Are healthcare professionals delivering opportunistic behaviour change interventions during COVID-19?

By Dr Chris Keyworth

New research examines if and how COVID-19 has affected healthcare professionals talking to patients about health behaviours.

The UK public health policy “Making Every Contact Count” (MECC) compels healthcare professionals to use the millions of day-to-day clinical interactions with patients to offer concise health behaviour change interventions (e.g. increasing physical activity, helping people to quit smoking), to encourage them to change their behaviour and to direct them to local services that can support them.

The pressures of the COVID-19 pandemic may have led this policy to be overlooked. However, given that COVID-19 has increased health inequalities, supporting people to modify health behaviours is more important now than when the policy was introduced. For example, research suggests that the COVID-19 pandemic may have led to increased alcohol intake, reductions in physical activity, and lower diet quality, compared to pre-pandemic levels. Health behaviour change interventions are therefore crucial in order to avert an impending public health crisis.

Our previous work showed inconsistencies in how the MECC policy is implemented. Whilst this work is currently being used as part of the MECC training resources for NHS healthcare professionals, we have identified an important gap to develop and test a behaviour change intervention (implementation intentions) which improves uptake of the policy. Implementation intentions (if-then plans) work by making automatic links in memory between a critical situation (“If I think a patient would benefit from a weight management intervention…”) and an appropriate response (“…then I will signpost to a local support service”). There is a wide body of research illustrating the effectiveness of implementation intentions, but currently no research has tested this approach for healthcare professionals.

Our new programme of research is currently underway to examine healthcare professional practice in line with the MECC framework, and to explore, develop and test new methods of encouraging healthcare professionals to deliver behaviour change interventions in light of COVID-19.

Using a mixed-methods approach, the research has two key objectives: (1) explore and identify healthcare professionals’ enablers, barriers (i.e. critical situations), and solutions (i.e. appropriate responses) to engaging with the public health policy “Making Every Contact Count” during COVID-19, and (2) develop and test a behaviour change intervention, based on implementation intentions, for healthcare professionals to improve engagement with MECC policy.

Phase one of the research involves qualitative interviews with a range of patient-facing NHS healthcare professionals. Findings will be used to inform the development of a behaviour change intervention based on implementation intentions. Building on these initial findings, phase two will involve a quantitative survey and intervention pilot (with one-month follow-up) with a nationally representative sample of NHS healthcare professionals. The survey will: (a) quantify the experiences of healthcare professionals engaging in policy-related practices during COVID-19, and (b) pilot a behaviour change intervention for healthcare professionals to promote engagement with policy-related practices.

The research is led by Dr Chris Keyworth and involves collaborators at the University of Leeds (Prof Mark Conner, Dr Judith Johnson, Dr Kathy Vogt) and the University of Manchester (Prof Chris Armitage), and is due for completion in June 2022.