Behaviour Change - Science and Technology Committee Contents


CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS

Definitions, categorisation and the ethics of behaviour change interventions (Chapter 2)

INTERVENTIONS AND ETHICAL ACCEPTABILITY

8.1.  The idea of the Government intervening to change people's behaviour will often be controversial, and so it is important that ministers are always able to explain the evidence-base of any proposed behaviour change intervention, and why it is a necessary and proportionate means of addressing a well-defined problem (paragraph 2.20).

Understanding what influences behaviour (Chapter 3)

APPLIED RESEARCH AT A POPULATION LEVEL

8.2.  There is a lack of applied research at a population level to support specific interventions to change the behaviour of large groups of people (including a lack of evidence on cost-effectiveness and long-term impact). This is a barrier to the formulation of evidence-based policies to change behaviour. To address this problem, the Government will need both to evaluate their own behaviour change interventions rigorously and establish new evidence by commissioning and funding more applied behavioural research on this scale (paragraph 3.10).

Evidence-based policy (Chapter 4)

ARE GOVERNMENT POLICIES EVIDENCE-BASED?

8.3.  We acknowledge that there will be occasions when it is legitimate for a government not to implement behaviour change interventions for which there is good evidence of effectiveness. In these circumstances, however, we believe that ministers have a responsibility to explain why they have decided not to do so (paragraph 4.7).

8.4.  We agree with the principle, stated in the Government's Principles of Scientific Advice, that ministers should explain publicly their reasons for policy decisions, particularly when a decision is not consistent with scientific advice and, in doing so, should accurately represent the evidence. This places a responsibility on scientists and social scientists within government to ensure that ministers are provided with accurate and up-to-date advice on the available evidence about how to change behaviour so that they can identify where and why they are not basing a policy on the evidence (paragraph 4.8).

Addressing the barriers to evidence-based policy

8.5.  We urge ministers to consult their departmental Chief Scientific Advisers about whether the amount of money spent on applied behaviour change research at a population level is sufficient to meet their policy needs (paragraph 4.16).

Translation of research

ROLE OF GOVERNMENT SCIENTISTS

8.6.  We recommend that, at the earliest opportunity, the Government appoint a Chief Social Scientist who reports to the Government Chief Scientific Adviser and is an independent expert in social science research to ensure the provision of robust and independent social scientific advice (paragraph 4.23).

8.7.  We further recommend that the Government consider whether existing mechanisms for the provision of social scientific advice, in particular advice on behavioural science, are fit for purpose. This should include consideration of how departmental Chief Scientific Advisers and social scientists within departments can best work together to provide up to date social scientific advice to support evidence-based behaviour change interventions (paragraph 4.24).

BETTER LINKS BETWEEN THE ACADEMIC AND POLICY MAKING COMMUNITIES

8.8.  Departmental Chief Scientific Advisers, whether or not they have experience of the sciences of human behaviour, should be responsible for establishing and maintaining contacts with leading behavioural scientists with expertise relevant to their policy areas and for consulting them as necessary (paragraph 4.30).

BEHAVIOURAL INSIGHTS FOR POLICY MAKERS

8.9.  We recommend that the Cabinet Secretary, in consultation with the Government Chief Scientific Adviser and Chief Social Scientist, once appointed, should take steps to ensure that civil servants with responsibility for policy making have the necessary understanding of the importance of changing behaviour and can identify the most appropriate people to consult in their own departments about the development of behaviour change interventions (paragraph 4.32).

GUIDANCE TO POLICY MAKERS

8.10.  We recommend that the Cabinet Office, in consultation with the Chief Social Scientist, once appointed, consider how to consolidate the available guidance in a form which is evidence-based and accessible to policy makers (paragraph 4.35).

8.11.  We further recommend that the National Institute for Clinical Excellence updates its 2007 Behaviour Change Guidance and considers whether accessible, multi-disciplinary guidance could be provided in relation to health-related behaviour change policies, particularly to offer more explicit advice on how behaviour change techniques could be applied to reduce obesity, alcohol abuse and smoking (paragraph 4.36).

SHARING KNOWLEDGE ACROSS GOVERNMENT

8.12.  We recommend that the Cabinet Office, together with the Government Chief Scientific Adviser and Chief Social Scientist, once appointed, review the current mechanisms for sharing knowledge about behaviour change among government departments with a view to introducing a more streamlined structure (paragraph 4.41).

8.13.  We recommend further that this revised structure should involve the continuation of work begun on the "inventory of behaviours" in order to establish an archive of behaviour change interventions. This archive should provide accounts of the evaluation of the interventions and include unsuccessful as well as successful interventions (paragraph 4.42).

