Behavior change theories healthcare

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This poses a significant challenge to changing these behaviors. To design effective interventions with which to change behavior, it is useful to understand the theories and models of behavior change. This article will cover the leading theories and models, as well as an interesting study and some simple techniques to help your clients change their behavior.

Before you continue, we thought you might like to download our three Goal Achievement Exercises for free. These detailed, science-based exercises will help you or your clients create actionable goals and master techniques to create lasting behavior change. Behavioral change is about altering habits and behaviors for the long term. These changes can have knock-on effects on the health of others Swann et al. Other behaviors that are the target of change interventions are those affecting the environment, for example:.

These are just a few examples of behavior changes that many have tried at some time in their lives. Some changes may be easy, but others prove quite challenging. There are many theories about behavior and behavior change. In a literature review by Davis et al. We will discuss the most frequently occurring theories and models in this article.

Fishbein and Ajzen developed the theory of reasoned action in the s. In the s, Ajzen extended this model to incorporate perceived behavioral control as an influencer of intention and sometimes as a direct influence on behavior Madden et al. This extended model is known as the theory of planned behavior and accounts for more variation in behavior change than the theory of reasoned action Madden et al.

The image above, adapted from Madden et al. The social cognitive theory, proposed by Bandura in , is an expansion of his earlier social learning theory, in which he states that many behaviors are learned by observing others in our social environment Bandura, For us to adopt a behavior, we have to pay attention to the behavior being modeled, remember it, and reproduce it. We may be rewarded for this, which reinforces the behavior, or punished, which reduces the likelihood we will do it again.

However, Bandura acknowledged that there is more to adopting a behavior than this. He expanded his theory to include personal factors of the individual: cognitive, affective, and biological. Bandura emphasizes that we are the agents of our own development and change, and our perceived self-efficacy and outcome expectations play an important role in determining our actions.

Our social surroundings can aid or inhibit our goals by providing opportunities or imposing restrictions, which in turn can affect our perceived self-efficacy and outcome expectations for next time Bandura, Theories can be used to build models and frameworks that have more practical applications and can be used to develop interventions. Three frequently occurring models are explained below.

Otherwise known as the stages of change , this is the most frequently occurring model in the literature. Identifying the stage an individual is in helps health professionals, coaches, and therapists provide targeted interventions for that stage.

They propose three key factors that influence behavior change:. Information includes automatic thoughts about a behavior as well as consciously learned information. Motivation includes both personal motivation , the desire to change behavior for oneself, and social motivation, the desire to change behavior to fit into the social environment. Information and motivation influence behavioral skills, which include objective skills and perceived self-efficacy.

The combination of information, motivation, and behavioral skills influences behavior change see image below. As a helping professional, increasing the amount of information your client has, helping them find their motivation, or increasing their objective behavioral skills or perceived self-efficacy could help them change their behavior. In , Michie, van Stralen, and West pulled together different behavior change frameworks to create a behavior change wheel.

The aim of this was to provide guidance for policy makers and those performing behavioral interventions, based on the existing evidence. The hub of this wheel, the most relevant part for us, involves three conditions: capability, opportunity, and motivation.

These components have been put together to form the COM-B model, where opportunity and capability influence motivation, and all three factors influence behavior. Improving any of these areas could help your client change their behavior. In a fascinating study, Verplanken and Roy tested the habit discontinuity hypothesis, which suggests behavioral changes are more likely to be effective when undertaken in a period when there are already significant life changes occurring.

They wanted to see if interventions to promote sustainable behaviors were more likely to induce behavior change in people who had recently moved. They studied participants, half of whom had moved within the previous six months. The other half lived in the same areas and were matched for home ownership, house size, access to public transport, and recycling facilities, but had not recently moved. The researchers gave an intervention on sustainable behaviors to half of the movers and half of the non-movers, and compared self-report data on behaviors before and after the intervention.

This supports the habit discontinuity hypothesis: behavioral changes are more likely when individuals are already undergoing significant life changes. The process of change can seem daunting, and many people find it difficult. It is important to remember that change is a process and not a one-off event. It can be difficult to make large changes in one step, but breaking up a large goal into smaller parts takes planning and commitment.

