There is evidence that the use of theory to design and implement behavior change interventions improves their effectiveness. (2,12)
For this reason, I have attempted to summarize four of the most-often used behavior change theories below. They are: 1) Health Belief Model, 2) Theory of Planned Behavior, 3) Transtheoretical Model/Stages of Change, and 4) Social Cognitive Theory.
Here's a quick overview, from the socio-ecological perspective:
Health Belief Model
One of the most widely used models for understanding health behavior, the Health Belief Model has 6 constructs:
Perceived susceptibility - A person's subjective perception of the risk of getting an illness or disease.
Perceived severity - A person's feelings on the seriousness of contracting an illness or disease (or not treating the illness or disease).
Perceived benefits - A person's perception of the effectiveness of the actions available to cure or reduce the threat of illness or disease.
Perceived barriers - A person's feelings with regard to the obstacles to performing a recommended health action.
Cue to action - The stimulus needed to trigger the decision-making process in order to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, media, etc.).
Self-efficacy - The level of a person's confidence in their ability to successfully perform a behavior. Self-efficacy is an important construct in many behavioral theories as it directly relates to whether a person performs the desired behavior.
Theory of Planned Behaviour
This theory has been used successfully to predict and explain health behaviors ranging from smoking, to drinking, to breastfeeding and substance use. In this theory, behavior depends on both motivation (intention) and ability (behavioral control). It distinguishes between three types of beliefs – behavioral, normative, and control – and its six constructs collectively represent a person's control over the behavior.
Attitudes - The degree to which a person has a favorable or unfavorable opinion of the behavior.
Behavioral intention - The motivational factors that influence a given behavior, where the stronger the intention to perform the behavior, the more likely the behavior will be performed.
Subjective norms - The belief about whether peers and people of importance approve or disapprove of the behavior.
Social norms - The customary codes of behavior in a group or larger cultural context.
Perceived power - The perceived presence of factors that may facilitate or impede the behavior.
Perceived behavioral control - A person's perception of the ease or difficulty of performing the behavior (which may vary across situations and actions).
Transtheoretical (or Stages of Change) Model
This model states that an individual moves through six stages before achieving behavior change: precontemplation, contemplation, preparation for action, action, and maintenance, and termination (added at a later time).
Precontemplation - an individual may or may not be aware of a problem but has no thought of changing their behavior.
Contemplation - when the individual begins thinking about changing a certain behavior.
Preparation - when an individual begins planning for change, and the Action stage is when the individual starts to consistently perform the new behavior.
Maintenance - when the individual has been performing the new behavior consistently for over six months.
Termination - when people have no desire to return to their unhealthy behaviors and are sure they will not relapse. As this stage is rarely reached, people tend to stay in the maintenance stage and this last stage is often not considered in health promotion programs.
Social Cognitive (or Learning) Theory
This theory seeks to explain how people regulate their behavior through control and reinforcement, in order to maintain the behavior over time. It now includes six constructs:
Reciprocal Determinism - The dynamic and reciprocal interaction of three factors: the person (including their thoughts and feelings), environment, and behavior.
Behavioral Capability - A person's actual ability to perform the behavior through use of knowledge and skills.
Observational Learning - The idea that people can observe someone else's behavior and repeat it.
Reinforcements - The internal or external responses to a person's behavior that affect the likelihood of continuing or discontinuing it.
Expectations - The anticipated consequences of a person's behavior. Expectations come largely from previous experience and vary based on both the individual and the value they place on the outcome.
Self-efficacy - A person's confidence in their ability to successfully perform a behavior.
Developing Theories of Change and Logic Models can also be helpful to explain the thinking behind program design and show how certain activities could lead to the desired results. Below is a logic model template from Johns Hopkins University. "Inputs include the resources, contributions, and investments that go into a program; outputs are the activities, services, events and products that reach the program’s primary audience; and outcomes are the results or changes related to the program’s intervention that are experienced by the primary audience." *
All of this said, theories are more like tools for creative thinking rather than formulas for success. As theories, they should be used to check assumptions and tailored to each behavior and environment.
2. National Institute for Health and Clinical Excellence (NICE) (2007). NICE Public Health Guidance 6 ‘Behaviour change at population, community and individual levels’. London: NICE.
12. Michie S & Johnston M (2012). Theories and techniques of behaviour change: Developing a cumulative science of behaviour change. Health Psychology Review 6(1):1-6.
* https://www.thecompassforsbc.org/sbcc-tools/logic-model-template
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