helping patients change behaviour: models of behaviour change

block two week 3 socpop

health behaviours

Health behaviours are behaviours related to an individual’s health status.

categories of health behaviour

• Good health behaviours

  • Sleeping 7–8 hours

  • Regular exercise

  • Healthy diet and eating breakfast

• Health-protective behaviours

  • Wearing seatbelts

  • Attending screening and health checks

• Health-impairing behaviours

  • Smoking

  • High-fat diet

  • Alcohol misuse

why all patients don’t change behaviour

• Habit: Behaviour change requires effort and breaking habits.

• Fear and lack of skills: Patients may feel unable to change.

• Information alone is ineffective.

• Short-term vs long-term benefits: Long-term gains may reduce motivation.

• Being told what to do: Can cause frustration and disengagement.

• Motivation: Skills and knowledge are insufficient without motivation.

social cognition theories

• attempt to explain the relationship between social cognitions (beliefs, attitudes, goals) and behaviour

  • health belief model (rosenstock, 1966)

  • theory of plannes behaviour (ajzen, 1988)

  • transtheoretical model (prochaska and diclemente, 1983)

  • COM-B model

health belief model

using HBM in the clinical practice

• need to explore patient’s perceived susceptibility, severity, benefits and barriers

• use education for perceptions of threat and goal setting/action planning and problem solving to help overcome barriers

e.g of HBM for smoking

• how do you think smoking is affecting your health? (current susceptibility)

• how might it affect your health in ten years time? (future susceptibility)

• what would it be like if that happened to you/you got the illness (severity)

• exploring perceived susceptibility and severity

  • educate pt about risks of smoking which can increase perceived susceptibility and severity

• perceived benefits and barriers

  • what are the pros and cons of smoking for you

  • is there anything stopping you from giving up

• work with the pt to problem solve and overcome barriers

HBM example for COVID

• Health messaging targeted perceived susceptibility, severity, benefits, and barriers.

• Highlighted importance of acknowledging barriers alongside benefits.

theory of planned behaviour

Behaviour determined by behavioural intention.

components of TPB

1. Attitude – beliefs and outcome evaluations

2. Subjective norms – influence of others and motivation to comply

3. Perceived behavioural control – skills, confidence, and external barriers

• Perceived behavioural control is the strongest predictor.

• Predicts 55–71% of health behaviour intentions.

  clinical use:

• Explore attitudes, norms, intentions, and control.

• Support problem-solving or planning depending on perceived control.

using TPB in clinical practice

• TPB can predict between 55-71% of intentions for these health related behaviours: smoking, testicular cancer, self examination, exercise, diet and oral hygiene

• explore attitude: what do you think about smoking? is smoking good/bad for you and in what way?

• explore perceived norms: what do your family think about smoking

• whose opinion is most important to you: motivation to comply

• would you like to give up smoking for :

using TPB in clinical practice continued

explore intentions:

• have you ever thought about giving up smoking

• do you intend to give up smoking in the next few months

explore perceived behavioural control

• do you think you can give up smoking

• if control is low, you can explore further by asking why

• if perceived control is high, ready to attempt behaviour change and then work with patient to plan next steps

transtheoretical model (stages of change)

stages of change

the behaviour change wheel

the COM-B model

• Capability: physical and psychological skills

• Opportunity: physical and social environment

• Motivation: reflective (planning, intentions) and automatic (habits, emotions)

• All three interact to influence behaviour.