1. Theories of Behaviour Change
and their Applications
Dr.Abdelaziz M. Elfaki,Phd.
University of Dammam
2. Theories of Behaviour Change
Most efforts to improve health require some
changes in behavior on the part of patients.
• These changes in behavior might involve :
• 1-Reduction or elimination of destructive
• 2- Promotion of healthier life-styles.
• 3- Adherence to medical regimens.
3. The Health Belief Model-HBM
• The Health Belief Model (HBM) is a
psychological model that attempts to
explain and predict health behaviors. This
is done by focusing on the attitudes and
beliefs of individuals.
4. The Health Belief Model-HBM
The HBM was first developed in the 1950s
by social psychologists Hochbaum,
Rosenstock and Kegels working in the U.S.
Public Health Services. The model was
developed in response to the failure of a
free tuberculosis (TB) health screening
5. The Health Belief Model-HBM
• The HBM predicts that behavior is a result
of a set of core beliefs ,which have been
redefined over the years. The original core
beliefs are the individual`s perception of :
6. The Health Belief Model-HBM
1- Susceptibility to illness (e.g." my chances
of getting lung cancer are high”)
2- The severity of the illness (“oral cancer is
a serious illness”)
3- The costs involved in carrying out the
behavior (“stopping smoking will make me
7. The Health Belief Model-HBM
4- The benefits involved in carrying out the
behavior (e.g. “stopping smoking will save
me money” )
5- Cues to action ,which may be internal( e.g.
“the symptoms of breathlessness”) ,or
external ( e.g. information in the form of
health education leaflets).
8. Health Belief Model -- Revised
(Rosenstock, Strecher, & Becker, 1988)
BACKGROUND PERCEPTIONS ACTION
(e.g., education, age,
sex, race, ethnicity)
(or acceptance of the
•Perceived severity of
•Perceived benefits of
•Perceived barriers to
to perform action
Cues to Action
to reduce threat
Adapted from Rosenstock (1990). In
Glanz, Lewis, & Rimer, Health Behavior
and Health Education.
[Need to confirm source.]
Define population(s) at risk, risk
levels; personalize risk based on a
person's features or behavior;
heighten perceived susceptibility if
One's opinion of chances of
getting a conditionPerceived Susceptibility
Specify consequences of the risk and
One's opinion of how serious a
condition and its consequences
Define action to take; how, where,
when; clarify the positive effects to
One's belief in the efficacy of
the advised action to reduce
risk or seriousness of impact
Identify and reduce barriers through
reassurance, incentives, assistance
One's opinion of the tangible
and psychological costs of the
Provide how-to information,
promote awareness, reminders.
Strategies to activate
"readiness"Cues to Action
Provide training, guidance in
Confidence in one's ability to
10. The Health Belief Model-HBM
Support for the HBM
• Research indicates that dietary compliance
,safe sex ,having vaccinations ,making
regular dental visits and taking part in
regular exercise programmes are related to
the individual`s perception of susceptibility
to the related health problem
11. The Health Belief Model-HBM
• , to their belief that the problem is severe
and their perception that the benefits of
preventative action outweigh the costs.
12. Self-Efficacy and Health
• There is overwhelming evidence that
perceived self-efficacy is closely associated
with behavioral intentions and health
• Three groups of cognitions are influential in
establishing a behavioral goal or intention :
• A- Risk perceptions.
• B – Outcome expectancies.
• C- Perceived self-efficacy.
14. Theories of Behaviour Change
• Prochaska and DiClemente’s Stages of
The Stages of Change Model introduced the
idea that people move through a succession
of six (five) relatively distinguishable stages
in making changes in behavior.
15. Key Features of the Stages of
• Deals with intentional behaviour change
• Views change as a process rather than an
• The change process is characterized by a
series of stages of change
• In attempting to change a behaviour a
person typically cycles through these stages
16. Clinician StrategiesPatient CharacteristicsStages of change
Ask permission to discuss
Denies problem and its
Elicit patient`s perspective firstWeighs pros and cons.Contemplation
Negotiate a start date to begin
some or all change activities.
Begins to form commitment to
specific goals ,methods ,and
Discuss difference between
slip and relapse
Follows a plan of regular activity
to change problem.
Support life-style and
personnel redefinition that
reduce risk of relapse
Has varying levels of awareness
regarding importance of long
Frame relapse as a learning
opportunity in preparation for
next action stage.
Consistent return to a problem
behavior after period of
17. Transtheoretical Model
(Prochaska & DiClemente, 1982, 1983)
Stages of Change in Which Particular Processes Are Emphasized
Adapted from Prochaska, DiClemente, & Norcross (1992).
American Psychologist, 47, 1102-1114.
Precontemplation Contemplation Preparation Action Maintenance
18. Motivational Interviewing –MI
• MI works by activating patient`s own
motivation for change and adherence to
19. Three Components of MI Spirit
• Working in
• Draw out ideas
• Decision making
left to the person
20. Motivational Interviewing –MI
• Four Guiding Principles
• Resist the Righting Reflex
• Understand Your Patient`s Motivations.
• Listen to Your Patient
• Empower Your Patient
21. Motivational Interviewing-
1- Resist the Righting Reflex
• The urge to correct another`s course often
becomes automatic ,almost reflexive.
• It is a natural human tendency to resist
22. Motivational Interviewing-
2- Understand Your Patient`s Motivations
It is the patient`s own reasons for change
,and not yours ,that are most likely to trigger
23. Motivational Interviewing-
3- Listen to Your Patient
• Normal expectations of a health care
consultation are that the practitioner has
answers and will give them to the patients.
When it comes to behavior change ,the
answers most likely lie within the patient
,and finding them requires some listening.
24. Motivational Interviewing-
• 4- Empower Your Patient
• A patient who is active in the consultation
,thinking aloud about the why and how
of change ,is more likely to do something
about this afterward.