A serious shortage of skills and resources is hindering the use of behavioural and cultural insights (BCI) in countries of the WHO European Region, reveals a study led by WHO/Europe’s BCI Unit jointly with the European Centre for Disease Prevention and Control (ECDC). Leveraging BCI in health policies, services, and communications offers an avenue for more effective and evidence-based solutions to address significant public health issues. Earlier this year, WHO/Europe issued the first status report on BCI implementation in the countries of Europe and central Asia, covering 2021–2022.
A follow-up interview study delved deeper into the barriers and drivers faced by public health authorities in the WHO European Region. During the interviews, BCI emerged as an effective and efficient mechanism to address health challenges, complementing other interventions. The study reveals a prevailing sense of dedication and optimism towards future BCI initiatives, with positive anticipation regarding the evolution of BCI practices in their respective countries over the next 5 years.
“This is a time of momentum, and we need to build on it because there is growing interest in applying a more evidence-based and more participatory approach to understanding and enabling health behaviours,” remarked Katrine Bach Habersaat, WHO/Europe’s Regional Advisor for BCI.
Growing commitment for future BCI work
Public health authorities from 23 Member States participated in the study, sharing their insights and experiences of working with BCI for health. They also shared their view of a WHO resolution in the field and a 5-year action framework with 5 strategic country commitments for Member States:
- build understanding and support for BCI among key stakeholders
- conduct BCI research
- apply BCI to improve outcomes of health-related policies, services and communication
- commit human and financial resources for BCI and ensure their sustainability
- implement strategic plan(s) to apply BCI for better health.
While recognizing that the BCI resolution, BCI action framework and reporting requirements together act as positive drivers of change, country representatives also identified significant barriers hindering the expansion of BCI work.
Addressing skills gaps and resourcing
Public health authorities emphasized the importance of addressing skills gaps to fulfill ambitious commitments, notably in relation to behavioural science, problem definition and understanding, and trialling and impact evaluation. Other key barriers cited were staffing inadequacies, financial constraints, and time limitations.
“The pandemic strained our health systems like never before, highlighting the need to channel resources where they can have the strongest impact,” said Robb Butler, Director of WHO/Europe’s Division of Communicable Diseases, Environment and Health. “Prioritizing BCI-informed methods, where we try to understand behaviours before addressing them, is a win-win and the most cost–effective and efficient way to address today’s health challenges. For too long, we have approached health-care provision as a top-down endeavour, but we must understand and engage with the recipient of health services as well as the provider, if we truly want to change behaviours for the better.”
These challenges impede the translation of evidence into policy interventions and the application of BCI findings in health policies, practices, and communications. Organizational culture and disjointed research-to-decision-making processes further compound these challenges.
“This domain remains underfunded, underexplored, and underutilized, necessitating increased investment and prioritization,” said John Kinsman, ECDC expert on social and behaviour change.
Looking ahead: priorities for advancing BCI work for health
Envisioning the future of BCI endeavours in health, respondents proposed a range of actions to overcome barriers and bolster BCI implementation.
Within countries, priorities include addressing skills gaps, allocating sustainable resources such as dedicated staff, funding, and time, strengthening the link between evidence and decision-making, and fostering organizational cultures conducive to effective knowledge translation. Meanwhile, within the WHO Regional Office for Europe, efforts should focus on establishing platforms for country dialogue, providing comprehensive training initiatives, advocating for BCI advancement in health, and contributing to building a robust evidence base.
About the BCI flagship initiative
The BCI Unit was established when WHO Regional Director for Europe Dr Hans Henri P. Kluge took office in 2020 and envisioned the integration of BCI into the European Programme of Work, setting it forth as a flagship initiative.
“Behaviours are at the heart of public health,” concluded Katrine Bach Habersaat. “Yet experts in health behaviour are often absent from health-care policy-making. This is slowly changing. Since its launch, the BCI flagship programme has progressed at rapid speed and is engaging with more and more countries that wish to use BCI to tackle critical health challenges, such as understanding low rates of breastfeeding or developing effective approaches for increasing cancer screening uptake among critical risk groups.”