as people adapt to life conditions

Life conditions A to I Mental models N to V

Ref: Graves 1974, Beck and Cowan, 1996.

100,000 years ago – BEIGE – Instinctive – birth to 2 years

50,000 years ago – PURPLE – Safety and security – aged 2 to 4

10,000 years ago – RED – Power, action and will – aged 4 to 7

5,000 years ago – BLUE – Structure, stability and order – 7 to adolescence

300 years ago – ORANGE – Achievement and rationality – begins in adolescence

60 years ago – GREEN – Diversity and community – begins in adulthood

Emerging from level to level… The subject to object move (Professor Robert Kegan, Harvard)

Life conditions

Subject

Ref: Kegan (Harvard) 1998

Emerging from level to level.. subject to object

Life conditions

Object Subject

The momentous leap from first to second tier – what’s the shadow of green?

Purple Red Blue Orange Green

Yellow - Second Tier

First tier levels exclude each other – ‘the culture wars’ No awareness they are part of the same pathway

Purple Red Blue Orange Green

Green is actually the most exclusive to people with different worldviews People and systems run out of money Deconstructs the foundations of its own structure

Purple Red Blue – holds structure Orange – generates money Green

Needs to integrate and translate messages into other value systems.. ...to meet people where they are at.

Purple Red Blue Orange Green

Second tier - from sustainable to regenerative development Flexible flow and functionality Healthy worldview diversity and translation

Purple Red Blue Orange Green

Yellow - Second Tier

Tools for personal and organisational assessment

Integral organisational analysis – aligned with Reinventing Organisations

Self-management Wholeness Evolutionary purpose

Thanks for listening.

Thanks for listening. Facebook group: Integral View. E-mail: jonathan@integralview.co.uk www.integralview.co.uk

The Application of Behaviour Change models to self care

Presentation delivered by Alison Trout Chartered Psychologist and Senior Specialist in Public Health

What is self care?

The actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness

• r accidents; care for minor ailments and long-

term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital

The Self Care Continuum

Supporting people to self manage using Behaviour Change Example 1 - EAST

Supporting people to Self Manage using EAST

Example 2 - COM-B

The COM-B Model All changes in behaviour are underpinned by Capability, Motivation and Opportunity which form the basis of the Model. These elements can be applied to all aspects within the system e.g. At Strategic Level; through Commissioning; Social Marketing (Public Health Campaigns); Service Delivery (Direct communications with the patient & carers).

COM-B

The Behaviour Change Wheel

Michie et al (2011)

• For addressing systems based change,

the process of using the Behaviour Change Wheel (BCW) is likely to provide the best tool for behavioural

• analysis. It can however be used in

conjunction with other tools (e.g. Mindspace and EAST)

• The BCW provides a structured

approach to designing or updating behaviour change interventions and strategies.

• Its purpose is to promote a systematic

and comprehensive analysis of the available options using behaviour change theory and available evidence. It facilitates application of behavioural science to ensure the component parts of an intervention or strategy act synergistically.

Considerations

• Where are we likely to get the best ROI?
• What are the strategic priorities? Inequalities

/ Target Groups / Disease Specific?

• Once we have chosen an area to focus upon,

which part of the system should we focus on first (perhaps focus upon the quickest wins).

Self Care and Prevention within a system of behaviours – the example of Falls prevention

Behaviour Conducive with Falls avoidance

Materials , marketing and resources available to support self care and prevention Communication and behaviour change skills of Falls Team Behaviour of other relevant health and care professionals in primary / secondary and social care requiring cultural change across the system

Capability: -

The Falls Team are trained in behavioural change competencies including communication skills and Motivational Interviewing and use of models such as EAST and COM . Specific Behaviour Change Techniques might include:- i) Visual demonstration of desired behaviour / opportunity to model; ii) Feedback on own practice ; iii) Traing in use of all necessary resources and equipment which available to assist / enable practice iv) Standardised Manulisation

• f practice.

