Training to Change Practice

Jo Hart, Professor of Health Professional Education, Division of Medical Education, University of Manchester, UK.

Lucie Byrne-Davis, Professor of Health Psychology, Division of Medical Education, University of Manchester, UK.

Wendy Maltinsky, Senior Lecturer, Division of Psychology, Faculty of Natural Sciences, University of Stirling, UK.

Eleanor Bull, Senior Health Psychologist, Manchester University NHS Foundation Trust and Derbyshire County Council, UK; Honorary Senior Lecturer, Division of Medical Education, University of Manchester, UK.

Contents

Foreword ix

Acknowledgements xi

CHAPTER 1 Education and Training as a Behaviour Change Intervention 1

Jo Hart, Lucie Byrne-Davis, Wendy Maltinsky, Eleanor Bull, Nicola McCleary and Chris Armitage

What Is Continuing Professional Development? 2

The Purpose(s) of CPD 2

The Challenges of Changing Practice through CPD 3

Important Concepts and Theories 4

Miller’s Pyramid 4

Figure 1: The interaction of capability, opportunity, motivation and Miller’s Pyramid 5

A Shared Theoretical Language 6

Why Think about Behavioural Theory? 7

The COM-B Framework 8

Figure 2: Influences on behaviour mapped to capability, opportunity and motivation 8

A Focus on Motivation 9

Why Is Behavioural Science Important? 10

Effective and Enjoyable Training 10

Principles for Effective Training 11

Principle 1. Starting from Where Learners Are 11

Principle 2. Working in Partnership 11

Principle 3. Interactive/Active Learning 12

Principle 4. Communication 13

Principle 5. A Collaborative Learning Environment 13

Principle 6. Individual and Group Voices 14

Principle 7. Time for Reflection 15

Check Your Understanding and Reflect 15

Useful Links and Further Reading 16

Behavioural theories and types of behaviours 16

Dual processing 16

The COM-B Framework 16

PRIME Theory and other briefings on behaviour change 16

References 16

CHAPTER 2 Defining the Behaviours That You Want to Change 20

Jo Hart, Lucie Byrne-Davis, Wendy Maltinsky and Eleanor Bull

Introduction 21

Developing a Theory of Change 22

Tips and examples 22

Intended Behavioural Outcomes (IBOs) 23

Tips and examples 24

How to Develop IBOs 24

Tips and examples: Topic guide and cues for a behavioural specification focus group 26

What Does the Evidence Say? 26

Choosing the IBOs on Which to Focus 27

Whose IBOs Are They? 27

Check Your Understanding 28

Useful Links and Further Reading 28

Developing A Theory of Change 28

References 29

CHAPTER 3 Exploring the Influences on Behaviours 30

Jo Hart, Lucie Byrne-Davis, Wendy Maltinsky and Eleanor Bull

Influences on Practice 31

Figure 3: The COM-B framework 31

Capability 31

Tips and examples 31

Opportunity 31

Tips and examples 32

Motivation 32

Tips and examples 32

How to Explore Influences on Each IBO 32

Before Developing CPD 33

Tips and examples 33

Tips and examples 35

During CPD 35

Check Your Understanding and Reflect 36

Further Reading 36

More About Exploring Influences on Behaviour 36

References 36

CHAPTER 4 Developing CPD to Change Behaviour 38

Jo Hart, Lucie Byrne-Davis, Wendy Maltinsky and Eleanor Bull

The Active Ingredients of Behaviour Change Activities 39

Reminder: What is COM-B Again? 39

BCTs and Communication Skills in Education and Training 40

Tips and examples 40

How to Develop Your Training Activities 41

Capability 44

What Does the Evidence Say? 45

Figure 4: The Johari Window 45

Tips and examples 45

Figure 5: Post-it notes to illustrate an effective practitioner 46

Building Psychological Capability 47

Tips and examples 47

Building Physical Capability 48

Figure 6: A cycle for physical capability improvement (learning a skill) 49

Tips and examples 49

Opportunity 50

Building Physical Opportunity 50

Tips and examples 51

An Appreciative Inquiry Approach 52

Building Social Opportunity 52

Tips and examples 53

Tips and examples 53

Figure 7: Comic book strip 54

Motivation 55

Building Reflective Motivation 55

Tips and examples 56

Building Automatic Motivation 56

Tips and examples 57

Planning the ‘How’ of Your Training 57

Consider Space 57

Consider Numbers 58

Consider Acoustics and Visuals 58

Consider Time 58

Consider Dynamics 58

Consider Technical Equipment and Skills 59

Consider Administrative Support 59

Consider Refreshments 59

Consider Culture/Contexts/Countries 59

Online 60

Blended Learning – Synchronous and Asynchronous 61

Figure 8: Considerations for a blending learning course 62

The Building Blocks of Your Training 63

Figure 9: Overview of training structure 63

Introductions 63

Welcoming 63

Introductory Activities 64

Trainee Introductions 64

Create Name-Plates 64

Introductory Bingo 65

Introduce Your Neighbour 65

Throw the Soft Toy 65

Group Agreements 65

Course Expectations, Hopes and Fears 66

Balancing Training Energy 66

Endings: Reflection, Action Planning and Evaluation 67

Check Your Understanding and Reflect 67

Further Reading 68

References 68

CHAPTER 5 Assessing and Evaluating 70

Jo Hart, Lucie Byrne-Davis, Wendy Maltinsky and Eleanor Bull

Process vs. Outcome 71

Why Are You Evaluating? 72

Theories and Frameworks to Help Us Evaluate 72

The Kirkpatrick Model 73

Tips and examples 73

Evaluation of Complex Interventions 74

Assessing Behavioural Influences 75

Topic guide 76

Figure 10: Topic guide example for interviews about the impact of a course on practice at follow-up 76

Assessing Behaviour 78

Check Your Understanding 79

Further Reading 79

References 80

Guides 81

Sample Training Plans 81

Aims 88

Tips and Examples: Setting up A Session 88

Cards for Change 94

Index 111