If there are no immediate rewards for changing a behavior, or if there are immediate costs, such as nicotine cravings when quitting smoking, this can make it difficult to stay motivated.

This is why it is helpful to identify these issues in advance and create plans for when they occur. As described in the theories and models above, there are many elements at play that determine how successful a behavior change will be. Having the intention does not necessarily translate into the behavior Gollwitzer, A meta-analysis by Webb and Sheeran found that a medium-to-large change in intention leads to a small-to-medium change in behavior, known as the intention—behavior gap.

Although models provide a useful, evidence-based background for behavioral interventions, it is helpful to have behavior change techniques to apply these ideas.

It is a way to create new habits and has been effective in a multitude of situations Gollwitzer, Motivational interviewing helps individuals gain clarity in their thoughts and motivations for change, and identifies barriers to change so that solutions can be considered.

This is known as change talk. Motivational interviewing is a process of guiding rather than directing, helping a client to identify their strengths and goals, and improving their sense of self-efficacy and autonomy.

In this nine-minute talk, American psychiatrist, neuroscientist, and author Judson Brewer suggests that mindfulness can be a useful method in behavior change. He invites us to notice our urge toward a certain behavior, be curious about why we have the urge, and decide whether the behavior is truly rewarding or whether we can let it go. On our site, we have several resources that are invaluable for implementing behavior changes.

To help, check out some of the following:. If your aim is to design interventions that are effective in helping clients change their behavior, then understanding the theories and models of behavior change is a useful first step. Behavior change is more complicated than having the knowledge or even the right intentions to behave a certain way. We hope that this article gave you the guidance, inspiration, techniques, and resources you need to help your clients implement change.

About the author Nicole is a behavioral scientist and writer based in Perth, Western Australia. Her research interests lie at the intersection between wellbeing, personal energy, and positive psychology, and her work appears in several top business journals, including the Journal of Organizational Behavior. How useful was this article to you? Not useful at all Very useful 1 2 3 4 5 6 7 8 9 10 Submit Share this article:.

It is also known as social and behavior change communication, or SBCC. The assumptions is that through communication of some kind, individuals and communities can somehow be persuaded to behave in ways that will make their lives safer and healthier.

From Wikipedia, the free encyclopedia. Efforts to change people's personal habits to prevent disease. Main article: Social and behavior change communication. This section does not cite any sources. Please help improve this section by adding citations to reliable sources.

Unsourced material may be challenged and removed. August Learn how and when to remove this template message. Motivational interviewing Goal oriented technique for eliciting and strengthening intrinsic motivation for change. Behavioral contract Intent formation, making a commitment, being ready to change. Behavioral capabilities Skill development through practice, modeling, imitation, reenacting, rehearsing.

Choices Building autonomy and intrinsic motivation through relevance, interests and control Graded tasks Planning ahead Anticipate barriers Problem solving Self-reporting Self-adjustment Rewards Stimulus control Social support. Retrieved February Retrieved Archived from the original on Private Sector Partnerships.

SAID project focused on increasing the private sector's role in providing high-quality health products and services in developing countries. Barrier Analysis website. Designing for Behavior Change Curriculum. PMID Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors.

Applied Psychology: An International Review, 57 1 , 1— Clinical Nurse Specialist. PMC American Journal of Health Promotion. S2CID Health Education Quarterly. The Journal of Psychology.

ISSN John Snow Inc.

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The stages by which a person adopts an innovation, and whereby diffusion is accomplished, include awareness of the need for an innovation, decision to adopt or reject the innovation, initial use of the innovation to test it, and continued use of the innovation.

There are five main factors that influence the adoption of an innovation , and each of these factors is at play to a different extent in the five adopter categories. There are several limitations of Diffusion of Innovation Theory, which include the following:. This theory has been used successfully in many fields including communication, agriculture, public health, criminal justice, social work, and marketing. In public health, the Diffusion of Innovation Theory is used to accelerate the adoption of important public health programs that typically aim to change the behavior of a social system.

