Changing behaviour: A public policy perspective

8. A Comprehensive Model of Behavioural Change

The discussion of behavioural change in this paper has focused particularly on the insights that behavioural theory and empirical research can add to the fundamental building block of behavioural change for policy makers—the rational choice model. These additional insights are especially useful when dealing with psychologically complex behaviours. The traditional policy tools that flow from the rational choice model will, however, generally still form a core part of a comprehensive approach to achieving widespread, sustainable behavioural change. Action needs to be taken on a range of fronts within an integrated, longer-term strategy for maximum behavioural change. The different policy tools used by government that potentially influence a certain public behaviour should be internally consistent and mutually supportive within this integrated strategy.

A good example of a successful, comprehensive behavioural change strategy is Australia’s approach to tobacco control. There is a consensus in the Australian and international literature that a long-term and comprehensive approach to tobacco control is the most effective way of influencing the behaviour of smokers and potential smokers. Ad hoc, piecemeal action can have some impact but it is significantly more limited than a carefully planned, comprehensive, long-term approach encompassing education and information, legislation and restrictive measures and smoking cessation services. The comprehensive approach to tobacco control takes action in a range of areas using a range of policy tools. The effectiveness of the whole package is significantly greater than the sum of its parts.

The components of the comprehensive approach are set out in the Australian National Tobacco Strategy 2004–2009. The strategy was developed by the Australian Government in consultation with all state and territory governments and a range of NGOs. It sets out agreed areas for actions to be taken and makes clear the distribution of responsibilities. It was the consensus view of the representatives from NGOs and state government officials interviewed for the Australian Public Service Commission’s case study that successive National Tobacco Strategies have been very useful strategic frameworks for coordinating and focusing the activities of the large number of organisations involved in tobacco control. The comprehensive 2004–09 strategy includes the following measures:

Regulation of Tobacco
The regulation of tobacco uses the traditional range of policy tools to influence behaviour, including taxes, legislation, fines and sanctions. Australia’s federal, state and territory governments have regulated the promotion, sale, price, place of use and packaging of tobacco products.
Promotion of Quit and Smokefree Messages
The social marketing approach used in recent mass media quit messages, which is sophisticated and well-informed by the research on what shapes and influences human behaviour, also extensively focus tested the demographic group being targeted.
Cessation Services and Treatment
The provision of cessation services such as Quit lines, treatments such as nicotine replacement therapy and counselling and referral by health professionals are key components of a comprehensive tobacco control strategy. ‘Without assistance, around 95% of quitters will fail on any single attempt.’ ³⁸
Community Support and Education to Prevent Young People Taking Up Smoking
Research on the predictors of smoking uptake suggests that the most promising ways to prevent young people taking up smoking are to:
- help children develop negative attitudes to smoking
- teach children how to cope socially while resisting peer offers to smoke
- get parents to quit while their children are young
- prevent children from failing academically and becoming alienated from school.
Addressing Social, Economic and Cultural Determinants of Health
Smoking is linked to general social disadvantage, other aspects of unhealthy lifestyle choices (e.g. lack of exercise, obesity, alcoholism) and also to the use of illicit drugs. Under the National Tobacco Strategy, all jurisdictions in Australia have agreed to endorse policies that prevent social alienation associated with the uptake of high-risk behaviours such as smoking and to advocate policies that reduce smoking as a means of addressing disadvantage.
Tailoring Initiatives for Disadvantaged Groups
This is one component of Australia’s comprehensive approach which has been less successful, and where less activity has occurred. More needs to be known about what might work in reducing tobacco use amongst particular groups, including Indigenous people, people with a mental illness and prisoners.
Research, Evaluation and Monitoring
Australia has invested in research and a number of ongoing surveys and evaluations aimed at monitoring the impact of the tobacco strategy. These include the International Tobacco Control Policy Evaluation Study, three-yearly surveys of students’ smoking behaviour and the three-yearly National Drug Strategy Household Survey. The resulting information and evidence base assists policy makers in planning the evolution of the comprehensive strategy and maintaining support for the long-term investment required for tobacco control by demonstrating its effectiveness.
Workforce Development
This can be an overlooked part of any comprehensive behavioural change strategy. Investment is required in recruitment, training and continuing education in order to develop the necessary knowledge and skills among those working in tobacco control, including people employed in government departments and those delivering health services.

Australia’s comprehensive tobacco control strategy is represented in the diagram at the end of this paper. The diagram used is an adaptation of the seven Es model developed by the UK Institute for Public Policy Research.³⁹ It is a tool for policy makers to assess their intervention approaches and to capture the dynamic interaction between the different types of interventions for influencing behaviour. In this model, enabling, environment encouraging and enforcing are the main categories under which specific interventions fall. Exemplifying, engaging and considering equity implications are all principles to which a comprehensive strategy would generally adhere. Evaluation is vital in enabling policy makers to learn as they go along. As revealed in the diagram referred to above, Australia undertakes significant actions under each of the seven Es. The key message from the model is that action needs to be taken on a range of fronts within an integrated longer-term strategy in order to maximise behavioural change.

The National Tobacco Strategy illustrates another general point about behavioural change— many approaches to influencing public behaviour are only effective if sustained over time. Approaches also need to evolve as community attitudes and behaviours change over time. As smoking has become the habit of a smaller and smaller minority, for example, new options have opened up for policy makers. The recent move in a number of Australian states and territories to ban smoking in all areas of public clubs, hotels and restaurants, for instance, would have been unacceptable ten years ago. The need for evolving approaches is particularly important in tackling the most complex policy problems as they tend to evolve over time, as new evidence or technology becomes available or as other constraints change. Behavioural change strategies are most effective in tackling these problems if planned, evaluated and refined over years or even decades.

38 US Department of Health and Human Services 1988, The Health Consequences of Smoking: Nicotine Addiction, The Department, Rockville, Maryland, cited in Ministerial Council on Drug Strategy, National Tobacco Strategy, 2004–2009, p. 29.

39 M. Lewis, States of Reason, pp. 64–7.

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Changing behaviour: A public policy perspective

8. A Comprehensive Model of Behavioural Change