DEBATE: Do interventions based on behavioral theory work in the real world?
Hagger, M., & Weed, M. (2019). DEBATE: Do interventions based on behavioral theory work in the real world?. International Journal of Behavioral Nutrition and Physical Activity, 16, Article 36. https://doi.org/10.1186/s12966-019-0795-4
Julkaistu sarjassa
International Journal of Behavioral Nutrition and Physical ActivityPäivämäärä
2019Tekijänoikeudet
© The Author(s). 2019
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.
...
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