1.1. Summarise theories of behaviour change

This guide will help you answer 1.1. Summarise theories of behaviour change.

Theories of behaviour change are frameworks that help explain why people make decisions to change their behaviour, or why they resist making changes. Understanding these theories is important for professionals in health and social care, as it supports efforts to encourage positive behaviour in individuals. Behaviour change is complex and influenced by psychological, social, and environmental factors.

In this guide, we cover the main theories of behaviour change, including examples of how they might apply in practice.

The Theory of Planned Behaviour

The Theory of Planned Behaviour (TPB) was developed by psychologist Icek Ajzen. This theory states that an individual’s behaviour is largely determined by their intentions, which are influenced by three key factors:

1. Attitude towards the behaviour: This is how the person feels about the behaviour. If they believe the outcome will be beneficial, they are more likely to form a positive attitude towards it. For example, a person who thinks quitting smoking will improve their health might be motivated to stop smoking.
2. Subjective norms: This refers to social pressure. If family, friends, or society expect the individual to behave in a certain way, they may feel more motivated to comply. For instance, if most of someone’s friends are non-smokers, they may feel encouraged to quit smoking.
3. Perceived behavioural control: This is the person’s belief in their ability to perform the behaviour. The easier they think it is to make the change, the more likely they are to try. For example, someone may feel more confident about sticking to a diet plan if they have access to healthy food and enough time to cook.

In practice, health professionals can use this theory by identifying barriers to an individual’s perceived control or addressing misconceptions about the desired change.

The Transtheoretical Model of Change

The Transtheoretical Model (TTM), also known as the Stages of Change model, was developed by Prochaska and DiClemente. It suggests that behaviour change is a process, not a single event. This model divides behaviour change into six stages:

1. Pre-contemplation: The person is not considering change. They may not see their behaviour as a problem. Example: A smoker who isn’t worried about their health might not think about quitting.
2. Contemplation: The person is starting to think about change but hasn’t committed to it. Example: A smoker starts considering the health risks and weighs the benefits of quitting.
3. Preparation: The person makes plans to change their behaviour, such as setting a quit date or seeking advice. Example: The smoker buys nicotine patches or speaks to their GP.
4. Action: The person actively takes steps to change their behaviour. Example: The smoker stops smoking and avoids situations where they might be tempted.
5. Maintenance: The person works to maintain their changed behaviour and avoid relapse. Example: The person continues to stay smoke-free by attending support groups.
6. Relapse or Termination: Relapse is common and can occur at any stage, but it is part of the process. Termination is when the behaviour change is permanent, and there is no desire to return to old habits.

TTM is particularly helpful in tailoring interventions to an individual’s stage of change. For example, motivational interviewing techniques might be used during the contemplation stage to strengthen their commitment to change.

The Health Belief Model

The Health Belief Model (HBM) is one of the oldest models of behaviour change. It focuses on an individual’s perceptions and beliefs about health risks and behaviours. This model identifies six factors that influence behaviour:

1. Perceived susceptibility: How likely an individual feels they are to experience a health problem. For example, someone who believes they are likely to get diabetes may be more motivated to change their diet.
2. Perceived severity: How serious they believe the consequences of the health issue could be. For instance, a person who fears the complications of diabetes may be more likely to act.
3. Perceived benefits: The individual’s belief in how effective the change will be. If they believe that exercising will significantly improve their health, they are more likely to do it.
4. Perceived barriers: Factors that might make the behaviour change difficult. These could include financial issues, lack of time, or cultural factors.
5. Cues to action: Triggers that prompt the individual to take action, such as a health scare or advice from their GP.
6. Self-efficacy: The confidence to perform the new behaviour. If someone feels capable of making the change, they are much more likely to succeed.

The HBM can be useful when creating health promotion campaigns, as it helps identify the common barriers stopping people from changing their behaviour.

Social Learning Theory

The Social Learning Theory (SLT), developed by Albert Bandura, highlights the importance of observing and imitating the behaviour of others. This theory explains that people often learn behaviours by watching others, especially those they consider role models.

Key concepts in SLT include:

1. Observational learning: Seeing someone else succeed or fail at a task can greatly influence behaviour. For example, a person might start eating healthier if their colleague successfully loses weight through healthy eating.
2. Reinforcement: Positive reinforcement (rewards) or negative reinforcement (avoiding an unpleasant experience) can encourage behaviour change. For example, a person may exercise regularly because they enjoy the praise they receive from others.
3. Self-efficacy: This is the belief in one’s own ability to change their behaviour, and it is a recurring theme in many behaviour-change theories.

In practice, SLT shows the value of group support or providing positive examples, as individuals are influenced by the people around them.

Motivational Interviewing

Motivational interviewing is not a theory but a method that integrates several behaviour-change principles. It focuses on strengthening an individual’s motivation to change by addressing their ambivalence. A fundamental aspect of this approach is that the individual, not the professional, identifies their reasons for changing behaviour.

Motivational interviewing revolves around:

• Empathy: Listening and reflecting without judgment to build trust.
• Acknowledging ambivalence: Supporting the person as they weigh both the benefits and challenges of changing their behaviour.
• Supporting autonomy: Encouraging the individual to take ownership of their change process.

Health and social care workers often use motivational interviewing to help service users explore and resolve doubts about behaviour change.

Final Thoughts

Behaviour change theories generally share some common elements:

• They highlight the importance of both internal (beliefs, perceptions) and external (social, environmental) factors.
• Self-efficacy, or confidence in one’s ability, plays a major role across several theories.
• Behaviour change is often a process, not a single decision.

Using these theories can guide professionals in providing the right support for individuals, whether through education, encouragement, or practical assistance. By understanding these frameworks, professionals are better equipped to help individuals make long-lasting, positive changes to their behaviour.