Understanding behaviour change: A Porterhouse Insights specialism


At Porterhouse Insights, we help pharmaceutical and healthcare companies understand the changes in behaviour needed to make better healthcare choices.

To promote a change in a certain behaviour, we must first successfully analyse and understand the underlying dimensions that contribute to the behaviour itself. This is not a simple task, and it remains an ongoing and developing area of research for the behavioural science community. However, there is a consensus that a behaviour is a result of a decision or a timeline of decisions, whether this is premeditated or automatic/implicit. Health behaviours are often deeply seated and complex, and they sit within both subconscious and conscious levels.

Decades of research have led to multiple cascade behaviour models that illustrate the processes preceding health decisions and the final exhibited health behaviour. Seminal behaviour models include the health belief model (HBM) [1], the theory of planned behaviour [2], the transtheoretical model [3] and the emotion-imbued choice (EIC) model [4], but this is not an exhaustive list. These behaviour models help to map out the input values that may be relevant to the decision making and provide a blueprint for areas that must be explored, and therefore targeted, during a behavioural intervention.

There are pros and cons to these seminal frameworks, and we must fully understand how to apply the behaviour models correctly to generate actionable insights. For example, the HBM (Figure 1) describes several input values in health behaviours. These input values are comprised of: demographic variables, psychological characteristics, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action. Although the model provides a structured direction as to the inputs that may be involved in the equation, there are missing elements. For instance, the HBM does not explicitly acknowledge emotionally related inputs in health behaviours, which have been demonstrated as being a pivotal source of influence on decision-making and such behaviours. [5] To successfully address health behaviour, we must respond to these missing elements accordingly.

Health Belief Model Diagram
Source: en.wikipedia.org/wiki/Health_belief_model

At Porterhouse Insights, we have critically evaluated multiple behaviour models and concatenated their strengths and weaknesses to therefore bridge the gaps, leading to the development of our hybrid Porterhouse behaviour profiler (PBP). We employ the HBM, but we draw on the EIC model to acknowledge the role of emotion in decision-making, therefore addressing the specific criticism of the HBM previously described. The PBP thus uses an evidence-based approach to behaviour mapping and ensures we do not omit any key behaviour dimensions relevant to pharmaceutical and healthcare companies that would make important targets for a behaviour change intervention.

Once we are able to map out the relevant behavioural dimensions (via primary insight generation using the PBP), we can understand how and to what extent each dimension is contributing to a specific health behaviour.

Strategic interventions can then be directed accordingly, creating more efficient and successful engagements. A simple, theoretical example to illustrate this is that we may find (through application of the PBP) a segment of healthcare professionals who are more likely to exhibit delays in diagnosing a certain disease. Taking this theoretical example further, we may find that such a behaviour specifically relates to: neurologists who do not consider themselves a specialist in the disease area of interest; negative emotion, including anxiety surrounding diagnosis delivery; perceived lack of treatment options; and perception that other physicians also do not have much to offer these patients after diagnosis. With this knowledge, we can begin to tailor a behaviour change plan to shift perceptions and decrease diagnostic delays.

Behaviour change is a multistep process [3], and the above is just one example of how we at Porterhouse Insights ensure an evidence-based approach to understanding behaviour change.

Porterhouse Insights is the research, insight and evidence consultancy of the Porterhouse Medical Group. If you would like to find out more about our approach and how our strategic insights power smarter decisions and communications, please visit porterhousemedical.com/our-approach/

1. Becker MH. The health belief model and personal health behavior. 1st ed. Slack Incorporated; Thorofare, NJ, USA, 1974.
2. Ajzen I. The theory of planned behaviour: Reactions and reflections. Psychol Health 2011; 26 (9): 1113–1127.
3. Prochaska JO, DiClemente CC and Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992; 47 (9): 1102–1114.
4. Lerner JS, Li Y, Valdesolo P et al. Emotion and decision making. Annu Rev Psychol 2015; 66: 799–823.
5. Ferrer RA and Mendes WB. Emotion, health decision making, and health behaviour. Psychol Health 2018; 33 (1): 1–16.

Author: Melissa Goulding
Senior Research Executive  | Porterhouse Insights