Designing behaviour change journeys

Why stage models are an important part of the practitioner toolkit

At what point do we decide we are going to change our behaviour?  This is an issue that often comes up in a range of contexts we work in from financial behaviour, sustainability, food and beverage choices, to wellbeing and health: for example, I may be carrying too much weight but at what point does that mean I decide to change my eating habits or at when should I go and see a health professional?  Of course, this can apply to a range of conditions where there is no clear way of defining when something is wrong, such as acne or sleep disorders.  It is also relevant to all areas of course – when do we decide we are going to get help with our finances or get training to support our employment?  Or on the more commercial side, this is helpful to explore willingness to change brands or products.

Part of the challenge here is that behaviour change is often characterised as a one-time event – for example, a ‘nudge’ is something that is done at a specific point which results in a specific outcome.  But life is not that simple – if we do not even think there is a problem then we are unlikely to be receptive to a ‘nudge’.  And we may be resistant to seeing ourselves as needing to change – it is quite a significant step for people to see themselves as ‘obese’ or ‘financially vulnerable’ for example. 

Stage models of behaviour change

To help make sense of this we can turn to ‘stage’ models of behaviour change:  these recognise that the change is a process rather than an event and as such incorporate a temporal dimension.  One of the best-known stage-based models of behaviour change is the Transtheoretical Model as shown below:

The stages of this model are:

  • Precontemplation:  Not planning to change behaviour and may be unaware that their behaviour is a problem

  • Contemplation: Start to recognize that their behaviour may need to change, and being to look at the pros and cons of this

  • Preparation:  Intending to take action soon, and may start taking small steps toward behaviour change

  • Action: Make specific and overt changes to their behaviour

  • Maintenance:  Sustain action and work to prevent relapse

We find that apart from some very narrow behaviour change challenges, we typically have to consider the different stages people are at:  most issues have a journey to them, with people at different points.  Indeed, our experience is that a lot of work often needs to be done at the ‘Precontemplation’ and ‘Contemplation’ stages.  We cannot hope to persuade people to change behaviour if they do not consider there is a problem.  If I do not think I am unfit, then why would I exercise?  Or if I was having trouble sleeping, then while I may be suffering, I might just consider this to be normal.  Helping people start to be aware of potentially better alternatives and how they might be able to access these through changing their behaviour is an important part of many programmes.

Take care of the way everything looks like a nail when you carry a hammer

There can often be less focus on the earlier stages of the behaviour change process (Precontemplation and Contemplation) partly due, perversely, to the way in which our thinking about the behaviour change challenge can at times get defined by the tools available. This is a somewhat subtle but nevertheless important point: behaviour change is often thought about in terms of ‘nudges’, a particular type of intervention that relies on small changes to the environment to direct our more automatic processes towards desired outcomes. 

These are helpful when there is a fairly clear target behaviour that people are well disposed to enact (e.g. people that are disposed to the winter flu vaccine may need to be nudged to make it happen) – essentially this is when people are at the later stages of the process (e.g. ‘Preparation’).  But if we are not careful then our ‘nudge first’ approach frames the entire problem as assuming people are at this point, failing to see there may be a much larger volume of people that may not be receptive or even have thought about the behaviour, (in this case perhaps not being aware that there is a winter flu vaccine or thinking that it is relevant to them). In other words, we need to be careful that our tools do not lead us to solving artificially simple problems instead of addressing the more complex problems which are the reality of our lives.

Guiding people at each stage

The important implication of staged models of behaviour change is that people need guiding through these different stages – with each needing a particular solution that leads to the final desired behaviour change outcome.  Hence the task at the Pre-contemplation stage is to help people to see that there is a problem that needs action.  It is only at the Preparation stage that the challenge is to get to the final desired outcome. 

In our experience, therefore, having a temporal dimension is important – with more work often needing to be done at the earlier stages than is often discussed.  If we take the issue of managing debt for example:

  • Precontemplation: Understanding that they are in debt

  • Contemplation: Recognising that this is a problem that requires action

  • Preparation: Formulating the sorts of action that might be needed (e.g. budgeting, restructuring finances) and identifying the ways to obtain help (e.g. financial advisor, bank, credit card companies)

  • Action: Enacting the appropriate behaviours (e.g. contacting the different organisations to get guidance and put in place a course of action)

  • Maintenance: Sustaining the behaviour (such as sticking to budgets and repayment plans)

Clearly there are different behaviours we are seeking at each stage; for example, we may want to encourage people to collate their financial position at the Precontemplation stage and to make an evaluation of their financial health at the Contemplation stage.  This means that different interventions are needed at each stage – it is unrealistic to assume people will move from the beginning of the journey to the final point in one step.  Survey work is often helpful to understand how many people are at the different stages while qualitative work can help us properly understand the nature of the challenge at each stage.

Identity changes

Finally, while these issues can be tackled with tangible intervention activities to take people through the different stages, there is a wider ‘meta’ issue that needs to be considered:  in our experience, the way that people see themselves in this process is critical.  Our identity may be tied up with our current behaviours – how we spend money, enjoy food, or associate ourselves with a particular brand, for example.   To question these behaviours may mean people start to see themselves differently, and sometimes perhaps in a less than positive way.  After all, who wants to see themselves as ‘overweight’, an ‘insomniac’ or a ‘debtor’.  Care therefore needs to be taken to help guide people in a way that helps them avoid punishing stereotypes about themselves and maintain their identity in a positive way (e.g. taking control of my life’ or ‘being a good parent or partner by managing things’).

Conclusions

While our MAPPS behaviour change framework does not explicitly have a temporal element, we will often have this as an additional ‘layer’ in our work.  In this way behavioural science works well with customer journey consulting – by collaborating with customer experience teams we can understand the full pathway and how different interventions are needed to effect different outcomes at each stage.  This also links to the need to think of behaviour change as a programme rather than a single intervention – there will always be people at different points of the behaviour change journey that need attention.