Motivation:-

The Falls Team understand and are bought into the benefits of their Behaviour Change training and see it as a core part of their

• role. Behaviour Change Techniques include:- i) Senior Staff and

Managers lead by example; ii) Regular feedback to practitioners on the effectiveness of their practice; iii) Specifics of practice built into JD; iv) Regular comparisons on effectiveness made between teams or teams from other areas

Opportunity:-

The Falls team are given the necessary time as part of their role to utilise the skills and competencies fully from the Behaviour Change

• training. Behaviour Change techniques could include:- i) The

Commissioner clearly stating in the service Spec the requirements for skills and competencies and allowing time commitments to undertake; ii) As part of manualised practice, prompts to practice are available throughout the interaction e.g. as part of assessment

Behaviour:-

Practitioner Behaviour

• Personalised
• Assets based
• Holistic
• Collaborative

Any Questions?

March 2018 Bex Bolland, Head of Air Quality

Bex.Bolland@Globalactionplan.org.uk @BexBolland

I believe it is time for policy makers to take seriously the threat to health posed by pollution, and therefore to understand that addressing pollution is disease prevention. Professor Dame Sally Davies, The Chief Medical Officer

Breathing polluted air should not be a fact of life

At the moment:

• Air pollution has the equivalent impact on health as 29,000 early

deaths in the UK every year.

• The costs to society (including the NHS) of air pollution are on a

par with those from smoking and obesity.

• Air pollution increases our risk of heart disease, stroke, cancer,

and asthma attacks. Children are especially vulnerable. But, there is plenty we can do:

• Health professionals are trusted advisors and could help equip

millions of people to understand how to improve the air we breathe and reduce our exposure to air pollution.

BAR ARTS TS HEAL ALTH TH NH NHS TR TRUST ST CLEANE ANER R AI AIR R PROJ ROJECT CT 20 2013-20 2016 16

AM AMBITION: ION: IMPROV ROVE E THE HE HE HEAL ALTH H OF T F THO HOSE E WHO HO WO WORK K AN AND L D LIVE VE IN EA N EAST LOND NDON ON BY R Y REDU DUCI CING NG EMISSIONS SIONS AN AND E D EXP XPOSURE URE TO THE HE HA HARMFU FUL L AI AIR POLL LLUTION UTION THA HAT THE HEY CA Y CAUS USE.

WHY ACTION IS IMPORTANT

• Serve vulnerable communities
• Most polluted areas of London
• Future sustainability of the NHS
• Long term health and wellbeing of our

patients

OVERARCHING AIMS

• Reach 11,000 Barts Health Service

Users (patients, visitors, staff) with key air quality messages

• Increase airText uptake by 10% across

four boroughs

ACHIEVEMENTS BY APRIL 2016

 11,000,000 media reach  100,000 reach with key air pollution messages in East London  6,000 Barts Health service users engaged  6,000 Cleaner Air packs deployed  300 Barts Health professionals trained  10% increase in airText sign ups in the four boroughs  Recommended approach for NHS in RCP and RCPCH report

https://www.globalactionplan.org. uk/cleaner-air-with-barts-health

http://tinyurl.com/zeaun2s

SUMMARY VIDEO

KEY MESSAGES FOR PARTNERS

• Affects and Contributes
• Built around three key behaviours
• Worked with most vulnerable:

Children, elderly, those with heart and lung conditions and maternity patients

• While air quality is improving, levels of key

pollutants, Particulate matter and Nitrogen Dioxide are still too high

• Cleaner Air project is helping East Londoners

to live longer, healthier lives.

LIVING WARM LIVING WELL

16 Teams 828 households engaged 157 clinicians engaged 1,250 packs deployed

Case Study: https://www.globalactionplan.

• rg.uk/living-warm-living-well

Health messengers proved to be 15% to 33% more effective at engaging patients on energy saving

PHARMACIES PROVIDING AIR POLLUTION ADVICE

1,030 packs deployed 10 pharmacies trained 25,600 people reached >684 patients engaged

• Respiratory physio
• Community

respiratory

• Acute heart failure

team

• 4 GP surgeries
• Maternity unit
• Children’s

respiratory

• utpatients

9 Teams 1,604 patients engaged via clinicians 85 clinicians trained 2,924 maps deployed

PROTECTING PATIENTS

FEEDBACK

“I have not been aware of this problem with air pollution”

