1.2. Compare and contrast models of behaviour change

This guide will help you answer 1.2. Compare and contrast models of behaviour change.

Understanding behaviour change is important in health and social care. It helps workers support individuals to make positive changes in their lives. Several models explain how behaviour change occurs. In this task, let’s compare and contrast these models. In this guide, we will look at the Transtheoretical Model (Stages of Change), the Health Belief Model, and the Theory of Planned Behaviour. Each model has strengths, weaknesses, and unique features.

The Transtheoretical Model (Stages of Change)

The Transtheoretical Model (TTM), also called the Stages of Change model, explains change as a process that unfolds over time. Developed by Prochaska and DiClemente, it identifies six key stages:

1. Precontemplation: The individual is not considering change. They may not see a problem or feel ready to act.
2. Contemplation: Change becomes a possibility. The individual starts thinking about it but might feel unsure.
3. Preparation: The individual makes small steps towards change. They may set goals or seek support.
4. Action: Active efforts to change occur. For example, someone trying to quit smoking may start using nicotine patches.
5. Maintenance: The individual works to sustain the change and prevent relapse.
6. Termination: The change becomes permanent. The individual no longer feels tempted to return to old behaviours (not always achieved).

This model works well for gradual behaviour change. It recognises that change is not a one-time event but a process. Workers can use it to tailor support based on where the individual is in the cycle.

Strengths:

• It’s flexible. People can enter or exit at any stage.
• Easy to understand and use in practice.
• Identifies relapse as a natural part of the process, not failure.

Weaknesses:

• It’s not suited for urgent or sudden changes.
• People may not move through stages in order, making it harder to predict outcomes.
• It may over-simplify complex behaviours.

The Health Belief Model

Developed in the 1950s by social psychologists, the Health Belief Model (HBM) explains how beliefs about health influence decisions. It suggests individuals take action if they believe:

1. Perceived Susceptibility: They are at risk of a particular issue (e.g., developing diabetes).
2. Perceived Severity: The consequences of the problem are serious.
3. Perceived Benefits: Taking action will reduce that risk.
4. Perceived Barriers: The benefits of changing outweigh the effort or cost (e.g., time, money, or discomfort involved).
5. Cues to Action: A prompt or trigger encourages change (e.g., advice from a GP or a health campaign).
6. Self-Efficacy: They are confident in their ability to change.

For example, an individual might quit drinking excessive alcohol if they believe it could lead to liver damage (susceptibility), see this as serious (severity), feel they can stop (self-efficacy), and recognise the health improvements (benefits) outweigh any social challenges (barriers).

Strengths:

• It’s focused on personalised beliefs, which vary widely.
• Highlights the importance of self-confidence and motivational triggers.
• Useful for designing public health campaigns or targeted interventions.

Weaknesses:

• Doesn’t explain why two people with the same beliefs behave differently.
• May focus too much on individual responsibility, overlooking social or environmental factors.
• Relies heavily on self-reporting, which may not always reflect true beliefs.

The Theory of Planned Behaviour

The Theory of Planned Behaviour (TPB), proposed by Ajzen in the 1980s, focuses on the intention to change. It suggests three factors determine whether someone will act:

1. Attitude: How they feel about the behaviour. Do they think it’s beneficial or harmful?
2. Subjective Norms: How much influence they feel from others. For instance, do friends or family expect them to act?
3. Perceived Behavioural Control: How much control they feel over the situation. This is similar to self-efficacy.

For example, someone thinking about starting a fitness programme will weigh their attitude (do they enjoy exercise?), norms (will friends approve?), and perceived control (do they have the time or resources?). If these align, they are more likely to act.

Strengths:

• Focuses on intention, which often predicts behaviour.
• Shows how social pressure influences decisions.
• Combines individual and external factors (attitudes and norms).

Weaknesses:

• Intention doesn’t always lead to action. For example, someone may intend to quit smoking but may still struggle.
• It’s less effective for automatic or impulsive behaviours (e.g., comfort eating).
• Provides limited guidance for interventions beyond intention.

Comparing the Models

Each model is useful, but they approach behaviour change differently. Let’s look at key points of comparison and contrast:

Focus of the Model:

• The Transtheoretical Model focuses on readiness for change. It’s about where a person is in the cycle.
• The Health Belief Model focuses on the individual’s beliefs about health risks and benefits.
• The Theory of Planned Behaviour focuses on intentions and external factors like social expectations.

Stages or No Stages:

• The Transtheoretical Model uses specific stages, which may make it feel more structured.
• The Health Belief Model and the Theory of Planned Behaviour don’t have clear stages, which may work better for more fluid or flexible approaches.

Role of Social Influence:

• The Theory of Planned Behaviour gives social pressure a key role. It considers subjective norms as a major factor.
• The Health Belief Model and the Transtheoretical Model focus less directly on social feedback.

Flexibility:

• The Transtheoretical Model allows for relapse and re-entering at different points, which aligns with real-life behaviour.
• The Health Belief Model and the Theory of Planned Behaviour assume a more straightforward progression towards change.

Practical Use:

• The Health Belief Model suits public campaigns by targeting specific beliefs through education.
• The Transtheoretical Model works well for one-to-one or long-term intervention.
• The Theory of Planned Behaviour may be best when addressing social and external influences on behaviour.

Real-world Applications

To understand how these models work in practice, let’s look at some examples.

Smoking Cessation

• A healthcare worker could use the Transtheoretical Model by identifying whether the person is in the precontemplation stage or ready to take action. If they’re just thinking about quitting, motivational interviewing could help.
• The Health Belief Model might help them explore the smoker’s perceptions—do they believe they’re at risk of lung cancer? What personal barriers, like stress, prevent quitting?
• The Theory of Planned Behaviour might address social factors. Does the smoker’s peer group support quitting? Encouraging positive group norms could make a difference.

Weight Loss

• The Transtheoretical Model might guide step-by-step support, with initial goals like reducing sugary drinks or adding a 10-minute walk daily.
• A public health campaign using the Health Belief Model could emphasize the link between obesity and heart disease, aiming to shift beliefs.
• The Theory of Planned Behaviour might encourage someone to join a fitness class by combining positive attitudes, supportive friends, and practical advice to increase control over their schedule.

Final Thoughts

Different situations call for different approaches. Workers can combine models for the best results. For example, understanding beliefs (Health Belief Model) can inform how to prepare someone for action (Transtheoretical Model). Meanwhile, addressing social pressures (Theory of Planned Behaviour) can reinforce positive changes.

No single model works for everyone. People are complex and their motivations differ. By comparing models, we can choose the best tools to support individuals effectively.