Healthy Settings
Health promotion approaches that aim to change the environment in which we make decisions have the potential to bring about significant behaviour change at low cost [20].
This hydration intervention draws on healthy settings theory - building health promotion into routine activities of a system [25]. Health promotion operating beyond the individual in a wider context is increasing in popularity [36].
The Sundsvall Statement describes how creating supportive environments for health can contribute to reducing inequities in health [38]. This can be realised when reflecting upon care homes as healthy settings, which contain some of the UK's most vulnerable populations.
For a successful settings-approach, research suggests there must be strong organisational commitment to change in both policy and practice, supported at various levels throughout the organisation [14].
For a successful settings-approach, research suggests there must be strong organisational commitment to change in both policy and practice, supported at various levels throughout the organisation [14].
Extending Action
One of the challenges to settings-based approaches is the difficulty in translating projects into wider, more penetrating achievements within settings [36]; to maximise the contribution to health, joined up action across settings is essential [6]. Therefore hydration promotion should be advocated for within other relevant settings also. |
Behaviour Change Theories
The Behaviour Change Wheel - Michie et al. 2011
The behaviour change wheel below provides a framework for designing and evaluating behaviour change interventions.
Sources of Behaviour
This wheel was developed from nineteen behaviour change frameworks, which has enabled the model to overcome limitations of previous frameworks [24].
It is centered on the COM-B model, which looks at sources of behaviour. It is widely recognised that successful interventions must target more than one of these sources [24].
This approach to hydration has the ability to address them all, as demonstrated below:
It is centered on the COM-B model, which looks at sources of behaviour. It is widely recognised that successful interventions must target more than one of these sources [24].
This approach to hydration has the ability to address them all, as demonstrated below:
Physical
Improved physical access to drinks e.g. modified utensils, accessibility of physical location Psychological Education to all individuals within the care home on the importance of hydration. |
Social
Social activities involving hydration - making it the norm to consume plenty of liquids. Physical Providing a varied selection of drinks on a regular basis. |
Reflective
Taking preferences into consideration, presenting food and drink attractively, providing flavours, promoting benefits and consequences through trusted 'messengers' Automatic Making consuming fluids the pre-set option [5] - Having food high in fluid part of menus, always providing drinks with meals, including hydration promoting activities |
When designing a hydration strategy, it is essential to include actions which address more than one of these sources of behaviour.
Intervention Functions
Potential actions fit into the following categories:
Policy Category
These intervention functions all fit into the policy category of:
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Environmental / Social Planning |
Nudge Theory
Elements of nudge theory are part of the Behaviour Change Wheel [24] and is particularly useful to consider within settings-based approaches [19].
MINDSPACE is a checklist for application of nudge theory [5]. Highlighted below are the key relevant elements of this checklist that should be considered within this intervention design.
MINDSPACE is a checklist for application of nudge theory [5]. Highlighted below are the key relevant elements of this checklist that should be considered within this intervention design.
We 'go with the flow' of pre-set options.
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Our acts are often influenced by sub-conscious cues.
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