DEBATE: do interventions based on behavioral theory work in the real world?

Journal article


Hagger, M. and Weed, M. 2019. DEBATE: do interventions based on behavioral theory work in the real world? International Journal of Behavioral Nutrition and Physical Activity. 16 (36), pp. 1-10. https://doi.org/10.1186/s12966-019-0795-4
AuthorsHagger, M. and Weed, M.
Abstract

Background:
Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes.

Discussion:
Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the ‘real world’. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions.

Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations.

Hagger responds that behavioral interventions work in the ‘real world’ in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate.

Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings.

Summary:
Hagger contends that interventions based on behavioral theory are effective in changing population-level behavior in ‘real world’ contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population.

KeywordsBehavioural interventions; health behaviour change; efficacy; effectiveness; health outcomes; implementation
Year2019
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Journal citation16 (36), pp. 1-10
PublisherBioMed Central
ISSN1479-5868
Digital Object Identifier (DOI)https://doi.org/10.1186/s12966-019-0795-4
Related URLhttps://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0795-4
Publication dates
Print25 Apr 2019
Publication process dates
Deposited16 May 2019
Accepted27 Mar 2019
Accepted author manuscript
License
Output statusPublished
Additional information

Open Access

ContributorsHagger, M. and Weed, M.
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