• Resp. patient

"I thought there was no escaping air pollution in London“ Resp. patient “The activities were really fun and the map was brilliant”

• Resp. patient

“It's good to know that I can reduce my exposure to air pollution by taking less polluted routes” Expectant mother “Wherever I can I will avoid high air pollution zones” Resp. patient “My daughter has chronic lung "I feel more knowledgeable about air pollution in Tower Hamlets and am confident I could give my patients advice

• n how they can reduce their

exposure to air pollution“ Respiratory Physio “The women are happy to hear about how they can protect themselves [against air pollution] as many weren’t aware of the issue before” Midwife “The patients have reported back their confidence and empowerment that there is something that the individual

3 ENHANCED BREATHING SPACES

3 Breathing Spaces created 30,000 people reached via media 399 service users engaged 24% increase in awareness of Barts Health taking action on air quality

SWITCH YOUR TRIP

Encouraging staff to increase active travel (walking & cycling) and car sharing to and between sites

9 Teams 14,351 staff reached 928 staff engaged 1,412 journeys logged

Switch Your Trip Challenge Logged 8,251 miles of journeys Switched 771 trips to lower pollution ones

CLEANER FLEETS, HEALTHIER STREETS

Reducing emissions by engaging drivers and increasing the profile of low emission driving behaviours.

143 drivers reached 1,500 reached 60 drivers trained Telematics to measure

Video: https://www.globalactionplan.org.uk/ ers-medical-cleaner-fleets-healthier- streets

Over 95,000 trips affected to date

CLEAN AIR ACTION ON NHS SUSTAINABILITY DAY (24TH MARCH)

Case Study: https://www.globalactionplan.org.uk/clean er-air-action-days

Engaging drivers in #noidling at the Central London Barts Health sites

ACTION ON AIR POLLUTION: COLLABORATION AND PUBLIC HEALTH AT SCALE

https://www.globalac tionplan.org.uk/air- pollution-report

CLEANER AIR FOR LONDON 2016

The programme used the ‘trusted messenger’ behaviour mechanic, training cardiovascular and respiratory health professionals on air pollution and empowering them to give advice and materials that signposts patients to avoid exposure to high air pollution.

AIMS

• Raise awareness of dangers of air pollution with

cardiac & respiratory health professionals and patients

• Embed air pollution exposure reduction advice

within two care pathways for cardiac & respiratory patients at health partners, Healthy Hearts and St Mary’s.

• Train health professionals to deploy 3,000 maps

(1,000 per borough) to help increase adoption of low pollution exposure behaviours amongst cardiac & respiratory patients.

KEY ATTRIBUTES

• Trained health practitioners
• Co-designed with patients
• Symptom-based approach
• Provided maps & leaflets
• Targeted point on patient

pathway

Members of the Pulmonary Rehab Support Group complete an impact likelihood graph at which air pollution actions they would consider taking Bespoke air quality training session with the Community Cardio- Respiratory Service, Imperial College Healthcare NHS

HEALTHY HEARTS CLIENTS’ JOUR URNEY NEY – AD ADUL ULT WE WEIGH GHT MAN ANAGE GEMENT MENT COUR URSE SE

Maps given out alongside the Healthy Hearts Manual in the 1-2-1 care planner sessions Maps used to walk low pollution routes in the ‘Let’s Get Active Session’ A summary of their journey is discussed including how to reduce the client’s exposure with reference to the maps Week k 1 Week k 10 Week k 7

WE ARE DISTRIBUTING AT WEEK 7 ‘PHYSICAL ACTIVITY’ OF OUR ADULT

WEIGHT MANAGEMENT PROGRAMMES.

THESE WOULD THEN BE PASSED TO

GROUPS OF 15/20... WE’VE ALSO IMPLEMENTED WITHIN THE 1-1 CARE

PLANNER SESSIONS AS WE FEEL IT’S

WHERE CLIENTS WILL BENEFIT FROM IT MOST.

