This guide will help you answer The RQF Level 2 Diploma in Care Unit 2.1 Outline theories of behaviour change.

Theories of Behaviour Change

Understanding theories of behaviour change is essential for healthcare workers. These models help explain how and why people change their behaviour. These insights are essential in promoting healthier lifestyles and improving patient outcomes. In this section, we will explore several key theories of behaviour change.

Health Belief Model (HBM)

The Health Belief Model (HBM) is a psychological model that helps explain and predict health behaviours. It focuses on the attitudes and beliefs of individuals.

Key Components of HBM:

• Perceived Susceptibility: Beliefs about the chances of getting a disease.
• Perceived Severity: Beliefs about the seriousness of a condition and its potential consequences.
• Perceived Benefits: Beliefs about the effectiveness of taking action to reduce the risk or seriousness.
• Perceived Barriers: Beliefs about the costs, both tangible and psychological, of taking the advised action.
• Cues to Action: Factors that activate “readiness to change”.
• Self-Efficacy: Confidence in one’s ability to take action.

Example:

An individual may decide to quit smoking if they believe they are highly susceptible to lung cancer (perceived susceptibility) and view lung cancer as a severe disease (perceived severity). If they believe quitting smoking will improve their health (perceived benefits) and consider the effort and costs of quitting to be worth it (perceived barriers), they are more likely to take action, especially if they also have the confidence in their ability to quit (self-efficacy).

Theory of Planned Behaviour (TPB)

The Theory of Planned Behaviour (TPB) suggests that individual behaviour is driven by intentions. Intentions are influenced by attitudes towards the behaviour, subjective norms, and perceived behavioural control.

Key Components of TPB:

• Attitudes: Positive or negative evaluations of the behaviour.
• Subjective Norms: Beliefs about whether key people approve or disapprove of the behaviour.
• Perceived Behavioural Control: The perceived ease or difficulty of performing the behaviour.

Example:

If a person has a positive attitude towards exercising, believes that their friends and family support them in staying fit (subjective norms), and thinks they can easily find time to exercise (perceived behavioural control), they are more likely to form an intention to exercise regularly and follow through with that intention.

Transtheoretical Model (TTM)

The Transtheoretical Model, also known as the Stages of Change Model, describes the stages individuals go through to change their behaviour. This model features that behaviour change is a process, rather than a single event.

Key Stages of TTM:

• Precontemplation: No intention to change behaviour in the foreseeable future.
• Contemplation: Aware of the need to change and thinking about it.
• Preparation: Intending to take action soon and may start small steps.
• Action: Actively modifying the behaviour.
• Maintenance: Sustaining the behaviour change over time.
• Termination: The change has been fully integrated, and the individual no longer feels the temptation to revert.

Example:

An individual wanting to lose weight might start in the precontemplation phase, not even considering dieting or exercise. Gradually, they move to contemplation, thinking about the benefits of a healthier lifestyle. In the preparation stage, they might buy healthier foods and a gym membership. Once in the action stage, they actively diet and exercise. Finally, in the maintenance stage, they continue their new habits long-term.

Social Cognitive Theory (SCT)

Social Cognitive Theory (SCT) emphasises the influence of other people’s behaviours and feedback on an individual’s own behaviour. It introduces the concept of reciprocal determinism, where personal, behavioural, and environmental factors interact to influence behaviour.

Key Components of SCT:

• Observational Learning: Learning from the behaviours and outcomes of others.
• Reinforcement: Responses to a person’s behaviour that can increase or decrease the likelihood of the behaviour repeating.
• Self-Efficacy: Belief in one’s ability to succeed in specific situations.

Example:

A person trying to eat healthier might look at how a friend has adopted a nutritious diet and the positive outcomes they’ve achieved. Witnessing this, they might feel motivated to emulate these behaviours, especially if they receive positive reinforcement, like compliments on their food choices.

COM-B Model

COM-B stands for Capability, Opportunity, and Motivation Behaviour. This system helps identify what needs to change for behaviour change to happen.

Key Components of COM-B:

• Capability: The physical and psychological ability to perform the behaviour.
• Opportunity: External factors that make the behaviour possible or prompt it.
• Motivation: Both reflective (self-conscious planning) and automatic (emotions and impulses) motivations to perform the behaviour.

