Behaviour change: The key to implementing evidence on COPD prevention, diagnosis and management

Abstract

Translating clinical evidence into prevention behaviours and healthcare practice is complex and difficult. In healthcare systems, this translation (or ‘implementation’) involves someone doing something differently: the CEO endorses a local policy; a healthcare team clarifies members’ responsibilities; a clinician discusses prevention strategies with a patient; the patient quits smoking. In other words, implementation requires behaviour change. We know that changing behaviour is difficult, but not impossible. Empirical research and theoretical development in behavioural science show that some behaviour change techniques are likely more effective than others, and that these effects depend on contextual, organizational and personal factors. Implementation science (the study of methods to support uptake of evidence-based interventions into practice and policy to improve health) draws on bodies of knowledge from behavioural science, organizational disciplines and systems thinking to design interventions to support change. Nonetheless, ‘implementation interventions’, even if plausible, require evaluation to identify whether they are effective and cost-effective. Randomized evaluations of implementation interventions show that they can be effective. For example, reviews published by the Cochrane group, Effective Practice and Organisation of Care (EPOC; https://epoc.cochrane.org/), show positive effects on clinical behaviour change resulting from implementation strategies such as audit-and-feedback, clinical pathways or reminder systems. However, the heterogeneity around effects sizes is large and unexplained. There is still much to learn about how implementation strategies can be optimized to support changes in clinical practice and health behaviour. As we mark the World COPD Day on 17 November 2021, embracing the theme of ‘Healthy Lungs: Never More Important’, this is an opportune time to reflect on improving behaviour change and implementation strategies for the care of people living with chronic obstructive pulmonary disease (COPD). These principles can be broadly applied to prevention, biomarkers, diagnosis and management of COPD.