” JIMMY

MY RUSHWORT RTH REFERRA RRAL

GENERA

RATIO ION & PARTNERSH RSHIP IPS MANAGER ER

ADAPTED HEALTHY HEARTS MANUAL

“Clients are very receptive to information about air pollution especially given that most of our clients main form of physical activity is walking. It's good for them to compare their current walking routes which are often polluted for less polluted routes. The messages we give match up to the messages on your information sheets, it's good we share the same values”. Toby Turner, Healthy Hearts Care Planner in Kensington and Chelsea.

Significantly increased confidence

The percentage of health professionals who were unconfident before has reduced by 78.4%, this difference is statistically significant (p = .021)

Increased frequency

• f signposting actions

to patients

An average increase of 169.2% of the two chosen low pollution behaviours being suggested by health professionals following the intervention compared to beforehand.

Broadened their air pollution avoidance advice to patients

Before the intervention, the behaviour ‘Take low pollution routes’ was spoken about twice as much as ‘Travel outside

• f rush hour’. Both behaviours are now spoken about

equally as often.

Found the programme valuable

88.6% of health professionals found the programme informative, useful and effective.

Highly recommend the programme to colleagues

74.1% health professionals would recommend the Cleaner Air for London programme to a colleague.

KEY FINDINGS: HEALTH PROF.

Specific patient audience demographic

80.4% of patients surveyed in the programme were 51 years and

• ver. Being aware that cardiovascular and respiratory patients

typically fall into such a specific demographic is useful for future programmes.

Patients may not self-identify as ‘cardiac patients’ Symptom- based approach resonates

There is a discrepancy in the number of patients identified by the health professionals as cardiovascular and the number of patients who self-identify as cardiovascular, with many identifying as ‘Other’ in our surveys. Common answers included; ‘at risk of cardiovascular disease’, ‘prevention of cardiac disease’, ‘Obese/Overweight’ and ‘Inactive’. All of these terms can be related to cardiovascular conditions and could be termed ‘Pre- cardiac’. The symptom-based approach taken marries well with the prevention agenda, engaging people pre-diagnosis of a possible cardiac condition.

KEY FINDINGS: PATIENT

• 1. Time with Senior stakeholders
• 2. Ample Stakeholder recruitment time
• 3. Adapt to Health partner timelines
• 4. Co-Design with Health Professionals
• 5. Mindful of communications constraints
• 6. Collaborate with other health organisations
• 7. Buy in from borough communications teams
• 8. Timing of monitoring period
• 9. Patient before & after surveys

10.Collaborate with academics

10 RECOMMENDATIONS

National Clean Air Day

Information for health professionals

Watch the Webinar: https://youtu.be/TiIOnzLOCcQ

How to help protect patients from air pollution

TALK and join forces to beat pollution together

• 1. Incorporate air pollution advice

into care pathways

• Print out leaflets and give

them to your patients

• 2. Tell your colleagues

TALK and join forces to beat pollution together

• 3. Work with local partners
• 4. Include air quality in Joint Strategic Needs

Assessments and Health and Wellbeing Strategies

• 5. Walk the walk

CLEAN AIR DAY 2017 CELEBRATION REPORT

https://www.cleanairday.org.uk/celebration-report

Clean Air Day 2018 - June 21st

DRAFT Campaign Messages

in 2018 the main campaign will focus on the following elements

• Sources of outdoor air

pollution, and how to avoid it

• Sources of air pollution inside

buildings, and how to avoid it

Awareness Raising: Helping people learn how to protect their health

• Leaving the car at home
• TBC
• Exploring low-emission

vehicles for essential driving

Inspiring Action: Activating people to try a pollution- cutting action

www.cleanairday.org.uk 21st June 2018 - Join Us!

@CleanAirDayUK

Workshop

• Thinking about your organisation........
• Do you have a case study of an effective behaviour

change campaign that has addressed a challenge – share your good practice.

• Do you have a challenge that could be addressed via

behaviour change – ask others for advice.

• Each table to feedback with ONE example.

Next steps....

• Fill in your evaluation forms please
• Follow us on twitter (@SWMtweet)
• Become a member
• Sign up for our newsletter
• Spread the word about our events/networks
• Come along to future events – keep an eye on
• ur website

Sustainability West Midlands 0121 237 5890 enquiries@swm.org.uk http://www.sustainabilitywestmidlands.org.uk @SWMtweet

Thank You