Seppälä Tuija, Hankonen Nelli, Korkiakangas Eveliina, Ruusuvuori Johanna, Laitinen Jaana
Faculty of Social Sciences, University of Tampere, Linna, -33014, Tampere, FI, Finland.
Finnish Institute of Occupational Health, -00251, Helsinki, FI, Finland.
BMC Public Health. 2017 Aug 2;18(1):87. doi: 10.1186/s12889-017-4574-3.
Health policy papers disseminate recommendations and guidelines for the development and implementation of health promotion interventions. Such documents have rarely been investigated with regard to their assumed mechanisms of action for changing behaviour. The Theoretical Domains Framework (TDF) and Behaviour Change Techniques (BCT) Taxonomy have been used to code behaviour change intervention descriptions, but to our knowledge such "retrofitting" of policy papers has not previously been reported. This study aims first to identify targets, mediators, and change strategies for physical activity (PA) and nutrition behaviour change in Finnish policy papers on workplace health promotion, and second to assess the suitability of the Behaviour Change Wheel (BCW) approach for this purpose.
We searched all national-level health policy papers effectual in Finland in August 2016 focusing on the promotion of PA and/or healthy nutrition in the workplace context (n = 6). Policy recommendations targeting employees' nutrition and PA including sedentary behaviour (SB) were coded using BCW, TDF, and BCT Taxonomy.
A total of 125 recommendations were coded in the six policy papers, and in two additional documents referenced by them. Psychological capability, physical opportunity, and social opportunity were frequently identified (22%, 31%, and 24%, respectively), whereas physical capability was almost completely absent (1%). Three TDF domains (knowledge, skills, and social influence) were observed in all papers. Multiple intervention functions and BCTs were identified in all papers but several recommendations were too vague to be coded reliably. Influencing individuals (46%) and changing the physical environment (44%) were recommended more frequently than influencing the social environment (10%).
The BCW approach appeared to be useful for analysing the content of health policy papers. Paying more attention to underlying assumptions regarding behavioural change processes may help to identify neglected aspects in current policy, and to develop interventions based on recommendations, thus helping to increase the impact of policy papers.
卫生政策文件传播促进健康干预措施制定与实施的建议和指南。此类文件在其假定的行为改变作用机制方面鲜有研究。理论领域框架（TDF）和行为改变技术（BCT）分类法已用于对行为改变干预描述进行编码，但据我们所知，此前尚未有关于政策文件这种“改造”的报道。本研究旨在首先确定芬兰工作场所健康促进政策文件中身体活动（PA）和营养行为改变的目标、调节因素和改变策略，其次评估行为改变轮（BCW）方法用于此目的的适用性。
我们检索了2016年8月在芬兰有效的所有国家级卫生政策文件，重点关注工作场所背景下的PA促进和/或健康营养（n = 6）。使用BCW、TDF和BCT分类法对针对员工营养和PA（包括久坐行为（SB））的政策建议进行编码。
在六份政策文件及其引用的另外两份文件中，共编码了125条建议。心理能力、身体机会和社会机会被频繁提及（分别为22%、31%和24%），而身体能力几乎完全未被提及（1%）。在所有文件中均观察到三个TDF领域（知识、技能和社会影响）。在所有文件中都确定了多种干预功能和BCT，但有几条建议过于模糊，无法可靠编码。建议影响个人（46%）和改变物理环境（44%）的频率高于影响社会环境（10%）。
BCW方法似乎有助于分析卫生政策文件的内容。更多关注行为改变过程的潜在假设可能有助于识别当前政策中被忽视的方面，并根据建议制定干预措施，从而有助于提高政策文件的影响力。