The Government approach to changing behaviour (Chapter 5)

THE NEED FOR A RANGE OF INTERVENTIONS

8.14.  In general, the evidence supports the conclusion that non-regulatory or regulatory measures used in isolation are often not likely to be effective and that usually the most effective means of changing behaviour at a population level is to use a range of policy tools, both regulatory and non-regulatory. Given that many factors may influence behaviour, this conclusion is perhaps unsurprising (paragraph 5.13).

8.15.  We welcome efforts by the Government to raise awareness within departments of the importance of understanding behaviour, and the potential this has for the development of more effective and efficient policies. We are concerned, however, that emphasising non-regulatory interventions will lead to policy decisions where the evidence for the effectiveness of other interventions in changing behaviour has not been considered. This would jeopardise the development of evidence-based, effective and cost-effective policies (paragraph 5.14).

8.16.  We therefore urge ministers to ensure that policy makers are made aware of the evidence that non-regulatory measures are often not likely to be effective if used in isolation and that evidence regarding the whole range of policy interventions should be considered before they commit to using non-regulatory measures alone (paragraph 5.15).

PARTNERSHIP WORKING AND VOLUNTARY AGREEMENTS

8.17.  The involvement of other organisations to support the Government's behaviour change initiatives may provide valuable opportunities to improve the effectiveness of behaviour change interventions, in particular by allowing a range of messengers to be used to deliver them. We welcome the Government's intention to use such collaborations (paragraph 5.25).

8.18.  However, we have major doubts about the effectiveness of voluntary agreements with commercial organisations, in particular where there are potential conflicts of interest. Where voluntary agreements are made, we recommend that the following principles should be applied in order to ensure that they achieve their purpose:

  • The Government should specify clearly what they want businesses to do based on the evidence about how to change behaviour, and what steps they will take to achieve the same result if voluntary agreements are not forthcoming, or prove ineffective.
  • Voluntary agreements should be rigorously and independently evaluated against measurable and time-limited outcomes (paragraph 5.26).

8.19.  Given that these principles do not appear to have been applied consistently to the Public Health Responsibility Deal Network, we urge the Department of Health, in particular, to ensure that these principles are followed when negotiating further voluntary agreements. In relation to the current agreements, we recommend that the Department of Health should state for each pledge what outcomes are expected and when, and provide details of what steps they will take if the agreements are not effective at the end of the stated period (paragraph 5.27).

THE ROLE OF LOCAL AUTHORITIES

8.20.  Although decentralising responsibility may provide a useful opportunity to tailor local behaviour change initiatives and to help build the evidence-base for applied behaviour change research at the population level, steps should be taken to ensure that interventions are evidence-based and properly evaluated. To this end, we recommend that the Government:

  • produce guidance for local authorities on how to use evidence effectively to design, commission and evaluate interventions and on the need to involve experts in the design and evaluation process, and provide advice on how to best use the tendering process to ensure value for money;
  • take steps to ensure that evaluation of interventions, including data collection and reporting of behaviour change outcomes, across local areas is of sufficiently high quality to allow comparisons and analysis;
  • takes steps to ensure that what is learnt by a local government in one place can be readily transmitted to other local governments; and
  • provide funding only for those schemes which are based on sound evidence. Demonstration of rigorous evaluation and contribution to the evidence-base should be a requirement for future funding for behaviour change interventions (paragraph 5.30).

Evaluation of behaviour change interventions (Chapter 6)

ENSURING EFFECTIVE EVALUATION

8.21.  Effective evaluation requires that:

  • evaluation should be considered at the beginning of the policy design process. External evaluation expertise should be sought, where necessary, from the policy's inception;
  • relevant outcome measures—as distinct from outputs—should be established at the beginning of the policy development process;
  • the duration of the evaluation process should be sufficiently long-term to demonstrate that an intervention has resulted in maintained behaviour change;
  • pilot studies, using population-representative samples, followed by controlled trials assessing objective outcomes should be used whenever practicable; and
  • sufficient funds should be allocated for evaluation, recognising that establishing what works, and why, is likely to result in better value for money in the long-term (paragraph 6.14).

8.22.  We find however that, at present, evaluations of Government behaviour change interventions often lack one or more of these necessary elements. While we welcome the Government's revision of the Magenta Book, the evaluation guidance for policy makers and analysts, we believe that it could be further improved. We recommend that the Government consult external evaluation experts on the creation of a concise document for policy makers, containing only the most important principles of evaluation. We further recommend that they make clear what steps they will take to ensure that the revised guidance leads to a change in evaluation culture across Whitehall (paragraph 6.15).

