Taking centre stage: the role of behaviour change initiatives in the management of long-term conditions

Behaviour change should sit right at the heart of chronic disease management, but is it given the focus it deserves?

Behaviour change – the practice of changing people’s behaviour – is hot right now. Partly due to interventions around COVID-19, but also due to ever-increasing numbers of people living with chronic conditions.

Behaviour change is one of the most important interventions in disease management. From adherence to a healthy lifestyle reducing mortality from type 2 diabetes and cardiovascular disease, to using psychological interventions in managing chronic symptoms, such as pain and fatigue. Behaviour change is not an ‘add-on’, it’s core to enabling patients to get the best possible health outcomes.

Healthcare professionals (HCPs) recognise the impact of behaviour on mortality and morbidity in chronic disease, but often interventions are not optimised. So, what can be done?

There’s a huge opportunity to tap into and apply evidence-based strategies developed by specialist health psychologists, whether ‘baked-in’ or ‘overt’ interventions. For example, Sprout’s Alicia Hughes is running a trial at King’s College London to test a tailored, low-intensity online approach for managing fatigue, while applying the same principles to inform a digital module for an industry-sponsored patient support initiative. Alicia’s top tips are:

• Keep messaging person-centred: people are more than their disease. Knowing what patients struggle with and what drives their health behaviour is crucial in identifying how best to support them in managing their condition
• Take a 360 view: when people lack resources, they focus their attention on immediate needs and management of their long-term condition can become periphery. Adequately supporting all patients requires an acknowledgment of the influence of social and environmental factors
• Make sure it’s evidence-based: there are millions of apps out there aimed at getting people to change their behaviour but the ones that work are rooted in behavioural science
• Keep it engaging. A recent scientific review conducted by the Sprout team found that content must be tailored and personalised, easy to understand and include visual summaries in order to be engaging.

Supporting HCPs to identify issues, such as treatment non-adherence, and training them in behaviour change techniques (employing the very same techniques in the training to increase the likelihood of HCP uptake) has the potential to be extremely effective. With King’s College London, Christina Jackson combined evidence-review and HCP co-creation to develop a pragmatic screening tool to facilitate discussion of adherence in routine consultations with training for HCPs about behaviour change techniques to overcome patients’ barriers.

Long COVID has increased government funding for research into chronic symptoms and there’s more interest in patient-reported outcomes in clinical trials. Consequently, symptoms such as fatigue, depression and pain will increasingly be selected as trial endpoints. Since patients tend to describe behaviours that perpetuate these types of symptoms, a behaviour change adjunct to a clinical trial could increase the overall efficacy of a treatment. For example, specialist nurses could be trained in delivering behavioural support, or a software as a medical device (SaMD) solution could be delivered alongside prescription. These services could provide robust differentiation for pharmaceutical companies – and would be difficult to replicate.

It’s time pharma fully embraced behaviour change strategies for people’s care, from clinical trial stage to patient support programmes and beyond. The industry has a huge opportunity to combine traditional approaches alongside behaviour change interventions with NHS stakeholders to transform patient outcomes in chronic diseases.

HAVAS Just:: and Sprout have partnered to offer bespoke behaviour change solutions to clients across clinical and communications disciplines.

‘It’s time pharma fully embraced behaviour change strategies for people’s care, from clinical trial stage to patient support programmes and beyond’