Wednesday, March 20, 2013
Theory and Behavior Change
Several factors exist that may increase or decrease an individual's chances of changing negative health behaviors. Additionally, a variety of motivations may initiate behavioral changes. The goal of this paper is to describe factors that instigate negative and positive health behaviors and the influences that motivate an individual to change. In addition, it will explain the role of theory in the development of health behavior interventions.
Altering the Chances for Change
Negative health behaviors are usually coping behaviors initiated because of an underlying inability to cope with stress (Glanz, Rimer, & Viswanath, 2008). Having adequate social support and a supportive and encouraging environment increase an individual's chances of maintaining long-term positive changes in health behavior (Glanz et al., 2008). Isolation and a sense of personal vulnerability decreases self-efficacy and the opportunity to instigate lasting behavior change. Further, individuals usually need constant reinforcement (from a support system) of strategies that help maintain self-efficacy, and the perceived ability to manage stress.
When individuals perceive their circumstances as beyond their control, they experience a decrease in self-control and self-efficacy. Negative perceptions of personal circumstances, or subjective psychological burden, initiates a cycle of negative health behavior and a lack of self-care. (Schwarzer & Luszczynska, 2008). If individuals initiate negative health behaviors because of stress, changing their perception of the stress (or their psychological burden) may contribute to an increase in self-control and self-efficacy (Gräßel & Adabbo, 2011).
Descriptive Norm Information
Burger and Shelton (2011) found that presenting individuals with descriptive norm information changed their behavior. For example, Burger and Shelton installed a sign near the building elevators that explained more people used the stairs rather than the elevator. After reading the sign, a significant number of people began using the stairs (Burger & Shelton, 2011). Similar research by Cialdini, Reno, and Kallgren (1990) found individuals behave according to expected and established norms. Applying this concept to health behaviors may instigate systemic changes in large populations by establishing and utilizing readily available norms, in effect, manipulating the normal expectations for the individuals (Burger & Shelton, 2011). As individuals initiate behavioral change, they establish new norms for behavior, which will reinforce the change. Utilizing this concept, it may be possible to change health behaviors by establishing norms that suggest most people do not smoke, or participate in whichever health behavior needs change (Burger & Shelton, 2011).
Changes in self-perception have been shown to motivate change. Cognitive strategies that increase self-control and self-efficacy have been proven effective for managing emotions and decreasing negative behaviors and thought patterns that are often established in chronically stressful circumstances. Perceived self-efficacy and other cognitive strategies facilitate behavioral change when intentions alone fail to promote successful outcomes (Schwarzer & Luszczynska, 2008). Wood and Neal (2007) suggested changing one's environment and consequently the cues for negative behaviors may lead to creating positive behaviors. By removing the psychological triggers for negative behavior, behavior is changed (Wood & Neal, 2007). Schwarzer and Luszczynska (2008) found individually tailored interventions were more effective than generic solutions.
The Role of Theory in Interventions
Interventions designed for changing health behaviors are far more effective when they are
informed by theory (Glanz et al., 2008). The combination of research and theory and the information they provide in practice contribute to the effective implementation of strategies that create sustained behavior change (Glanz et al., 2008). Theory is the conceptual framework foundational in the practical implementation of interventions successful in changing health behavior, and is a critical component of explaining and predicting health behaviors (Lippke & Ziegelmann, 2008). For example, before psychologists can predict changes in behavior, they must first understand the primary drive of the behavior. Theory can elaborate on these motivating factors and explicate techniques that may be used to instigate change (Lippke & Ziegelmann, 2008).
Theory-based interventions are a critical component of promoting long-term change in health behavior. Its importance, however, exists in the translation of theory into practice. As a greater number of theories are introduced and implemented in practice, empirical evidence is needed to determine that theory-based interventions are, in fact, superior (Bhattacharyya, Reeves, Garfinkel, & Zwarenstein, 2006). For example, in the field of mental health counseling, various theories and approaches claim superior effectiveness, yet Wampold (2001) determined that most modalities were effective, but none were necessarily superior.
Cognitive strategies have proven effective in altering perception and habit. Additionally, providing positive self-perceptions promotes self-control and self-efficacy which are central to establishing positive health behaviors. Theory provides a foundational conceptual framework for research, which ultimately determines the effectiveness of theoretical applications in practice.
Bhattacharyya, O., Reeves, S., Garfinkel, S., & Zwarenstein, M. (2006). Designing theoretically- informed implementation interventions: Fine in theory, but evidence of effectiveness in practice is needed. Implementation Science, 15-3. doi:10.1186/1748-5908-1-5
Burger, J. M., & Shelton, M. (2011). Changing everyday health behaviors through descriptive norm manipulations. Social Influence, 6(2), 69-77. doi:10.1080/15534510.2010.542305
Cialdini, R. B., Reno, R. R., & Kallgren, C. A. (1990). A focus theory of normative conduct: Recyling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58, 1015–1026.
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.
Gräßel, E., & Adabbo, R. (2011). Perceived burden of informal caregivers of a chronically ill older family member: Burden in the context of the transactional stress model of Lazarus and Folkman. Geropsych: The Journal Of Gerontopsychology And Geriatric Psychiatry, 24(3), 143-154. doi:10.1024/1662-9647/a000042
Lippke, S., & Ziegelmann, J. P. (2008). Theory-Based Health Behavior Change: Developing, Testing, and Applying Theories for Evidence-Based Interventions. Applied Psychology: An International Review, 57(4), 698-716. doi:10.1111/j.1464-0597.2008.00339.x
Schwarzer, R., & Luszczynska, A. (2008). How to overcome health-compromising behaviors: The health action process approach. European Psychologist, 13(2), 141-151. doi:10.1027/1016-9040.13.2.141
Wampold, B. E. ( 2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum.
Wood, W., & Neal, D. T. (2007). A new look at habits and the habit-goal interface. Psychological Review, 114(4), 843–863.