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How Does Behavior Change Occur?

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Compare and contrast the health belief model, the social cognitive
model, and the transtheoretical model of behavior change,
and explain how you might use them in making a specific behavior
change.

While many factors influence your health status, you have the most control over your individual behaviors. Over the years, social scientists and public health researchers have developed a variety of models to illustrate how individual behavior change occurs. We explore three of those here.

Health Belief Model

We often assume that when rational people realize their behaviors put them at risk, they will change to reduce that risk. However, it doesn’t always work that way. Consider the number of health professionals who smoke, consume junk food, and act in other unhealthy ways. They surely know better, but their “knowing” is disconnected from their “doing.”One classic model of behavior change suggests our beliefs may help explain why this occurs. A belief is an appraisal of the relationship between some object action, or idea (e.g., smoking) and some attribute of that object, action, or idea (e.g., “Smoking is expensive, dirty, and causes cancer” or “Smoking
is relaxing and I’m too young to get cancer”). Thousands of studies over the past 50 years have provided evidence that beliefs subtly influence behavior. In the 1950s, psychologists at the
U.S. Public Health Service developed the health belief model (HBM), which describes the ways in which beliefs affect behavior change.25 The HBM hold that several factors must support a belief before the change is likely:

  • Perceived seriousness of the health problem. The more serious the perceived effects are, the more likely action will be taken.
  • Perceived susceptibility to the health problem. People who perceive themselves at high risk are more likely to take preventive action.
  • Perceived benefits. People are more likely to take action if they believe that this action will benefit them.
  • Perceived barriers. Even if a recommended action is perceived to be effective, the individual may believe it is too expensive, difficult, inconvenient, or time-consuming. These perceived barriers must be overcome or acknowledged as less important than the benefits.
  • Cues to action. A person who is reminded or alerted about a potential health problem is more likely to take action. These cues to action can range from early symptoms of a disorder to an e-mail from a health care provider.

People follow HBM many times every day. Take, for example, smokers. Older smokers are likely to know other smokers who have developed serious heart or lung problems. They are thus more likely to perceive tobacco as a threat to their health than are teenagers who have just begun smoking. The greater the perceived threat of health problems caused by
smoking, the greater the chance a person will quit.

However, many chronic smokers know the risks yet continue to smoke. Why? According to Rosenstock, some people do not believe they are susceptible to a severe problem—they act as though they are immune to it—and are unlikely to change their behavior. They also may feel that the immediate pleasure outweighs the long-range cost.

Social Cognitive Model

Developed from the work of several researchers over the decades, the social cognitive model (SCM) is most closely associated with the work of psychologist Albert Bandura. Fundamentally the model proposes that three factors interact in a reciprocal fashion to promote and motivate change: the social environment in which we live, our thoughts or cognition (including our values, beliefs, and expectations), and our behaviors. We change our behavior in part by observing models in our environments—from childhood to the present moment— reflecting on our observations and regulating ourselves accordingly. For instance, if we observe a family member successfully quitting smoking, we are more apt to believe we can do it, too. In addition, when we succeed in changing ourselves, we change our thoughts about ourselves, potentially promoting further behavior change: After we’ve successfully quit smoking,
we may feel empowered to increase our level of physical activity. Moreover, as we change ourselves, we become a model for others to observe. The SCM is often used to design health promotion programs.
For example, one public health program engaged overweight and obese men in a program of goal-setting, reward the setting, journaling, and social support to improve their eating and activity patterns.27 Another recent study designed according to the SCM increased condom use in participants who viewed a video of someone modeling self-efficacy and consideration of partner expectations.

Transtheoretical (Stages of Change) Model

Why do so many New Year’s resolutions fail before Valentine’s
Day? According to Drs. James Prochaska and Carlos DiClemente,
it’s because most of us aren’t really prepared to take action. Their research indicates that behavior changes usually do not succeed when starting with the change itself. Instead, we must go through a series of stages to adequately prepare ourselves for that eventual change.29 According to Prochaska and DiClemente’s transtheoretical model of behavior change
(also called the stages of change model), our chances of keeping those New Year’s resolutions will be greatly enhanced if we have proper reinforcement and help during each of the following stages:

  • Precontemplation. People in the precontemplation stage have no current intention of changing. They may have tried to change a behavior before and given up, or they may be in denial and unaware of any problem.
  • Contemplation. In this phase, people recognize that they have a problem and begin to contemplate the need to change. Despite this acknowledgment, people can languish in this stage for years, realizing that they have a problem but lacking the time or energy to make the change.
  1. Preparation. Most people at this point are close to taking action. They’ve thought about what they might do and may even have a plan.
  • Action. In this stage, people begin to follow their action plans. Those with a plan of action are more ready for action then are those who have given it little thought.
  • Maintenance. During the maintenance stage, a person continues the actions begun in the action stage and works toward making these changes a permanent part of his her life. In this stage, it is important to be aware of the potential for relapses and to develop strategies for dealing with such challenges.
  • Termination. By this point, the behavior is so ingrained that constant vigilance may be unnecessary. The new behavior has become an essential part of daily living.

We don’t necessarily go through these stages sequentially. They may overlap, or we may shuttle back and forth from one

Transtheoretical Model People don’t move through the transtheoretical model stages in sequence. We may make progress in more than one stage at one time, or we may shuttle back and forth from one to another—say, contemplation to preparation, then back to contemplation—before we succeed in making a change.

to another—say, contemplation to preparation, then back to contemplation—for a while before we become truly committed to making the change (Image). Still, it’s useful to recognize “where we are” with a change so that we can consider the appropriate strategies to move us forward.

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