3b. What Do Behaviour Change Theories Have in Common? What Are the Practical Implications for Population Health?  

As you can see from your required readings, a plethora of competing theories focus on explaining the process of behaviour change. However, they share some common features and implications for population health practice.

Common Elements of Behaviour Change Theories and Implications for Practice

So what do all of these theories have in common? Are there key lessons about behaviour change shared by multiple theories, or do we have to commit multiple behaviour change theories to memory and figure out when to apply them to specific issues and situations?

Fortunately for public health practitioners, there is some agreement about important ideas that cut across behaviour change theories. In 2001, five leading behavioural science theorists, including those who developed some of the theories in your required readings, agreed on a set of eight key conditions as determinants of behaviour.1, 2

The following table describes each of these conditions in detail and identifies implications for population health practice developed by behaviour change theorists at the University of Toronto.3

Table 1. Conditions for Behaviour Change and Practical Implications for Interventions3
ConditionPractical Implications for Interventions

1. The person has formed a strong positive intention (or made a commitment) to perform the behaviour.

This means that the person/audience believes that they are at genuine risk of harm from the problem, that the consequences of failing to act are severe, and that the recommended behaviour will lower the risk or prevent the problem.
  • Raise awareness about the need for change by making the risk seem serious and at the same time personally relevant (e.g., show what people resembling the priority population have suffered as a result of people driving while impaired).
  • Emphasize likely positive outcomes of adopting the recommended action, while downplaying potential negative consequences (e.g., specify that negative consequences associated with quitting smoking are time-limited. For example, an intense craving usually passes within three minutes).

2. There are no environmental constraints (barriers) that make it impossible for the behaviour to occur.

Barriers can be tangible (e.g., lack of time or money, lack of access to facilities or programs) or psychological (e.g., anxiety, discomfort, peer pressure) and can occur at many levels: societal (e.g., local, provincial, or national government policies/practices), organizational (e.g., workplaces, schools), social networks, personal traits, and home environments.
  • Determine audience barriers and attempt to rectify them (e.g., provide subsidized transportation and childcare for low-income mothers to allow them to participate in healthy parenting classes).
  • Create supportive environments whenever possible (e.g., modifying the built environment to encourage walking or cycling).

3. The person has the skills necessary to perform the behaviour.

The person/audience has the knowledge and the ability to take steps to make behaviour change easier and success more likely. This includes performing the behaviour properly so that the desired outcome is achieved. For example, high-risk physical activity can result in injury or have no effect, rather than improvement in cardiovascular health.
  • Specify the recommended action in terms of how, where, and when and provide clear direction and training on how to perform the recommended action (e.g., provide simple directions for improving dental hygiene such as “two minutes, twice a day”).
  • Identify or provide role models who have adopted the recommended action and ensure that they are visible through health communication campaigns (e.g., profile community leaders who have adapted the recommended behaviour).
  • Provide suggestions or teach how to find healthier alternatives/solutions for certain barriers (e.g., take fewer cigarettes to work or change morning routine to avoid situations associated with smoking).
  • Teach how to critically and realistically assess past or current failures/relapses so that lessons can be learned and progress can continue rather than stop (e.g., to help someone avoid high-risk gambling, if idle time is a trigger, then suggest alternate activities).

4. The person believes the advantages (benefits, anticipated positive outcomes) of performing the behaviour outweigh the disadvantages (costs, anticipated negative outcomes).

These benefits and costs can be tangible (e.g., increased endurance, financial savings, weight gain, medication side effects) or psychological (e.g., anxiety, discomfort, sense of approval, and self-confidence). 
  • Emphasize likely positive results of adopting the recommended action and downplay negative consequences.
  • Set up systems of reinforcement through incentives (e.g., rewards), assistance (e.g., self-help/mutual aid groups), and regular updates on the given risk and recommended action.

5. The person perceives more social (normative) pressure to perform the behaviour than not to do so.

The person/audience perceives that people who matter to them (e.g., friends, family members, community/social network opinion leaders, celebrities, physicians) support/encourage the recommended behaviour. For example, as long as adolescents believe that the norm among their friends is striving for a dark tan, they are less likely to use sunscreen.
  • Identify key influencers/role models who are important to the intended audience and make the audience feel that these influencers/role models support the recommended behaviour.
  • Identify or provide role models who have adopted the recommended action and ensure that they are visible through health communication campaigns.

6. The person perceives that the behaviour is consistent with their self-image and does not violate their personal norms and standards.

It is critical that the recommended action/solution to an identified health problem is relevant and appropriate for the intended audience’s culture, lifestyle, values, beliefs, etc.
  • Raise awareness about the need for change by making the risk seem serious as well as personally relevant.
  • Assist with setting quantifiable, realistic, graduated, and moderately difficult goals within the context of pre-existing goals (e.g., start by walking slowly 10 minutes a day and work up to brisk walking 30 minutes a day).
  • Customize information on risks, benefits, and recommended actions, and tailor the intervention to the intended audience’s values, norms, and situation (e.g., teach low-fat cooking in culturally relevant ways).

7. The person’s emotional reaction to performing behaviour is more positive than negative.

An individual’s emotional reaction can be affected by how (s)he benefits or gets rewarded for health-related behaviours. Rewards can be tangible or psychological and can be provided by others or by self. It is important that rewards are meaningful, so the person/audience should participate in choosing appropriate rewards when feasible.
  • Emphasize likely positive results of adopting the recommended action and downplay negative consequences.
  • Set up systems of reinforcement through incentives, assistance, and regular updates on the given risk and recommended action.

8. The person believes they have the capability to perform the behaviour under a number of different circumstances (i.e., the person has the perceived self-efficacy to execute the behaviour).

The person/audience has the confidence in their ability to take action and sustain the action in spite of difficulties and barriers including relapse. For example, a person must have strength of confidence in themselves to state their wishes to use a condom clearly before or during an intimate encounter.
  • Specify the recommended action in terms of how, where, and when, and provide clear directions and training to perform the recommended action.
  • Determine audience barriers to action and attempt to rectify them.
  • Provide suggestions or teach how to find own healthier solutions/alternatives to certain barriers.
  • Assist with setting quantifiable, realistic, graduated, and moderately difficult goals within the context of pre-existing goals.
  • Teach how to critically and practically assess past failures/current relapse so that lessons can be learned and progress continues rather than stops.

References

  1. Fishbein, M., Triandis, H.C., Kanfer, F.H., Becker, M., & Middlestadt, S.E. (2001). Factors influencing behavior and behavior change. In A.S. Baum, T.A. Revenson, & J.E. Singer (Eds.) Handbook of Health Psychology (1–17). Mahwah, NJ: Lawrence Erlbaum.
  2. Montano, D.E., & Kaspryzk, D. (2015). Theory of reasoned action, theory of planned behavior and integrated behavioral model. In K. Glanz, B.K. Rimer, & K. Viswanath (Eds.) Health Behavior and Health Education: Theory, Research and Practice (5th ed., 168–222). San Francisco: Wiley.
  3. Chadran, U., Thesenvitz, J., & Hershfield, L. (2004). Changing behaviours: A practical framework. Toronto: The Health Communication Unit, Centre for Health Promotion, University of Toronto.