Exploring the development of an asset-based intervention to promote the maintenance of positive health behaviours during times of stress and challenge using the behaviour change wheel

Abstract

ABSTRACT Political interest in asset-based health interventions has increased in the wake of the Christie Report (2011) on the future delivery of public services. The development of these type of interventions, however, has been slow and there has been little evaluation of those developed against health outcomes. This thesis set out to redress that balance by choosing to explore the development of an asset-based intervention focussing on positive health behaviours. It used a systematised behaviour change intervention development tool (the Behaviour Change Wheel) to develop an intervention to help maintain breastfeeding despite difficulties. Three studies were carried out for this thesis: Study 1- A longitudinal study of over 200 people, found resilience to be predictive of the maintenance of a desired health behaviour. Study 2 - A qualitative synthesis of 11 papers identified assets that conferred resilience in breastfeeding. Study 3 – An in-depth focus group study of 47 women was used to test acceptability of the intervention. This study pointed to the use of targeted recruitment to ensure the intervention was going to be effective at narrowing health inequalities rather than widening them. The thesis showed that the Behaviour Change Wheel (BCW) was an easy to use comprehensive intervention development tool. Assets were able to be mapped onto the COM-B framework. The overarching behaviour system (COM-B) at the centre of the wheel ensures behaviour is the focus of the intervention. Having health behaviour central to an asset intervention ensures a health outcome evaluation can be adopted easily. For the current intervention further testing is needed to determine effectiveness. Using a health behaviour to develop assets for maintenance is likely to also develop resilience for other future adversities.