Module 6

• Unpacking barriers and facilitators to the WHAT

HOWs are the change strategies you can use to support people to change their behavior.

Selecting HOWs relies on a firm understanding of peoples’ barriers and facilitators to creating change, specifically, to doing each of your different WHATs.

To understand barriers and facilitators, it is important to avoid making assumptions. You want to ask the people who are being asked to change their behavior about their barriers and facilitators.

Understanding barriers and facilitators can be an iterative process. Ultimately, you are aiming to understand the root causes of why people are or are not ready to change their behaviour.

A theory of change tells us the mechanism by which we can support people to change their behavior. A great example of a theory of change is the COM-B. The COM-B tell us that in order for people to change their behavior:

• They need to be capable of change (i.e., do they have the necessary knowledge and skills)
• They need to have the opportunity to change (i.e., does their environment support the change)
• They need to be motivated to change (i.e., do they want to change)

You can use the COM-B (and the Theoretical Domains Framework) to understand barriers and facilitators to change. This will ultimately enable you to pick strategies that directly support people to change their behaviour.

Action: If you have a clearly defined WHAT or set of WHATs, the next step is to assess barriers and facilitators to each of those WHATs. You will need to engage with each of your WHOs to do this. If you have not selected a theory of change, the COM-B and TDF are easy and intuitive to use.

• Taking a deep dive into barriers and facilitators

The Theoretical Domains Framework (TDF) enables you to further break down peoples’ barriers and facilitators to change.

The TDF unpacks each component of the COM-B. For example, within the capability component of the COM-B, the TDF highlights that there are four domains of capability (knowledge, skills, memory, attention and decision processes, and habits).

When collecting information on barriers and facilitators, it is also important to consider equity. It is particularly important to make sure that you:

• Engage with the people impacted by and implementing the change. You are seeking to understand what they feel, what they think, and what they are experiencing.
• Consider whether differences between groups. For example, are different groups of people experiencing different kinds of barriers and facilitators.

The better you understand the barriers and facilitators to change that are operating in your implementation setting, the better you’re able to select and tailor strategies to support behaviour change.

Action: Once you have assessed barriers and facilitators to each of your WHATs, use the COM-B and/or the COM-B to categorize them.

• Selecting strategies to overcome barriers and leverage facilitators

Selecting strategies to support behaviour change comes after you have a well-defined WHAT (or sets of WHATs) and you have assessed barriers and facilitators to each WHAT.

The aim of selecting strategies is that they help people overcome their barriers to doing the WHAT and leverage their facilitators to doing the WHAT. This is how change happens. Assessing barriers and facilitators in your implementation setting and then linking them to the strategies you select to support behaviour change helps you avoid making assumptions about how change will happen.

If you use the COM-B and/or TDF to understand your barriers and facilitators, you can select change strategies that are connected to each of their components.

The strategies highlighted here are broad categories (e.g., education, training, modelling). The next step is to dig deeper and get more specific so you can define strategies that will be helpful and effective in your implementation setting. Some things you can consider when doing this are:

• The fit of the strategy in the implementation setting
• The acceptability of the strategy
• The feasibility of the strategy

After selecting your HOWs, you will need to consider how to operationalize them (e.g., who is going to do them, when will they be introduced, in what context will they be introduced). Sometimes, it can be helpful to consider this when selecting your strategies. If a change strategy is difficult to operationalize, it may be preferable to select an alternative that is more straightforward.

Action: Once you have categorized the barriers and facilitators to each of your WHATs, you can use the table above to help you understand the types of strategies you can use to address your barriers and leverage your facilitators. You will need to spend some additional time with your team thinking through the specifics of the strategies you select