For example, an intervention to address a public health problem is developed, and the intervention is promoted to people in a social system with the goal of adoption based on Diffusion of Innovation Theory.

The most successful adoption of a public health program results from understanding the target population and the factors influencing their rate of adoption. It developed into the SCT in and posits that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behavior.

The unique feature of SCT is the emphasis on social influence and its emphasis on external and internal social reinforcement. SCT considers the unique way in which individuals acquire and maintain behavior, while also considering the social environment in which individuals perform the behavior. These past experiences influences reinforcements, expectations, and expectancies, all of which shape whether a person will engage in specific behavior and the reasons why a person engages in that behavior.

Many theories of behavior used in health promotion do not consider the maintenance of behavior, but rather focus on initiating behavior. This is unfortunate as maintenance of behavior, and not just initiation of behavior, is the true goal in public health. The goal of SCT is to explain how people regulate their behavior through control and reinforcement to achieve goal-directed behavior that can be maintained over time. The first five constructs were developed as part of the SLT; the construct of self-efficacy was added when the theory evolved into SCT.

There are several limitations of SCT, which should be considered when using this theory in public health. Social Cognitive Theory considers many levels of the social-ecological model in addressing behavior change of individuals.

SCT has been widely used in health promotion given the emphasis on the individual and the environment, the latter of which has become a major point of focus in recent years for health promotion activities. As with other theories, the applicability of all the constructs of SCT to one public health problem may be difficult, especially in developing focused public health programs.

The Transtheoretical Model also called the Stages of Change Model , developed by Prochaska and DiClemente in the late s, evolved through studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so. Thus, the Transtheoretical Model TTM focuses on the decision-making of the individual and is a model of intentional change.

The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective.

The TTM posits that individuals move through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in the application of stages of change for health-related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified with some processes being more relevant to a specific stage of change than other processes.

These processes result in strategies that help people make and maintain change. There are several limitations of TTM, which should be considered when using this theory in public health. The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process.

This can result in interventions that are tailored i. The Social Norms Theory was first used by Perkins and Berkowitz in to address student alcohol use patterns. As a result, the theory, and subsequently the social norms approach, is best known for its effectiveness in reducing alcohol consumption and alcohol-related injury in college students. The approach has also been used to address a wide range of public health topics including tobacco use, driving under the influence prevention, seat belt use, and more recently sexual assault prevention.

The target population for social norms approaches tends to be college students but has recently been used with younger student populations i. This theory aims to understand the environment and interpersonal influences such as peers in order to change behavior, which can be more effective than a focus on the individual to change behavior.

Peer influence, and the role it plays in individual decision-making around behaviors, is the primary focus of Social Norms Theory. Peer influences and normative beliefs are especially important when addressing behaviors in youth. Peer influences are affected more by perceived norms what we view as typical or standard in a group rather than by the actual norm the real beliefs and actions of the group.

The gap between perceived and actual is a misperception , and this forms the foundation for the social norms approach. The Social Norms Theory posits that our behavior is influenced by misperceptions of how our peers think and act. Overestimations of problem behavior in our peers will cause us to increase our own problem behaviors; underestimations of problem behavior in our peers will discourage us from engaging in the problematic behavior.

Accordingly, the theory states that correcting misperceptions of perceived norms will most likely result in a decrease in the problem behavior or an increase in the desired behavior. Social norms interventions aim to present correct information about peer group norms in an effort to correct misperceptions of norms.

In particular, many social norms interventions are social norms media campaigns where misperceptions are addressed through community-wide electronic and print media that promote accurate and healthy norms about the health behavior. The phases of a social norms media campaign include:. Social norms media campaigns are currently being funded by many federal agencies, state agencies, foundation grants, and non-profit organizations. Sometimes social norms media campaigns are funded by industry.

There has been a good deal of evaluations conducted on social norms campaigns. There are five established adopter categories , and while the majority of the general population tends to fall in the middle categories, it is still necessary to understand the characteristics of the target population. When promoting an innovation, there are different strategies used to appeal to the different adopter categories.

