Behavior Change Theories

health behavior

an action taken by a person to maintain, attain, or regain good health and to prevent illness

example of a health behavior

washing hands

taking medications

diet

exercise

intrapersonal and interpersonal considerations for making a behavior change

behavior is mediated by cognitions; that is, what people know and think affects how they act

knowledge is necessary for, but not sufficient to, produce most behavior changes

perceptions, motivations, skills, and the social environment are key influences on behavior

behavior change theories

knowledge-attitude-behavior model

health belief model

the theory of planned behavior (TPB)

the stages of change (transtheoretical) model --> motivational interviewing

knowledge-attitude-behavior model

change in knowledge--> change in attitude --> change in behavior, assuming that behavior change is slow

pedagogical approach

weak scientific support, but comfortable for the expert

knowledge vs. skills

cigarette smoker example of the knowledge-attitude-behavior model

sees ad campaign about how smoking causes lung cancer and tooth decay --> thinks to himself that doesn't sound fun, I don't want to deal with lung cancer --> purchases nicotine patch and starts to cut back on smoking

health belief model

assumes health behaviors are based on:

- the desire to avoid illness/get well from illness

- the belief that a specific action will prevent/cure an illness

6 constructs of the health belief model

1. Perceived susceptibility

2. Perceived severity

3. Perceived benefits

4. Perceived barriers

5. Cues to action

6. Self-efficacy

Perceived Susceptibility

is this really going to happen to me?

perceived severity

what are the physical and/or social consequences?

percieved benefits

is it worth it to change?

percieved barriers

what are the obstacles to changing my behavior?

self-efficacy

level of confidence in ability to change

cues to action

stimulus that triggers the decision-making process

theory of planned behavior

behavior is based on one's intention to perform the behavior

behavioral intent is a function of 3 determinants:

- attitude toward behavior

- subjective/social norms

- perceived behavioral control

attitude toward behavior

positive/negative feelings toward the behavior, past successes/failures, possible outcomes of performing the behavior

subjective/social norms

beliefs about how family, friends, society will view the individual if they perform the behavior

perceived behavioral control

individual's perception of how easy/difficult it will be to perform the behavior

increases when individual has more resources and confidence

the stages of change model

Prochaska and DiClemente Transtheoretical Model of Change

assumptions:

- behavior change involves a series of steps or stages

- common stages exist across a variety of health behaviors

- individuals can move between stages in both directions

the 5 stages of change

1. Pre-contemplation - unaware/uninterested in change

2. Contemplation - thinking about a change (within 6 months)

3. Preparation - actively decides and plans to change (within 1 month). may have tried change before

4. Action - making change for less than 6 months

5. Maintenance - sustaining change for 6 months or more

strategies for the pre-contemplation stage

encourage the patient to self-analyze and rethink his/her behavior

explain risks of current behavior

strategies for the contemplation phase

weigh the pros and cons of changing behavior

address barriers and encourage confidence

strategies for the preparation phase

prepare an action plan or goal, motivate the patient to change

strategies for the action phase

encourage the patient to seek social support and motivate him/her to sustain the behavior

reward for success

strategis for the maintenance phase

strategies to cope with temptation, reward for the success

motivational interviewing

a collaborative, person-centered form of guiding to elicit and strengthen motivation for change

an effective way of talking with people about change

aspects of motivational interviewing

client-centered - help them help themselves to build commitment and change behaviors

requires assessing stages of change

might include assisting with client-generated realistic goals and strategies

use open-ended questions

RULE acronym

Resist: resist the urge to tell your patient how to fix (unsolicited)

Understand: what are their motivations

Listen: with empathy. Acceptance facilitates change

Empower: belief in the ability to change is an important motivator

scaling

a counseling skill in which the patient is asked to rate on a scale of 1-10 the following two items:

- how important it is to them to make a particular behavior change

- their confidence in their ability to make a particular behavior change

follow-up questions for scaling

"What made you pick a 2 and not a 10?"

"What would need to happen to bring your confidence from a 3 up to a 9?"

benefits of scaling and motivational interviewing

allows patients the opportunity to reflect on their values and self-efficacy

allows the patient/provider to focus efforts on making changes that are important to the patient

initiates conversation about potential barriers to success