DNP 815 Health behavior change theories

Health behavior change theories suggest behavior change as a “process,” not an “event.” How can you put this into action for developing an intervention for practice or research? Discuss how you would apply this in planning your DNP project.

Each behavioural change theory or model focuses on different factors in attempting to explain behaviour change. Of the many that exist, the most prevalent are learning theories, social cognitive theory, theories of reasoned action and planned behaviour, transtheoretical model of behavior change, the health action process approach and the BJ Fogg model of behavior change. Research has also been conducted regarding specific elements of these theories, especially elements like self-efficacy that are common to several of the theories.

Self-efficacy[edit]

Self-efficacy^[2] is an individual’s impression of their own ability to perform a demanding or challenging task such as facing an exam or undergoing surgery. This impression is based upon factors like the individual’s prior success in the task or in related tasks, the individual’s physiological state, and outside sources of persuasion. Self-efficacy is thought to be predictive of the amount of effort an individual will expend in initiating and maintaining a behavioural change, so although self-efficacy is not a behavioural change theory per se, it is an important element of many of the theories, including the health belief model, the theory of planned behaviour and the health action process approach.

In 1977, Albert Bandura performed two experimental tests on the self-efficacy theory. The first study asked whether systematic desensitization could effect changes in avoidance behavior by improving people’s expectations of their personal efficacy. The study found that “thorough extinction of anxiety arousal to visualized threats by desensitization treatment produced differential increases in self-efficacy. In accord with prediction, microanalysis of congruence between self-efficacy and performance showed self-efficacy to be a highly accurate predictor of degree of behavioral change following complete desensitization. The findings also lend support to the view that perceived self-efficacy mediates anxiety arousal.” In the second experiment, Bandura examined the process of efficacy and behavioral change in individuals suffering from phobias. He found that self-efficacy was a useful predictor of the amount of behavioral improvement that phobics could gain through mastering threatening thoughts.^[3]

Social learning and social cognitive theory[edit]

According to the social learning theory^[4] (more recently expanded as social cognitive theory^[5]), behavioural change is determined by environmental, personal, and behavioural elements. Each factor affects each of the others. For example, in congruence with the principles of self-efficacy, an individual’s thoughts affect their behaviour and an individual’s characteristics elicit certain responses from the social environment. Likewise, an individual’s environment affects the development of personal characteristics as well as the person’s behavior, and an individual’s behaviour may change their environment as well as the way the individual thinks or feels. Social learning theory focuses on the reciprocal interactions between these factors, which are hypothesised to determine behavioral change.

Theory of reasoned action[edit]

The theory of reasoned action^[6][7] assumes that individuals consider a behaviour’s consequences before performing the particular behaviour. As a result, intention is an important factor in determining behaviour and behavioural change. According to Icek Ajzen, intentions develop from an individual’s perception of a behaviour as positive or negative together with the individual’s impression of the way their society perceives the same behaviour. Thus, personal attitude and social pressure shape intention, which is essential to performance of a behaviour and consequently behavioural change.

Theory of planned behaviour[edit]

In 1985, Ajzen expanded upon the theory of reasoned action, formulating the theory of planned behaviour,^[8] which also emphasises the role of intention in behaviour performance but is intended to cover cases in which a person is not in control of all factors affecting the actual performance of a behaviour. As a result, the new theory states that the incidence of actual behaviour performance is proportional to the amount of control an individual possesses over the behaviour and the strength of the individual’s intention in performing the behaviour. In his article, Further hypothesises that self-efficacy is important in determining the strength of the individual’s intention to perform a behaviour. In 2010, Fishbein and Ajzen introduced the reasoned action approach, the successor of the theory of planned behaviour.

Transtheoretical or stages of change model[edit]

According to the transtheoretical model^[9][10] of behavior change, also known as the stages of change model, states that there are five stages towards behavior change. The five stages, between which individuals may transition before achieving complete change, are precontemplation, contemplation, preparation for action, action, and maintenance. At the precontemplation stage, an individual may or may not be aware of a problem but has no thought of changing their behavior. From precontemplation to contemplation, the individual begins thinking about changing a certain behavior. During preparation, the individual begins his plans for change, and during the action stage the individual begins to exhibit new behavior consistently. An individual finally enters the maintenance stage once they exhibit the new behavior consistently for over six months. A problem faced with the stages of change model is that it is very easy for a person to enter the maintenance stage and then fall back into earlier stages. Factors that contribute to this decline include external factors such as weather or seasonal changes, and/or personal issues a person is dealing with.

Health action process approach[edit]

The health action process approach (HAPA)^[11] is designed as a sequence of two continuous self-regulatory processes, a goal-setting phase (motivation) and a goal-pursuit phase (volition). The second phase is subdivided into a pre-action phase and an action phase. Motivational self-efficacy, outcome-expectancies and risk perceptions are assumed to be predictors of intentions. This is the motivational phase of the model. The predictive effect of motivational self-efficacy on behaviour is assumed to be mediated by recovery self-efficacy, and the effects of intentions are assumed to be mediated by planning. The latter processes refer to the volitional phase of the model.

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