3.1. Explain models of behaviour change used in health education

This guide will help you answer 3.1. Explain models of behaviour change used in health education.

Understanding how people change their behaviour is essential in health education. Behaviour change models help health and social care workers design effective strategies to encourage positive changes. These models explain why people act in certain ways, what motivates them, and how to guide them towards healthier choices.

In this guide, we cover several key models of behaviour change, including their purpose and how they apply to health education.

The Transtheoretical Model (Stages of Change)

The Transtheoretical Model (TTM) explains behaviour change as a process that happens over time. It identifies six stages individuals go through when making a change to their behaviour:

1. Pre-contemplation
   Individuals in this stage are not considering any change. They may not see a problem with their behaviour or might lack awareness of the risks involved.
2. Contemplation
   Here, individuals start thinking about changing their behaviour. They may weigh the pros and cons of the change but are not yet ready to act.
3. Preparation
   In this stage, people decide to make a change and begin planning how to do so. For instance, someone might set a quit date for smoking or sign up for a gym membership.
4. Action
   During this stage, individuals actively work on changing their behaviour. This could involve starting a new diet, exercising regularly, or attending counselling sessions.
5. Maintenance
   Once the behaviour has been changed, individuals focus on maintaining it. They put effort into avoiding relapse and consolidating their healthy habits.
6. Termination
   In the final stage, the new behaviour becomes a part of everyday life. The previous unhealthy behaviour is no longer tempting or relevant.

This model is widely used in health education because it recognises that change is not immediate. People need different types of support depending on which stage they are in. For example, raising awareness is crucial in the pre-contemplation stage, while skills training and relapse prevention are valuable in the maintenance stage.

The Health Belief Model

The Health Belief Model (HBM) suggests that people are more likely to change their behaviour if they believe the following:

• They are at risk from a specific health problem (perceived susceptibility).
• The health problem is serious (perceived severity).
• Taking action would reduce their risk (perceived benefits).
• The benefits of action outweigh the barriers (cost, time, effort).

It also considers whether:

• External factors (known as cues to action) push them to act, such as advice from a healthcare provider or public health campaigns.
• They feel confident in their ability to change the behaviour (self-efficacy).

For example, a smoker considering quitting might ask themselves:

• Am I at risk of serious health problems like lung cancer?
• Is my smoking already affecting my health?
• Would quitting smoking improve my health?
• Can I manage to quit despite the challenges (e.g., withdrawal symptoms)?

Health education using the HBM often focuses on information provision and addressing barriers. For instance, a worker might explain the risks of smoking, promote the benefits of quitting, and help someone create a practical change plan.

The Theory of Planned Behaviour

The Theory of Planned Behaviour (TPB) is based on the idea that an individual’s intentions drive their actions. Three factors influence these intentions:

1. Attitudes
   A person’s beliefs about the benefits or drawbacks of a behaviour affect how they feel about it. For instance, someone may view exercise positively because it improves mood and health.
2. Subjective Norms
   These refer to social influences. People are more likely to change if they feel that family, friends, or peers expect or encourage them to do so.
3. Perceived Behavioural Control
   If individuals feel they have control over their ability to change, they are more likely to succeed. This could depend on access to resources, time, or personal confidence.

The TPB is useful in health education because it shows the importance of addressing attitudes, social pressures, and barriers. For example, education programmes might include strategies to challenge negative beliefs about healthy eating, create support groups, or provide practical tools like meal plans.

Social Learning Theory

Social Learning Theory (SLT) explains that people learn behaviours by observing others. This learning often happens within social and familial environments. The theory highlights two key factors:

• Modelling
  People are more likely to adopt a behaviour if they see someone they admire doing it. For instance, children might follow their parents’ lead in eating fruit and vegetables.
• Reinforcement
  The outcomes of a behaviour influence whether it will be repeated. Positive outcomes (e.g., praise, benefits to health) encourage adoption, while negative outcomes (e.g., criticism, worsening health) discourage it.

In health education, SLT can be applied by:

• Using role models or ambassadors in campaigns to promote healthy behaviours.
• Encouraging group activities where individuals can support and learn from each other.
• Offering rewards for adopting and maintaining healthy behaviours.

For example, a smoking cessation group might bring together individuals who share their stories of successfully quitting, offering encouragement to others.

COM-B Model

The COM-B Model provides a simple framework for understanding behaviour. It highlights three elements:

1. Capability (C)
   This refers to a person’s ability to perform the behaviour. It can include physical skills (e.g., being able to exercise) and knowledge (e.g., knowing the health risks of poor diet).
2. Opportunity (O)
   Opportunity refers to external factors that make the behaviour possible. This could include having access to a gym, clean water, or resources like nicotine replacement therapy.
3. Motivation (M)
   Motivation relates to an individual’s desire to perform the behaviour. This includes conscious decision-making and subconscious processes like emotions and habits.

The model shows that behaviour change interventions need to address all three components. If one is missing, change is unlikely to happen. For example, even if someone wants to eat healthily (motivation), they may struggle if healthy food is unavailable in their local area (opportunity).

In health education, COM-B helps workers design holistic interventions. For instance, an anti-obesity programme might:

• Teach cooking skills and provide educational leaflets about healthy eating (capability).
• Work with communities to improve access to affordable fruit and vegetables (opportunity).
• Use motivational interviews to explore personal reasons for wanting to eat better (motivation).

The Self-Determination Theory

This theory focuses on the role of intrinsic (internal) and extrinsic (external) motivation in driving behaviour change. Its key idea is that people are more likely to make changes when they feel:

• Autonomy – They have chosen the behaviour themselves rather than being forced.
• Competence – They believe they can successfully make the change.
• Relatedness – They feel connected to a community or group supporting their efforts.

Health education based on this theory often involves personalised approaches. Workers might encourage someone to set their own health goals, provide skills training, and connect them with support networks.

Practical Applications of Behaviour Change Models in Health Education

Behaviour change models provide frameworks for developing effective strategies in health education. Here are some key ways they can be applied:

• Campaigns and public health initiatives
  Campaigns like “Change4Life” incorporate behaviour change models by combining education, social support, and resources to help people adopt healthier lifestyles.
• One-to-one interventions
  Health and social care workers use these models to personalise advice. For example, smokers might create a quit plan tailored to their stage in the Transtheoretical Model.
• Group-based programmes
  Models like Social Learning Theory are particularly helpful in group settings. Programmes can encourage participants to share successes, work together, and benefit from role modelling.

Limitations of Behaviour Change Models

While useful, behaviour change models are not perfect. Key limitations include:

• Over-simplifying complex behaviours.
• Not accounting for unpredictable life events or crises.
• Ignoring cultural, societal, or financial barriers faced by individuals.

Despite these limitations, these models remain valuable tools for health education when combined with practical understanding and responsiveness to individual needs.

By applying these models thoughtfully, you can encourage meaningful and lasting changes in the people you support, improving their health and overall quality of life.