The stages by which a person adopts an innovation, and whereby diffusion is accomplished, include awareness of the need for an innovation, decision to adopt or reject the innovation, initial use of the innovation to test it, and continued use of the innovation. There are five main factors that influence adoption of an innovation , and each of these factors is at play to a different extent in the five adopter categories.

This theory has been used successfully in many fields including communication, agriculture, public health, criminal justice, social work, and marketing.

In public health, Diffusion of Innovation Theory is used to accelerate the adoption of important public health programs that typically aim to change the behavior of a social system. For example, an intervention to address a public health problem is developed, and the intervention is promoted to people in a social system with the goal of adoption based on Diffusion of Innovation Theory.

The most successful adoption of a public health program results from understanding the target population and the factors influencing their rate of adoption. It developed into the SCT in and posits that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behavior. The unique feature of SCT is the emphasis on social influence and its emphasis on external and internal social reinforcement. SCT considers the unique way in which individuals acquire and maintain behavior, while also considering the social environment in which individuals perform the behavior.

The theory takes into account a person's past experiences, which factor into whether behavioral action will occur. These past experiences influences reinforcements, expectations, and expectancies, all of which shape whether a person will engage in a specific behavior and the reasons why a person engages in that behavior.

Many theories of behavior used in health promotion do not consider maintenance of behavior, but rather focus on initiating behavior.

This is unfortunate as maintenance of behavior, and not just initiation of behavior, is the true goal in public health. The goal of SCT is to explain how people regulate their behavior through control and reinforcement to achieve goal-directed behavior that can be maintained over time. The first five constructs were developed as part of the SLT; the construct of self-efficacy was added when the theory evolved into SCT.

There are several limitations of SCT, which should be considered when using this theory in public health. Social Cognitive Theory considers many levels of the social ecological model in addressing behavior change of individuals. SCT has been widely used in health promotion given the emphasis on the individual and the environment, the latter of which has become a major point of focus in recent years for health promotion activities.

As with other theories, applicability of all the constructs of SCT to one public health problem may be difficult especially in developing focused public health programs.

The Transtheoretical Model also called the Stages of Change Model , developed by Prochaska and DiClemente in the late s, evolved through studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own.

It was determined that people quit smoking if they were ready to do so. Thus, the Transtheoretical Model TTM focuses on the decision-making of the individual and is a model of intentional change. The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process.

The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective. The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.

Termination was not part of the original model and is less often used in application of stages of change for health-related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified with some processes being more relevant to a specific stage of change than other processes. These processes result in strategies that help people make and maintain change. There are several limitations of TTM, which should be considered when using this theory in public health. The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process.

This can result in interventions that are tailored i. The TTM encourages an assessment of an individual's current stage of change and accounts for relapse in people's decision-making process. The Social Norms Theory was first used by Perkins and Berkowitz in to address student alcohol use patterns. As a result, the theory, and subsequently the social norms approach, is best known for its effectiveness in reducing alcohol consumption and alcohol-related injury in college students.

The approach has also been used to address a wide range of public health topics including tobacco use, driving under the influence prevention, seat belt use, and more recently sexual assault prevention. The target population for social norms approaches tends to be college students, but has recently been used with younger student populations i. This theory aims to understand the environment and interpersonal influences such as peers in order to change behavior, which can be more effective than a focus on the individual to change behavior.

Peer influence, and the role it plays in individual decision-making around behaviors, is the primary focus of Social Norms Theory. Peer influences and normative beliefs are especially important when addressing behaviors in youth. Peer influences are affected more by perceived norms what we view as typical or standard in a group rather than on the actual norm the real beliefs and actions of the group.

The gap between perceived and actual is a misperception , and this forms the foundation for the social norms approach. The Social Norms Theory posits that our behavior is influenced by misperceptions of how our peers think and act. Overestimations of problem behavior in our peers will cause us to increase our own problem behaviors; underestimations of problem behavior in our peers will discourage us from engaging in the problematic behavior.

Accordingly, the theory states that correcting misperceptions of perceived norms will most likely result in a decrease in the problem behavior or an increase in the desired behavior.

Social norms interventions aim to present correct information about peer group norms in an effort to correct misperceptions of norms.

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