Leiden University: Involve behavioural experts sooner for a healthy lifestyle

Healthy lifestyle campaigns are often unsuccessful. It is hard to get people to eat healthily or do more exercise. Expertise on behaviour should be included at a much earlier stage in policy development, say twelve behavioural scientists in a position paper. They will present the paper to Maarten van Ooijen (State Secretary for Health, Welfare and Sport) on 31 August.

‘If we don’t make use of behaviour expertise at an earlier stage, we simply won’t manage to become a healthier country and to remain so,’ says Marieke Adriaanse, Professor of Behavioural Interventions in Population Health. Health care has traditionally focused on cure rather than prevention, and medicine and medical treatment generally take centre stage in our health care system. The increase in chronic, lifestyle-related conditions such as type 2 diabetes and cardiovascular disease demands a different approach. If patients and people with an unhealthy lifestyle are to live a longer and healthier life, they will need to change their behaviour – and so too will health care and policy professionals because they will need to give different advice, for example.

‘Everyone agrees that behavioural expertise should be used alongside other disciplines, but it shouldn’t cost anything.’

Behaviour change is complex and takes time and money. And the latter is often lacking. Andrea Evers, Professor of Health Psychology: ‘Everyone overwhelmingly agrees that behavioural expertise should be used alongside other disciplines, but it shouldn’t cost anything. It’s seen as an intrinsic part of things, and people fail to recognise that you have to invest in it from the start to ensure this knowledge is included systematically and that behaviour interventions succeed.’

Behavioural scientists are not the key to success
The Population Health interdisciplinary programme is about sustainable health care that focuses more on prevention. Adriaanse is a professor in this interdisciplinary Leiden University programme. ‘At Campus The Hague behavioural scientists work with GPs, epidemiologists, public administration experts and data scientists in the region. We look at health from a broad perspective. Behavioural scientists are not the key to the success of a new policy or health care that meets people’s needs more. It’s about collaboration between all sorts of different disciplines.’

Trick
At present behavioural experts are often asked to join a project once the policy is more or less complete. ‘Behavioural expertise is sometimes reduced to a kind of trick, when understanding behaviour and supporting behaviour change is really complex,’ says Adriaanse. ‘You need research and theoretical models to understand behaviour and to apply the right interventions and tools to different groups of people.’

‘Just living in a neighbourhood with lots of fast-food chains means that people live less healthily.’

To develop a successful policy, you need to analyse the target group’s needs. What problems are at play and what does the group need to live a healthier life and maintain this? The target group also needs to be involved in developing policy and interventions. What works in one neighbourhood may not work in another. Evers: ‘We know from research that just living in a neighbourhood with lots of fast-food chains means that people live less healthily. Finger wagging and good advice then have little effect. This makes it really important to take account of people’s lived environment and the limitations they face. Then interventions can be developed that take account of the influence of the environment.’

In addition, once it’s there, a policy has to be continuously evaluated. Situations, needs and technology constantly change. Take the coronavirus pandemic when no one could go to the gym anymore. And what was the latest technology five years ago is now outdated.

Example of good policy
Evers believes the BENEFIT project is a good example: here behavioural scientists were involved from the start in developing tailored interventions to help patients with cardiovascular disease change their lifestyles. Patients with cardiovascular disease receive support during and after cardiac rehabilitation in sticking to a healthy lifestyle. The support includes e-health tools and rewards for healthy behaviour, and takes account of the patient’s personal preferences and obstacles.

Climate change
The position paper is about using behavioural expertise in the field of lifestyle. But the researchers believe this knowledge should also be used more often and at an earlier stage in other fields. Evers: ‘With climate change and sustainability, for example, human behaviour is the key to successful policy change. Knowledge about behavioural expertise in one area can also be used in other areas that relate to people’s behaviour.’

Example of good policy
After all the problems with the coronavirus vaccine, it proved to be a good example of getting people to change their behaviour, says Adriaanse. ‘A community approach meant loads of people were reached in the end. By going into the communities – sometimes using key figures – and making space for questions and providing readily available vaccinations, it’s easier to meet peoples’ needs and remove any barriers. These are valuable initiatives that we can learn from for the future.’