Exploring factors influencing public health commissioners and service providers application of behavioural science research

Abstract

Background: Use of clinical and epidemiological evidence in public health is commonplace. Use of behavioural science evidence to support decision-making and action is not. Methods: Twenty semi-structured interviews were conducted with public health decision- makers and practitioners from three UK local authorities. Questions were underpinned by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Thematic analysis was conducted applying a deductive approach. Findings: Limits in knowledge around behavioural science research, and skills in assessing research quality were common. Public health decision-makers reported difficulties in deciding which theoretical models to draw on for commissioning specifications. They also held beliefs that research evidence can stifle innovation and overwhelm service providers. While commissioners’ professional identity aligned with the importance of using research evidence, service providers’ did not. Both groups reported low confidence in their ability to use behavioural science evidence, and would welcome training. Potential incentives for using evidence included: increasing ease of adoption for front-line services, adapting the format of academic papers and; making use of research evidence compulsory in commissioning. Local authority, public health and service provider cultures with their strong focus on outcomes were identified as barriers to evidence use. Environmental influences included challenges with the commissioning cycle and journal article accessibility. Conclusions: Embedding behavioural science into the design and delivery of public health programmes requires targeting multiple levels of behaviour and the public health environment. Findings are being mapped to potential intervention components for testing within a UK public health department.