Theories of behaviour change


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Behavioral Dentistry
Second Year

Published in: Health & Medicine

Theories of behaviour change

  1. 1. Theories of Behaviour Change and their Applications Dr.Abdelaziz M. Elfaki,Phd. University of Dammam
  2. 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 behavior. • 2- Promotion of healthier life-styles. • 3- Adherence to medical regimens.
  3. 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. 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 program.
  5. 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. 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 irritable”)
  7. 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. 8. Health Belief Model -- Revised (Rosenstock, Strecher, & Becker, 1988) BACKGROUND PERCEPTIONS ACTION Sociodemographic Factors (e.g., education, age, sex, race, ethnicity) Threat •Perceived susceptability (or acceptance of the diagnosis) •Perceived severity of ill-health condition Expectations •Perceived benefits of action (minus) •Perceived barriers to action •Perceived self-efficacy to perform action Cues to Action •Media •Personal influence •Reminders Behavior to reduce threat based on expectations Adapted from Rosenstock (1990). In Glanz, Lewis, & Rimer, Health Behavior and Health Education. [Need to confirm source.]
  9. 9. ApplicationDefinitionConcept Define population(s) at risk, risk levels; personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low. One's opinion of chances of getting a conditionPerceived Susceptibility Specify consequences of the risk and the condition One's opinion of how serious a condition and its consequences are Perceived Severity Define action to take; how, where, when; clarify the positive effects to be expected. One's belief in the efficacy of the advised action to reduce risk or seriousness of impact Perceived Benefits Identify and reduce barriers through reassurance, incentives, assistance One's opinion of the tangible and psychological costs of the advised action Perceived Barriers Provide how-to information, promote awareness, reminders. Strategies to activate "readiness"Cues to Action Provide training, guidance in performing action. Confidence in one's ability to take actionSelf-Efficacy
  10. 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. 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. 12. Self-Efficacy and Health Behavior Theories • There is overwhelming evidence that perceived self-efficacy is closely associated with behavioral intentions and health behavior change.
  13. 13. Self-efficacy • Three groups of cognitions are influential in establishing a behavioral goal or intention : • A- Risk perceptions. • B – Outcome expectancies. • C- Perceived self-efficacy.
  14. 14. Theories of Behaviour Change • Prochaska and DiClemente’s Stages of Change Model: 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. 15. Key Features of the Stages of Change Model • Deals with intentional behaviour change • Views change as a process rather than an event • 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 of change
  16. 16. Clinician StrategiesPatient CharacteristicsStages of change Ask permission to discuss problem . Express concern Denies problem and its importance. Precontemplation 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 timetable. Preparation/ Determination Discuss difference between slip and relapse Follows a plan of regular activity to change problem. Action Support life-style and personnel redefinition that reduce risk of relapse Has varying levels of awareness regarding importance of long term vigilance. Maintenance Frame relapse as a learning opportunity in preparation for next action stage. Consistent return to a problem behavior after period of resolution. Relapse
  17. 17. Transtheoretical Model (Prochaska & DiClemente, 1982, 1983) Stages of Change in Which Particular Processes Are Emphasized Consciousness Raising Dramatic Relief Environmental Reevaluation Adapted from Prochaska, DiClemente, & Norcross (1992). American Psychologist, 47, 1102-1114. Self-Reevaluation Self-Liberation Reinforcement Management Helping Relationships Counterconditioning Stimulus Control Precontemplation  Contemplation  Preparation  Action  Maintenance
  18. 18. Motivational Interviewing –MI • MI works by activating patient`s own motivation for change and adherence to treatment.
  19. 19. Three Components of MI Spirit Collaboration Evocation Autonomy • Working in partnership • Draw out ideas and solutions from individuals • Decision making left to the person
  20. 20. Motivational Interviewing –MI • Four Guiding Principles • Resist the Righting Reflex • Understand Your Patient`s Motivations. • Listen to Your Patient • Empower Your Patient
  21. 21. Motivational Interviewing- Guiding Principles 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 persuasion.
  22. 22. Motivational Interviewing- Guiding Principles 2- Understand Your Patient`s Motivations It is the patient`s own reasons for change ,and not yours ,that are most likely to trigger behavior change.
  23. 23. Motivational Interviewing- Guiding Principles 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. 24. Motivational Interviewing- Guiding Principles • 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.
  25. 25. GOOD LUCK