Is it time to update public health guidelines to include evidence about digital behaviour change interventions?

By Olga Perski

PhD candidate at UCL’s Centre for Behaviour Change

The National Institute for Health and Care Excellence (NICE), a key player in the UK’s public health policy landscape, released its first guideline on behaviour change in October 2007. The current guideline, informed by salient theories from the behavioural and social sciences, empirical evidence and expert input, includes recommendations on how to design, deliver and evaluate behaviour change interventions. In line with good scientific practice, NICE is committed to updating their guidelines in light of new evidence, and open the floor for discussion at regular intervals. Although NICE recently proposed not to update the guideline on behaviour change, new research has become available which has led us to believe that this conclusion may be a bit premature.

As a matter of fact, the current guideline hardly includes any evidence about digital behaviour change interventions, but since the release of the guideline in 2007, several studies evaluating the effectiveness of technology-based interventions (e.g. websites, text messages) have been published. Moreover, evidence reviews (which combine results from multiple studies targeting the same behaviour) have found that technology-based interventions can help people quit smoking, increase their physical activity, lose weight, reduce their alcohol consumption and better self-manage chronic conditions, such as diabetes and COPD. However, as observed effects tend to vary across studies, larger studies of high methodological quality are needed to advance our knowledge about what kinds of interventions work, who they work for, and in what particular circumstances. Evidence about more recent devices, such as smartphone apps and wearables, is still relatively scarce.

Given that some face-to-face health services are being replaced by new digital options (often with little or no evidence to support such decisions), we sent a letter to NICE proposing that it would be very helpful if they were to update their guideline on behaviour change to include available evidence about digital interventions. As commissioners that purchase services and healthcare professionals that recommend tools to patients need guidance about how to interpret the existing evidence when making decisions, we believe that guidance in this area is much needed. The extent to which digital behaviour change interventions meet criteria such as acceptability, (cost-)effectiveness and equity needs to be at the fingertips of decision-makers in the UK policy landscape.

Questions to consider:

 What do you think about the Centre for Behaviour Change’s suggestion to include available evidence about digital behaviour change interventions in national health guidelines such as those issued by NICE?

 What are the wider implications of not including such evidence in public health guidelines?

Bio:

Olga Perski is a PhD candidate funded by Bupa working with Professor Susan Michie (UCL Centre for Behaviour Change), Professor Ann Blandford (UCL Interaction Centre) and Professor Robert West (UCL Tobacco and Alcohol Research Group) to gain a better understanding of how to define, measure and promote “engagement” with digital behaviour change interventions. Olga is passionate about building evidence around the use, usability and effectiveness of digital health tools in order to help influence research, policy and practice.