Behavioural science and financial capability : designing and testing complex interventions

Financial capability is a multifaceted concept that describes the skills and knowledge of managing one’s financial resources. This area has seen recent interest in identifying the underlying factors due to the increasing responsibility placed upon consumers. Policy makers typically use financial education to improve financial behaviours (based on economic assumptions), which has demonstrated mixed effects. To develop more reliable methods, the current thesis uses a comprehensive model of behaviour to understand the barriers and facilitators of financial capability, in addition to developing and testing interventions to improve financial capability. The first chapter provides a conceptual review of financial capability through a behavioural science lens, to understand why greater financial literacy may not translate to optimal financial behaviours. The second chapter details the behavioural framework used in the thesis in greater depth, the third chapter details some of the issues why individuals fail to maintain their goals under the concept of cognitive control. In the fourth chapter I present secondary analyses of previously conducted formative research identifying several key behavioural mechanisms affecting people’s financial capability. Firstly, individuals often fail to keep within their means due to automatic mechanisms to improve their social rank amongst peers. Secondly, individuals often struggle to save for the future due to deficits in more reflective mechanisms, e.g., goal-directedness. I provide a behavioural diagnosis from these findings in chapter five, from which I design and pilot three intervention. The pilot study’s findings are then used to inform the design of a randomized control trial. The sixth chapter details a multi-site randomised-controlled trial. This trial uses Goal-Setting and Habit-Based interventions to improve participants’ financial capability, measured via their consumption, account balances, and savings. The Goal-Setting group demonstrated significant improvements across all three measures. In contrast, the Habit-Based group improved only in their account balances compared to the Control group. The seventh chapter examines the moderating effects of individual differences which have been previously demonstrated to account for variations in consumption and savings. These results demonstrate that higher levels of goal-directedness can improve reductions in monetary consumption

A Randomized Controlled Trial to Evaluate Interventions Designed to Improve University Students’ Subjective Financial Wellness in England

The current paper describes a randomized controlled trial to evaluate the effectiveness of intervention tools designed to help people save more or spend less money by enhancing their capabilities, motivations, and opportunities. The participants included 177 students from an English University who were randomly allocated to either the Control, Savings-Tool, or Savings+Habit-Tools group. Participants provided with the intervention tool(s) for four weeks were more likely to experience improvements in both their financial satisfaction and subjective perceptions than those in the Control group not asked to use either tool. The tools did not significantly affect financial behaviors or objective financial wellness. The discussion examines limitations of the study and discusses avenues for future research such as including a longer follow-up period

Digital cognitive behavioural therapy intervention in the workplace:study protocol for a feasibility randomised waitlist-controlled trial to improve employee mental well-being, engagement and productivity

INTRODUCTION: One in six workers experience some form of mental health problems at work costing the UK economy an estimated £70 billion/year. Digital interventions provide low cost and easily scalable delivery methods to implement psychological interventions in the workplace. This trial tests the feasibility of implementing a self-guided 8-week digital cognitive behavioural therapy intervention for subthreshold to clinical depression and/or anxiety versus waitlist control (ie, life as usual) in the workplace. METHODS AND ANALYSIS: Feasibility of implementation will be tested using a mixed-methods evaluation of the two-arm randomised waitlist-control trial. Evaluation will include examination of organisational buy-in, and the engagement of employees through the trial indicated by the completion of outcome measures. In addition, we also explore how participants use the platform, the appropriateness of the analysis both with reference to the outcome measures and linear modelling. Finally, we examine the acceptability of the intervention based on participants experiences using qualitative interviews. Assessments take place at baseline (T0), at 8 weeks post-treatment (T1), at short-term follow-up 4 weeks post-treatment (T2) and long-term follow-ups (6 and 12 months after-end of treatment). We will recruit from 1 July 2021 to 31 December 2021 for employees and self-employed workers with depression and anxiety symptoms (subclinical and clinical levels) who are not seeking or engaged in treatment at the time of the trial. ETHICS AND DISSEMINATION: Full approval was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20–21). The current protocol version is 2.8 (August 2021). Publication of results in peer-reviewed journals will inform the scientific, clinical and business communities. We will disseminate results through webinars, conferences, newsletter as well as a lay summary of results on the study website (mhpp.me). TRIAL REGISTRATION NUMBER: ISRCTN31161020

