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Making the change: Behavioural factors in person- and communitycentred approaches for health and wellbeing

This paper forms part of the first series of outputs from the Realising the Value project, a collaboration between the Health Foundation, Nesta, Voluntary Voices, Newcastle University, and the Behavioural Insights Team. Realising the Value makes the case for adopting person- and community-centred approaches in the UK’s healthcare system. A key objective of Realising the Value is to change the relationship between citizens and the health system from one of passive patient to active participant.

This is a broad topic. The report At the heart of health: Realising the value of people and communities was published by consortium partners in February and provides an overview of the existing evidence base with a particular focus on the potential benefits of adopting person- and community-centred approaches. This paper takes a different tack. It starts from the principle that person- and community-centred health and care approaches require a certain set of behaviours, therefore increasing the impact of these approaches requires:

1. Identifying the relevant behaviours (see Box 1).
2. Understanding the drivers of these behaviours and the barriers to achieving them.
3. Proposing evidence-based ways to facilitate these behaviours.

This paper is aimed at the second requirement. It presents five broad factors that have been shown to influence engagement and self-management behaviours, and suggests how they can be targeted in order to increase such behaviours. These factors all emerge from robust studies on what influences behaviour. However, they are not the products of a systematic review of the literature on person- and communitycentred approaches to health and wellbeing: we have made two deliberate choices that shape the content of this paper.

Firstly, we have taken the view that our target audience wants to put theory into practice (rather than rehearsing theory for the sake of it). Therefore, we have selected factors or concepts that can be communicated and acted upon easily. We have also drawn on interviews conducted during the summer of 2015, with 12 champions of person- and community-centred approaches, to inform the focus of this paper and to ground it in practice. Several of the case studies featured in this paper were identified during this interview process.

Secondly, we have drawn on both health and non-health examples, in order to bring new perspectives to the field. There are many existing reports on increasing self-management in health and we do not wish to duplicate their content. The examples cited from outside the field of healthcare each require a comparable change in behaviour (for example, learning how to do something new in adult education or overcoming the challenge of searching for a job). We believe that looking to other sectors will offer new routes to realising the value of people and communities in a health and wellbeing context.

Finally, we recognise that we are focusing only on a single aspect of person- and community-centred approaches (behaviour, see Box 1), at the expense of others, such as educating and changing attitudes. We touch on these aspects in the following report, but only if there is clear evidence that they result in changes in behaviour. We believe that this focus on behaviour will bring results.