Co-production of promising interventions to support multiple behaviour change in socially deprived communities

This project:

Aims to identify promising interventions (ideas) to support multiple behaviour change in socially deprived communities to inform practice innovation and research post-project.

Will facilitate the establishment of the region as a UK leader in tackling health inequalities through behaviour change.

Is directly relevant to the ‘healthy ageing’ theme as behaviours are key risk factors, and also ‘living with long-term conditions’ where self-management of behaviour is crucial.

Unhealthy behaviours are a substantial threat to population health and a heavy burden on health and social care services: Unhealthy diets, tobacco smoking, physical inactivity, and excessive alcohol consumption (‘the big four’) are responsible for ~50% of the population attributable fraction of years of life lost in the UK (Steel et al., 2018), with a large economic impact (Figure 1).

Figure 1: Impact of unhealthy behaviours and obesity on NHS and wider economy (Time to Think Differently, King’s Fund, 2015)

Last year, in Norfolk and Suffolk:
oObesity led to > 27,000 hospital admissions.
oSmoking led to > 28,000 hospital admissions (NHS Digital).
oExcessive alcohol consumption led to 10,000 hospital admissions (Norfolk Insights and Suffolk Observatory).

The threat is much higher in socially deprived communities.

People in these communities are much more likely to engage in all four unhealthy behaviours (King’s Fund, Clustering of Unhealthy Behaviours over Time, 2012). Behavioural risk factors largely explain the 19-years difference in healthy life expectancy and two times higher years of life lost from all causes between low-income and the most affluent communities (Marmot Review Ten Years On, 2020, Steel et al., 2018). People in the most deprived areas spend nearly a third of their lives in poor health; worsened by the Covid-19 pandemic (King’s Fund, What is Happening toLife Expectancy in England? 2021). In socially deprived communities, behavioural risk factors can present as coping mechanisms to mental ill health and markers of distress and poverty (Hanson et al., 2019).

We need to target multiple behaviours rather than single behaviours in research and practice:
We have known for >10 years that unhealthy behaviours cluster, but still don’t know how best to support multiple behaviour change (NICE, Public Health Guideline 49, 2014). In Tackling Multiple Behaviours (2018), the King’s Fund reported ‘academic evidence on how best to tackle multiple unhealthy behaviours remains weak...more can be done at national level to invest in research in this area but the quickest win is to support local areas providing these services to learn and self-evaluate in practice’. Given our collective expertise and infrastructure in multiple behaviours we are uniquely placed to address this research and service deficit.

Fit with strategic themes and policy priorities:
The project responds directly to national policy, e.g., NHS Long-Term Plan, the Government’s ‘Ageing Society’ Challenge (‘ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest’), local public health strategies (Suffolk prevention strategy) and research funder priorities (e.g., NIHR 2021 priorities).

This project is the first step in co-producing interventions supporting multiple health-related behaviour change among those most in need. Stakeholders from policy, practice, service users, and researchers will map links between the ‘big four’ risk behaviours and
identify best-practice examples targeting multiple behaviours. We will identify ways to ‘package’ interventions to address multiple behaviours, combining behavioural science insights with co-production and asset-based approaches, and generate ideas about promising interventions through consensus, building on the learning from emerging practice in our region and research evidence. This will inform practice innovation, commissioning decisions and research post-project, and increase partner collaboration.

Aim: To identify promising interventions to support multiple behaviour change among people living in socially deprived communities which are:

Not currently implemented in practice or not maximised to their full potential.
Judged by stakeholders to have great potential for improving community health and well-being and reducing service demand through prevention.

Ideas for promising interventions to inform service innovation and research (post-project) may include linking services/pathways, adapting existing interventions (e.g., new target groups) and optimising them by incorporating behaviour change insights.

Objectives:
1.To explore the views of multiple stakeholders (people working with service users in practice, service users, commissioners) about multiple unhealthy behaviours and targeting them together, including current initiatives in the region (Stage 1).
2.Building on the case studies in the King’s Fund (2018) Tackling Multiple Behaviours report, to identify similar innovative behaviour change services targeting multiple behaviours in the region and draw upon the learning (Stage 1).
3.To map how people’s ‘big four’ behaviours are interlinked and influenced by other behaviours (e.g., gambling) and behaviours of others (Stage 1).
4.To reach consensus on promising interventions to support multiple behaviour change (to take forward post-project), using a-priori criteria, in co-production with stakeholders (Stage 2).