Supporting employers and their employees with mental hEalth conditions to remain eNgaged and producTive at wORk (MENTOR):A feasibility randomised controlled trial

Employees with mental health conditions often struggle to remain in employment. During the COVID-19 pandemic, these employees faced additional stressors, including worsening mental health and work productivity. In 2020, as part of a larger programme of work called the Mental Health and Productivity Pilot (MHPP), we developed a new early intervention (MENTOR) that jointly involved employees, managers, and a new professional (Mental Health Employment Liaison Worker (MHELW). The intervention involved trained MHELWs delivering ten sessions to employees with existing mental health conditions and managers (three individual sessions and four joint sessions) over twelve weeks. These sessions aimed to improve psychological flexibility, interpersonal relationships, and engagement of employees. This feasibility randomised controlled trial aimed to examine the feasibility and acceptability of the intervention from the perspective of employees and managers using a mixed methods approach. The intervention was largely considered feasible and acceptable. Initial findings suggest there may be benefits for employee's productivity, mental health, and managers mental health knowledge. Logistical challenges acted as a barrier to the participation and retention of participants in the trial. The major strengths of this study were the co-design and inter-disciplinary approach taken. Overall, findings suggest that this novel intervention has potential but needs some adjustments and testing in a larger sample

Diagnostic validity of behavioural and psychometric impulsivity measures : an assessment in adolescent and adult populations

This investigation examined how different psychological and behavioural measures can be used to identify impulsive individuals. Five clinical groups split, between adolescents and adults, with varying levels of weight-management issues, were used to validate the impulsivity measures. The measures consisted of two behavioural, an inhibitory control measure (Stop Signal Task) and a Temporal Discounting measure, along with two personality measures, the Temperament and Character Inventory (Cloninger, Przybeck, Svrakic, & Wetzel, 1994) and the adolescent version (The Junior Temperament and Character Inventory) and finally the Barrat Impulsivity Scale (Patton, Stanford, & Barratt, 1995). The most sensitive was the Stop Signal Reaction time, which depicted significant differences in inhibitory control for all but two groups (Adult Lifestyle and Adult Healthy). The psychometric scales were able to sufficiently discriminate between obese and impulsive individuals with healthier participants. The Self-Control and Novelty Seeking subscales on the BIS. The Novelty Seeking subscale of the TCI-R and the JTCI, significantly discriminated between obese and healthy individuals. There was a high degree of association amongst the measures used, identifying that these measures can be used to monitor and measure impulsiveness in obese individuals for use in weight-loss interventions

Co-designing theoretically informed, conceptual prototypes for interventions to increase hand hygiene in hospital settings : a case study

This case study describes a design thinking workshop to develop conceptual prototypes for interventions that may increase hand hygiene in hospital settings. The workshop was held in London, United Kingdom. The workshop brought together nurses, doctors, and infection prevention/control staff with experience working in hospital settings along with behavioural scientists and designers with experience developing theoretically informed interventions. After the workshop, a core design team synthesised the initial conceptual prototypes into a set of five more distinct conceptual prototypes that can inform future interventions. Stanford d.School’s five-stage model was used to capture the design thinking process. We propose additional workshops should be conducted wherein multidisciplinary teams of relevant stakeholders (including patients) co-design novel solutions for enduring problems

Process evaluation protocol for the SLEEP study: a hybrid digital CBT-I intervention for working people with insomnia

Introduction: The Supporting Employees with Insomnia and Emotional Regulation Problems (SLEEP) pilot uses hybrid digital Cognitive Behavioural Therapy for Insomnia (CBT-I) to help working people address their sleep and emotion regulation problems, using cognitive, behavioural, and psychoeducation techniques. A process evaluation within this trial will improve our understanding of how the intervention brought about change, including identifying barriers and facilitators to engagement and subsequent change, and the extent to which contextual factors played a role. Methods and analysis: This qualitative process evaluation will use semi-structured interviews, conducted via online videoconferencing, to explore participant experiences of the SLEEP intervention. Twenty-five participants who completed the SLEEP intervention (16 %) will be randomly sampled. Interviews will be analysed using a thematic and framework analytic approach. A codebook style thematic analysis will be used, and a framework focusing on the research questions will be applied to the codebook. The final report will present themes generated, alongside the finalised codebook. The report resulting from this research will adhere to CORE-Q quality guidelines. Ethics and dissemination: Full approval for the SLEEP study was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20-21). All data collection adheres to data collection guidelines. Participants provided written informed consent for the main trial, and all interviewees provided additional written and verbal (audio-recorded) consent. The results of the process evaluation will be published in a peer-reviewed journal and presented at conferences. A lay report will be provided to all participants. Trial registration: ISRCTN13596153; Pre-results