Case studies (Chapter 7)

CASE STUDY 1: TACKLING OBESITY

Change4Life

8.23.  It appears that the Change4Life programme has, on the whole, been evidence-based and appropriately targeted. We note the Government's commitment to continue using the brand and urge the Department of Health to ensure that future evaluations are robust and establish whether or not the programme is likely to be successful in the longer term (paragraph 7.12).

Population wide interventions: advertising, marketing and food labelling

8.24.  We invite the Government to explain why their policy on food labelling and marketing of unhealthy products to children is not in accordance with the available evidence about changing behaviour. Given the evidence, we recommend that the Government take steps to implement a traffic light system of nutritional labelling on all food packaging. We further recommend that the Government reconsider current regulation of advertising and marketing of food products to children, taking a more realistic view of the range of programmes that children watch (paragraph 7.17).

Voluntary agreements

8.25.  We draw attention to our recommendation about the failures of all current pledges made by the Public Health Responsibility Deal (see paragraph 8.19). Moreover, obesity is a significant and urgent societal problem and the current Public Health Responsibility Deal pledge on obesity is not a proportionate response to the scale of the problem. If the Government intend to continue to use agreements with businesses as a way of changing the population's behaviour, we urge them to ensure that these are based on the best available evidence about the most effective measures to tackle obesity at a population level. In particular, they should consider the ways in which businesses themselves influence the behaviour of the population in unhealthy ways. If effective measures cannot be achieved through agreement, the Government must pursue them through other means (paragraph 7.20).

Weight management interventions

8.26.  We recommend that the Department of Health should commission a review of the provision of weight management services, including the Health Trainers programme, across the country. We recommend further that the National Institute for Clinical Excellence should compile a list of approved weight management services which adhere to their best practice guidance. If the Health Trainers programme is included in this list, we recommend that the Government should continue the programme, particularly in the light of its focus on tackling health inequalities (paragraph 7.25).

CASE STUDY 2: REDUCING CAR USE

Weaknesses of the evidence-base

8.27.  We recommend that the Department for Transport should prioritise funding to research the most effective behaviour change interventions to reduce car use for medium and longer-length journeys and undertake pilots of those interventions as soon as possible (paragraph 7.34).

Promoting and enabling choice: the role of regulation and infrastructure

8.28.  Bearing in mind our concern that the Government's preference for non-regulatory interventions may lead officials to give insufficient consideration to regulatory and fiscal interventions (see paragraph 8.15), we urge the Department for Transport to ensure that evidence for both non-regulatory and regulatory measures is taken into account when formulating policies to reduce car use (paragraph 7.36).

8.29.  As the evidence suggests that good infrastructure is a prerequisite for, and greatly enhances, the effectiveness of other "smarter choices" measures, we strongly encourage the Department for Transport to ensure that, wherever possible in a time of financial stringency, a sufficient proportion of funds is maintained to make effective improvements and changes to infrastructure (paragraph 7.38).

Integrated policy packages

8.30.  Whilst we welcome the Department for Transport's emphasis on the use of policy packages, we note they do not include regulatory and fiscal measures and so do not wholly reflect the evidence about how to change transport mode choice. This suggests that their effectiveness and, in turn, their cost-effectiveness could well be limited (paragraph 7.41).

Localism and the Sustainable Transport Fund

8.31.  Although we welcome the principle of the Department for Transport's Local Sustainable Transport Fund, the initiative is based on a pilot project which was incompletely evaluated and so did not provide evidence about the long-term effectiveness of interventions. Furthermore, (see paragraph 8.30), the Sustainable Travel Towns pilot did not wholly reflect the evidence about how to change transport mode choice (paragraph 7.46).

8.32.  We commend the Department for Transport's recognition that, if responsibility for interventions is to be devolved to local agents, guidance to commissioners on the evidence and an evaluation framework are necessary. We note, however, that current guidance does not take into account the evidence about the need for strong disincentives to car use needed to achieve significant changes in behaviour and fails to provide any analysis of the evidence associated with effective interventions (paragraph 7.47).

8.33.  We recommend that the Government (a) establish and publish targets for a reduction in carbon emissions as a result of a reduction in car use; (b) publish an estimate of the percentage reduction in emissions which will be achieved through reducing car use and the timescale for its achievement; and (c) details of the steps they will take if this percentage reduction is not achieved by this time (paragraph 7.48).


 
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