Harnessing the power of emotional drivers to promote behaviour change – Authors' Reply
Authors: Katie Greenland
Journal: The Lancet Global Health (2017)

I thank Peter Winch and Elizabeth Thomas for their thoughtful letter1Winch PJ Thomas ED Harnessing the power of emotional drivers to promote behaviour change.Lancet Glob Health. 2016; 4: e881-e882Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar concerning our trial2Greenland K Chipungu J Curtis V Schmidt W-P Siwale Z Mudenda M et al.Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial.Lancet Glob Health. 2016; 4: e966-e977Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar in The Lancet Global Health and for highlighting the profound challenges associated with changing multiple behaviours in public health interventions. To improve the effectiveness of public health strategies, we need more innovative behaviour change interventions that undergo rigorous evaluation3Craig P Dieppe P Macintyre S Michie S Nazareth I Petticrew M Developing and evaluating complex interventions: the new Medical Research Council guidance.Int J Nurs Stud. 2013; 50: 587-592Crossref PubMed Scopus (875) Google Scholar, 4Michie S Designing and implementing behaviour change interventions to improve population health.J Health Serv Res Policy. 2008; 13: 64-69Crossref PubMed Scopus (110) Google Scholar and more debate about what works, what doesn't, and why. It is thus vital that reports of trial outcomes be accompanied by detailed exploration of the reasons for the outcomes in the study context.5Moore GF Audrey S Barker M et al.Process evaluation of complex interventions: Medical Research Council guidance.BMJ. 2015; 350: h1258Crossref PubMed Scopus (2721) Google Scholar Winch and Thomas rightly point out the difficulty of interpreting trial findings testing complex interventions in the absence of data on fidelity and other key process indicators. As mentioned in the discussion of our paper2Greenland K Chipungu J Curtis V Schmidt W-P Siwale Z Mudenda M et al.Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial.Lancet Glob Health. 2016; 4: e966-e977Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar and prespecified in the objectives published in the trial registry record for our study, we integrated a full process evaluation into our study protocol. This measured seven domains (fidelity, dose delivered, reach, recruitment, participant engagement and responses, acceptability, and context), guided by Steckler and Linnan's framework6Linnan L Steckler A Chapter 1: Process evaluation for public health interventions and research: an overview.in: Linnan L Steckler A Process evaluation for public health interventions and research. L Jossey-Bass, San Fransisco2002: 1-23Google Scholar and the Theory of Change approach.7De Silva MJ Breuer E Lee L et al.Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions.Trials. 2014; 15: 267Crossref PubMed Scopus (294) Google Scholar Due to the convention of separating reports of process and outcome evaluations, the results are the subject of a second manuscript that will be published in due course. This subsequent report will engage in detail with the important questions raised by Winch and Thomas. It does, however, remain a question for journal editors and behavioural scientists as to whether separating process from outcome evaluations in short papers is the best way to advance the science of behavioural intervention. I declare no competing interests. Harnessing the power of emotional drivers to promote behaviour changeEfforts to address malnutrition, maternal and child mortality, and other global health priorities are heavily reliant on behaviour change, including adoption and correct use of health technology, and following treatment recommendations.1,2 One long-standing concern is the limited effectiveness of many behaviour change interventions, even when exposure to intervention activities is adequate, and activities are implemented with high fidelity.3 A second concern is low coverage of proven behaviour change interventions, under conditions of routine programme implementation. Full-Text PDF Open Access