Example:

For a person to start recycling, they need to:

• Understand how and what to recycle (Capability).
• Have access to recycling facilities (Opportunity).
• Believe that recycling is important and feel good about contributing to the environment (Motivation).

Self-Determination Theory (SDT)

Self-Determination Theory (SDT) is about motivation. It differentiates between different types of motivation based on different reasons or goals that lead to action.

Key Types of Motivation in SDT:

• Intrinsic Motivation: Engaging in behaviour because it is inherently interesting or enjoyable.
• Extrinsic Motivation: Engaging in behaviour to earn external rewards or avoid punishment.

Example:

A healthcare worker might follow a fitness routine because they enjoy the activity itself (intrinsic motivation) or because they want to meet workplace health requirements (extrinsic motivation).

Final Thoughts

These theories offer valuable insights into understanding and influencing behaviour change. The Health Belief Model, Theory of Planned Behaviour, Transtheoretical Model, Social Cognitive Theory, COM-B Model, and Self-Determination Theory each bring different perspectives on why people change their behaviour and how we can support them. Knowing these can help healthcare workers design better interventions to promote healthier lifestyles.

Example answers for unit 2.1 Outline theories of behaviour change

Example Answer 1:

As a care worker, understanding the Health Belief Model (HBM) is essential for my role. Once, I had a patient who was reluctant to take her medication for high blood pressure. Using the HBM, I first explained her susceptibility to severe health issues due to unmanaged blood pressure. I then discussed the severity of potential stroke or heart attack. Highlighting the benefits of the medication, I reassured her it could prevent these severe outcomes. Addressing her concerns about side effects (perceived barriers), I provided information and support to manage them. I also encouraged her by boosting her confidence in taking her medication regularly (self-efficacy). This structured approach helped her better understand and accept the importance of her medication.

Example Answer 2:

In my experience, the Theory of Planned Behaviour (TPB) has been very helpful. I worked with a patient who needed to increase physical activity to manage diabetes. By discussing his positive attitude towards health and the support from his family (subjective norms), I helped him understand the benefits of regular exercise. We also talked about perceived behavioural control, such as his concern about finding time for walking. Together, we planned a manageable schedule. By addressing these three factors—attitude, subjective norms, and perceived control—we were able to set a firm intention to start daily walks, and he followed through with it.

Example Answer 3:

The Transtheoretical Model (TTM) has been a useful tool in my practice. For instance, I worked with a client who needed to quit smoking. Initially, he was in the precontemplation stage, not seeing smoking as a problem. Through regular discussions, he moved to the contemplation stage, acknowledging the benefits of quitting. In the preparation stage, we set up a plan, including nicotine patches and support groups. During the action stage, I supported him closely as he reduced and then stopped smoking. Now, in the maintenance stage, he continues his non-smoking lifestyle, and I check in regularly to support him in keeping up his new habits.

Example Answer 4:

Social Cognitive Theory (SCT) played a significant role in helping one of my patients adopt a healthier diet. Observing another patient who improved their health through dietary changes inspired him (observational learning). We talked about how this individual was positively reinforced with compliments and better health outcomes. By building his self-efficacy, I encouraged him to believe he could also make similar changes. As he started altering his diet, I provided feedback and reinforcement, praising his efforts and celebrating his progress, which further motivated him to continue.

Example Answer 5:

The COM-B Model helped me effectively support a patient in adopting hand hygiene. Firstly, I ensured she had the physical capability by showing her the proper technique and providing easy-to-use hand sanitisers and soap (capability). I then made sure she had access to these items in all necessary locations (opportunity). To boost her motivation, I explained the importance of hand hygiene in preventing infections and keeping herself and others safe. Together, these steps created a situation where she was fully capable, had the opportunity, and was motivated to regularly practise good hand hygiene.

Example Answer 6:

Using the Self-Determination Theory (SDT), I helped a resident in our care facility engage more in social activities. This resident initially participated only to avoid feeling lonely (extrinsic motivation). I spent time discussing the activities she genuinely enjoyed, like painting and gardening. By focusing on these interests, she began participating more because she found them enjoyable (intrinsic motivation). Her intrinsic motivation led to more consistent engagement in social activities, greatly improving her overall well-being. By recognising and fostering her intrinsic motivation, I helped her find more personal fulfilment in her daily routine.