Supporting employers and their employees with Mental hEalth problems to remain eNgaged and producTive at wORk (MENTOR): A feasibility randomised controlled trial protocol.

Employees with mental health problems often struggle to remain in employment. During the COVID-19 pandemic, these employees face multiple additional stressors, which are likely to worsen their mental health and work productivity. Currently, it is unclear how to best support employees with mental health problems (and their managers) to improve wellbeing and productivity. We aim to develop a new intervention (MENTOR) that will jointly involve employees, managers, and a new professional (mental health employment liaison worker, MHELW), to help employees who are still at work with a mental health condition and currently receiving professional support for their mental health. A feasibility pilot study will then be undertaken to examine the feasibility and acceptability of the intervention from the perspective of employees and line managers. The study involves a feasibility randomised controlled study comparing outcomes of participants randomised to receive the intervention (MENTOR) with wait-list controls. Participants allocated to the waitlist control group will receive the intervention after three months. We aim to randomise 56 employee-manager pairs recruited from multiple organisations in the Midlands region of England. An intervention including 10 sessions for employees and managers (3 individual sessions and 4 joint sessions) will be delivered over 12 weeks by trained MHELWs. Primary outcomes include measures of feasibility and acceptability of the intervention and work productivity. Secondary outcomes include mental health outcomes. Qualitative interviews will be undertaken with a purposively selected sub-sample of employees and line managers at three-month post-intervention assessment. To our knowledge, this will be the first trial with a joint employee-manager intervention delivered by MHELWs. Anticipated challenges are dual-level consent (employees and managers), participants' attrition, and recruitment strategies. If the intervention and trial processes are shown to be feasible and acceptable, the outcomes from this study will inform future randomised controlled trials. Trial registration: This trial is pre-registered with the ISRCTN registry, registration number: ISRCTN79256498. Protocol version: 3.0_March_2023. https://www.isrctn.com/ISRCTN79256498

Role descriptors of the MHELW.

Employees with mental health problems often struggle to remain in employment. During the COVID-19 pandemic, these employees face multiple additional stressors, which are likely to worsen their mental health and work productivity. Currently, it is unclear how to best support employees with mental health problems (and their managers) to improve wellbeing and productivity. We aim to develop a new intervention (MENTOR) that will jointly involve employees, managers, and a new professional (mental health employment liaison worker, MHELW), to help employees who are still at work with a mental health condition and currently receiving professional support for their mental health. A feasibility pilot study will then be undertaken to examine the feasibility and acceptability of the intervention from the perspective of employees and line managers. The study involves a feasibility randomised controlled study comparing outcomes of participants randomised to receive the intervention (MENTOR) with wait-list controls. Participants allocated to the waitlist control group will receive the intervention after three months. We aim to randomise 56 employee-manager pairs recruited from multiple organisations in the Midlands region of England. An intervention including 10 sessions for employees and managers (3 individual sessions and 4 joint sessions) will be delivered over 12 weeks by trained MHELWs. Primary outcomes include measures of feasibility and acceptability of the intervention and work productivity. Secondary outcomes include mental health outcomes. Qualitative interviews will be undertaken with a purposively selected sub-sample of employees and line managers at three-month post-intervention assessment. To our knowledge, this will be the first trial with a joint employee-manager intervention delivered by MHELWs. Anticipated challenges are dual-level consent (employees and managers), participants’ attrition, and recruitment strategies. If the intervention and trial processes are shown to be feasible and acceptable, the outcomes from this study will inform future randomised controlled trials. Trial registration: This trial is pre-registered with the ISRCTN registry, registration number: ISRCTN79256498. Protocol version: 3.0_March_2023. https://www.isrctn.com/ISRCTN79256498.</div