The document discusses several theories of behavior change that can be applied to improve health behaviors. It summarizes the Health Belief Model, which focuses on perceptions of susceptibility, severity, benefits and barriers. It also describes the Stages of Change Model and Transtheoretical Model, which view behavior change as a process through stages. Motivational Interviewing is explained as a technique to activate a patient's own motivation for change through collaboration, evocation and autonomy.

1. Theories of Behaviour Change
and their Applications
Dr.Abdelaziz M. Elfaki,Phd.
University of Dammam

3. 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.

4. 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.

5. 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.

6. 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 :

7. 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”)

8. 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).

9. 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.]

10. 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

11. 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

12. 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.

13. Self-Efficacy and Health
Behavior Theories
• There is overwhelming evidence that
perceived self-efficacy is closely associated
with behavioral intentions and health
behavior change.

14. 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.

15. 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.

16. 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

17. 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

18. 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

19. Motivational Interviewing –MI
• MI works by activating patient`s own
motivation for change and adherence to
treatment.

20. Three Components of MI Spirit
Collaboration
Evocation
Autonomy
• Working in
partnership
• Draw out ideas
and solutions
from individuals
• Decision making
left to the person

21. Motivational Interviewing –MI
• Four Guiding Principles
• Resist the Righting Reflex
• Understand Your Patient`s Motivations.
• Listen to Your Patient
• Empower Your Patient

22. 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.

23. 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.

24. 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.

25. 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.

26. GOOD LUCK