Step 2: Review a worked example of how this tool can be used to identify barriers to a behaviour.
Take a look at the detailed example below before identifying the barriers that may be preventing the behaviour that you are trying to change.
Problem: Resistance to antibiotics is increasing due to high levels of prescribing from GPs. This means that a growing number of infections such as pneumonia are becoming more difficult to treat because antibiotics are less effective.
High Level Goal: To reduce antimicrobial resistance.
Specific behaviours we want to change: GP’s do not prescribe an antibiotic unnecessarily.
Using our Behavioural Barrier cards, we identified the following barriers that were preventing GPs from reducing their antibiotic prescription behaviours:
These refer to a person's physical or psychological ability to perform the behaviour.
GPs may not have the attention span to consider alternative recommendations.
GPs may not be aware that they are above the norm in terms of prescription rates.
GPs may not have the interpersonal skills or resources to say “no” to a demanding patient.
These refer to anything in the physical or social environment that may encourage or discourage a behaviour.
GPs don’t have the time to consider alternatives options to antibiotics.
Prescribing is a social norm and GPs imagine other doctors would prescribe in similar situations.
There are no prompts in the environment to discourage GPs from writing prescriptions.
These refer to internal reflective and automatic mechanisms that activate or inhibit a behaviour.
GPs want to see as many patients as possible within the day and believe that the consequences of refusing to give prescriptions will make appointments longer and lead to repeat appointments.
GPs write prescriptions as an emotional response to a patient in distress.
Writing prescriptions is a habit for GPs.
These cards are adapted from the COM-B Model, the Theoretical Domains Framework and the work of the University College London Centre for Behaviour Change.
To design these cards, BIT has used the domains and constructs from the COM-B Model and the Theoretical Domains Framework (with permission of the authors). BIT has then developed its own user-centred questions and practical examples to demonstrate how these domains and constructs influence behaviour.
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. BMJ Quality & Safety, 14(1), 26-33.
Michie, S., Atkins, L., West, R., 2014. The Behaviour Change Wheel: A Guide To Designing Interventions. Silverback Publishing, London.