A reflection on the co-design approach to the development of the Medway Can campaign; a whole systems approach to obesity prevention using COM-B

Figures & data

Figure 1. COM-B model adapted from Michie et al., 2011.

Table 1. Format of codesign sessions.

	Stakeholder group	Community group	School children group
Discover	Stakeholders were asked to identify groups or individuals who might need support to manage weight-related behaviours	Community members were asked to write down the drivers of and barriers to healthy weight behaviours. They were asked to ‘map’ the decision-making process for an example behaviour (e.g., physical activity)	Children were asked to write down keywords that they thought helped or prevented people from being active or eating healthily. They used parents, carers, and teachers as examples of people who might engage in these behaviours.
Define	Stakeholders were asked to identify potential interventions, messaging and campaign activities that might support these behaviours	Community groups were asked to write, draw and storyboard examples of things that would support the needs they had identified in the ‘define’ activity	Children were shown logos and campaign assets from past campaigns and then asked to creatively design their own.
Develop	Stakeholders were asked to appraise past campaigns, messaging copy, campaign name examples, and logos	Community members were asked to appraise past campaigns, messaging copy, campaign name examples, and logos	Children were asked to appraise past campaigns, messaging copy, campaign name examples, and logos
COM-B	Identify capability, opportunity or motivation gaps from stakeholder perspective, with particular focus on things which they can support with such as physical opportunity (through provision of services), and psychological capability (through messaging and providing information)	Identify capability, opportunity and motivation gaps unique to the target audience with particular focus on psychological capability (is there awareness of the issue), and motivation (are health related behaviours a priority?)	Identify capability, opportunity and motivation gaps unique to children such as psychological capability (is there an understanding?), social opportunity (are they supported by schools, peers, family, etc.?) and physical opportunity (child-friendly facilities and services, etc.)

Figure 2. The Medway Can brand, utilising the colour palette and shapes symbolising movement according to co-creation sessions.

Figure 3. Strategic approach to campaign bursts.

Table 2. Behaviour change techniques (BCTs) and corresponding campaign strategies.

BCT and code	Targeted construct or mechanism of action	Intervention/campaign strategy	Rationale
1.1 and 1.3 Goal setting (behaviour and outcome)	Intrinsic motivation; Intention	A tool embedded in the Medway Can website enables users to set their own goals.	Individuals lack motivation for physical activity- goal setting supports internalising of the behaviour.
1.2 Problem solving	Self-efficacy; beliefs about capability.	The campaign will give examples of “reframed” physical activity goals that address barriers such as time and access to facilities (e.g., using stairs at home to exercise).	Barriers such as lack of time were identified and need trouble-shooting to enable engagement with the behaviour.
2.1 Monitoring of behaviour by others without feedback and 2.3 self-monitoring of behaviour	Goals; motivation; behavioural regulation	The campaign landing page will enable users to track their progress and the progress of Medway as a community	Lack of motivation was identified as a key barrier to health behaviours.
1.8 Behavioural contract	Goals; motivation	Pledges can be made as part of the campaign	Lack of motivation was identified as a key barrier to health behaviours.
3.1 Social support (unspecified)	Social influences; motivation through relatedness	Medway Can offers community challenges to promote a sense of relatedness	Lack of perceived social opportunity was identified as a barrier to health behaviours.
6.1 Demonstration of the behaviour	Beliefs about capabilities; self-efficacy; competence	The first phase of the campaign will use ‘case study’ examples.	Low perceived physical capability is evident in specific groups such as people with disabilities.
6.2 Social comparison and 9.1 credible source	Subjective norms; social influences	The campaign will use relatable messengers and local people.	Co-production sessions showed that participants wanted messengers to be “people like us.”
7.1 Prompts/cues and 8.3 habit formation	Memory; attention; behavioural cueing; environmental context; behavioural regulation	Touch points for the campaign will focus on strategic placement to “remind” people to get active or make healthy nutrition choices; nudges to make healthy choices easier.	Automatic motivation (habits, for example) was described as lacking in codesign sessions.
13.2 Framing/reframing	Self-image; attitude towards the behaviour; self-efficacy; competence	The campaign will offer different ways of being active so that the “challenge” is more approachable (examples such as how many times you need to go up and down the stairs to meet recommended guidelines). The aim is to show people that they can find their own way to be active.	Low motivation and perceptions of physical capability were determined as key barriers to health behaviours.
15.3 Focus on past success	Beliefs about capabilities; self-efficacy; competence.	Phase 1b of the campaign will involve “sharing success stories” from phase 1a	Low perceived physical capability was identified as a barrier to health behaviours

Figure 4. Medway Can website strategy.

Figure 5. A Celebratory post on the Medway Can website congratulates residents on their ‘around the world’ achievement.

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 1–12. https://doi.org/10.1186/1748-5908-6-42

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