Arsenic abundance and legislation about water for human

As identified in section 2.1, the development of many chronic health conditions is strongly influenced by modifiable lifestyle factors, including PA and SB. Further, section 2.5 and 2.6 discussed factors that could be targeted within interventions to positively change PA and SB at work. Regarding the reporting of such behaviour change interventions, previous research suggested there was little consensus on the method of reporting, with great disparity in the terminology used to describe core intervention components and behaviour change techniques (Michie et al., 2009). On average, interventions consist of between one and fourteen behaviour change techniques (Michie et al., 2009), therefore such

39 inconsistent reporting can be problematic for standardising definitions of behaviour change strategies and identifying effective techniques to replicate in future trials (Abraham and Michie, 2008). A recent systematic review and meta-analysis identified 20 trials between 2003-2017 using behaviour change strategies to reduce sitting time at work (Peachey et al., 2018). The average reduction in occupational sitting was -23.8 min/day, however only 8 trials reported using a behaviour change framework to underpin their intervention. Similarly, Gardner et al. (2016) found that the majority (58%) of SB interventions in the workplace (n=14) and community (n=12) did not report a behaviour change framework to underpin their behaviour change interventions. Insufficient description of behaviour change techniques and the intervention development process potentially hinders the replication of interventions and can impact the ability to draw effectiveness and cost effectiveness comparisons (Michie et al., 2009). This limited evidence base and poor reporting of behavioural intervention components may contribute to inadequate knowledge of effective behavioural and educational trials compared to multi-component and environmental approaches (Chu et al., 2016; Peachey et al., 2018).

Theory-based interventions are therefore important for facilitating in depth understanding of effective and successful intervention components and provide a basis for improving the impact and evaluation of targeted trials (Michie et al., 2008).

To that end, the interventions in this thesis are underpinned by the COM-B system, which is a behaviour change model which allows interventions to be constructed at the individual level though a targeted and staged approach (Michie, Van Stralen and West, 2011). The central tenant of the COM-B model relies on an individual’s physical and psychological capabilities, reflexive and automatic motivation and the physical and social opportunities to perform the target behaviour (Figure 2.1). The interrelated nature of the COM-B model demonstrates the bi-directional relationship between increasing an individual’s capabilities or opportunities to increase motivation to change their behaviour. Likewise, increasing an individual’s motivation can lead to increased opportunities and capabilities over time due

40 to changes in their behaviour (Michie, Van Stralen and West, 2011). The COM-B system holds automatic motivation at the forefront of behaviour change and is the first behaviour change model to encompass a comprehensive, conceptual model of behaviour which recognises that a large proportion of every day behaviour occurs automatically (Wood, Quinn and Kashy, 2002; Michie, Van Stralen and West, 2011). The COM-B system has strong links to the SEM as it recognises the multiple interrelated factors that may independently and simultaneously act to influence behaviour (Michie, Van Stralen and West, 2011).

Aligned to the principles of the COM-B system therefore, the factors influencing PA and SB identified in section 2.5 may thwart or facilitate PA and SB behaviour change. For an individual to feel capable to sit less and move more they must possess either the physical attributes and/or the psychological abilities. In addition, the physical and social environment must be conducive to facilitate opportunities to reduce SB and increase PA by providing suitable environmental cues, resources and interpersonal (i.e. management) support. Finally, motivation is influenced by reflexive motivation which involves conscious planning and evaluation and automatic motivation which is more impulsive and unconscious (Lally et al., 2010). Importantly, an individual’s motivation to perform the target behaviour must sufficiently outweigh the motivation to not perform that behaviour (Gardner, de Bruijn and Lally, 2011). This highlights the conflict between automatic and reflective processing in the formation or termination of habitual behaviour where there current evidence demonstrates a large variation in the time taken to reach a plateau of perceived automaticity of a behaviour (18 to 254 days, median 66 days) (Lally, 2010).

41 Figure 2.1 The COM-B model.

The COM-B model is central to the Behaviour Change Wheel (Figure 2.2), which provides an evidence-based foundation for providing a comprehensive range of intervention functions and strategies which are likely to influence behaviour change (Michie, Van Stralen and West, 2011). A review of 19 existing behaviour change frameworks (including social cognitive theory and the transtheoretical model) identified nine behaviour change functions and seven independent policy categories that were fundamental in changing behaviour (Michie, Van Stralen and West, 2011). The Behaviour Change Wheel’s non-linear approach therefore offers a reliable method for characterising ‘active’ intervention components in line with the COM-B model, and identifying appropriate behaviour change techniques to promote PA and SB behaviour change in the contact centre setting (Michie, Van Stralen and West, 2011).

42 Figure 2.2. The Behaviour Change Wheel outlining pragmatic intervention components to target the COM-B system.

Underpinning intervention strategies in behaviour change theory is central to providing an insight into the processes and mechanisms influencing change, which in turn can inform the design of future interventions and policy makers (Cane et al., 2012). Aligned to phase 1 of intervention development in the MRC framework (Craig et al., 2008), an integral stage in understanding how to change behaviour is to first develop a holistic understanding of the interrelated contextual factors that influence behaviour, prior to intervention development (Norris, 2014). To date no contact centre trial has explored such influencing factors on call agents PA and SB, yet this exploratory process is advocated as a crucial prerequisite for identifying core factors within the COM-B system.

Adopting a multi-stakeholder approach through triangulation of multiple perspectives from senior management, middle management and call agents from across multiple contact

43 centres during this phase is therefore a novel approach to intervention development in the contact centre setting and has strong theoretical links to the SEM (Sallis, Owen and Fisher, 2008; Norris, 2014). After exploring the influential factors, the behaviour change wheel provides a systematic model for identifying tailored intervention strategies to target the behavioural needs of the contact centre agents within the specific working context (Norris, 2014). Once suitable intervention functions and categories have been identified within the behaviour change wheel, specific behaviour change techniques can be selected for the ‘active’ intervention ingredients to enhance agents capabilities, opportunities and motivation to sit less and move more at work (Michie, Van Stralen and West, 2011; Michie et al., 2013). For the first time, this body of work sets out to use a recognised behaviour change theory to underpin the development and implementation of strategies to support call agents to sit less and move more. This novel approach aims to tailor SB and PA strategies and enhance the effectiveness and sustainability of behaviour change in future trials.