Understanding Health Behavior Change Principles

Posted on May 4, 2025 in Other university degrees and diplomas

Models and Frameworks for Health Behavior

3-4-50 Rule

  • 3 key risk behaviors: poor nutrition, physical inactivity, tobacco use
  • Contribute to 4 major chronic diseases: heart disease/stroke, cancer, diabetes, respiratory diseases
  • Account for approximately 50% of preventable disease burden

Social Ecological Model

Framework illustrating how multiple levels of influence interact to affect health behaviors:

  • Individual: Knowledge, attitudes, behaviors, demographics
  • Interpersonal: Family, friends, social support systems
  • Community: Cultural/social norms, environment, organizations
  • Policy: Local, state, and national laws and policies

Behavior Epidemiology Framework

A systematic approach to studying health behaviors:

  • Phase 1: Establish links between health behavior and chronic disease
  • Phase 2: Develop methods for accurately assessing health behaviors
  • Phase 3: Identify factors that influence levels of health behaviors
    • Non-modifiable factors: Help identify who to target
    • Modifiable factors: Help identify what to target
  • Phase 4: Evaluate interventions to promote health behaviors
  • Phase 5: Translate research into practice

Key Concepts in Public Health Behavior

Prevalence vs. Incidence

  • Prevalence: Number of cases in a population at a given time
  • Incidence: Number of new cases in a population over a period

Health Behavior Trends

  • Obesity: Getting worse
  • Physical Activity: Stable
  • Smoking: Better

Health Disparities

Gaps in health between segments of the population, creating health inequities that are avoidable and unfair.

Factors Increasing Disparity Risk

Demographics and other factors can increase risk for groups engaging in unhealthy behaviors:

  • Individual (Psychological): Attributes, preferences, knowledge, mood
  • Interpersonal: Social support, family, model behaviors
  • Community Correlates: Diet (food desert and swamp), physical activity (walkability, built environment), smoking (exposure/access)

Behavior Change Theories

A theory is a testable hypothesis.

Health Belief Model

Explains people’s failure to participate in disease prevention and detection programs.

  • People will engage in the behavior if they value the outcome related to the behavior and think the behavior is related to the outcome.
  • Focuses on the individual; does not account well for social and environmental factors.

Theory of Reasoned Action/Planned Behavior

  • Behavior is due to people’s attitudes, norms, and perceived control.
  • Focuses on individual factors (perceived control) and not interpersonal or community-level control.
  • Assumes behavior is the output of rational, linear decision-making processes, predominantly relying on thoughts, knowledge, and perception.
  • Helpful for guiding wording/content; important, but not enough to produce behavior change on its own.
  • Lacks focus on “active” components of interventions.

Interpersonal Theories

Focus on individuals and interactions between people.

Social Cognitive Theory

Describes behavior as being affected by:

  • Personal/Individual factors
  • Environmental influences
  • Attributes of the behavior

Major constructs include: self-efficacy, behavioral capacity, expectations, self-control, coping, learning, reinforcement, situation (complex theory).

Transtheoretical Model

  • People vary in their level of motivation to change.
  • Interventions should be targeted to an individual’s level of motivation and focus on progressing through stages.
  • People can enter at any stage.
  • Not a “stand-alone theory” – meant to be used with other theories.
  • Stages include: pre-contemplation, contemplation, preparation, action, maintenance.
  • Critiques:
    • People do not always go through a fixed set of stages in a straight line.
    • Measurement of what stage someone is in can be tricky.

Intervention Strategies

Key Points for Picking a Theory

  • What behavior do you want to change, and what constructs impact that behavior?
  • What population are you working with, and what constructs matter for them?

Self Monitoring

  • Tracking target behavior
  • Provides feedback
  • Reveals patterns of behavior
  • Increases accountability (Note: Can be subject to recall bias)

Intention Formation

  • Increase motivation to change
  • Making a commitment

Goal Setting

  • Set a specific plan
  • Consider short-term and long-term goals
  • Need to balance: ability and challenge

Goal Review

  • Periodic review and reconsideration of set goals
  • Assessing progress

Performance Feedback (Loops)

Action → Information → Reaction

“Active information components” combine self-monitoring PLUS intention formation, goal setting, goal review, and performance feedback.

Delivery Channels

How intervention components are administered to the target person/population/community. Multiple channels can be used (e.g., print mail, apps, text, web, phone, video).

How to Decide on Channels

  • What are your intervention components?
  • Can they be delivered remotely or not?
  • Do they need technology or not?
  • Who is your target group?
  • What are the costs/resources?
  • What is feasible?

Timing of Intervention Delivery

When do people struggle with keeping a new behavior?

  • When motivation is high
  • Key times of relapse
  • Spread out to prevent message fatigue and reduce burden
  • Consider level of resources

Community Approaches

Diffusion of Innovations

Characteristics influencing adoption:

  • Relative advantage
  • Compatibility
  • Complexity
  • Trainability (or Trialability)
  • Observability

Community-Based Participatory Research (CBPR)

Importance of formative work to ensure all voices in the community are heard and incorporated.

  • Improves research
  • Increases trust
  • Provides resources
  • Potential to lead to policy change

Challenges include: lack of trust, inequitable power, difference in views, and balance between research and action.

Community Intervention Trial for Smoking Cessation (COMMIT)

  • Group randomized trial
  • Increased access to smoking cessation programs
  • Decreased access to places to smoke

Health Leads

  • Increased access to community resources

Detroit Park Restoration

  • Increased access to green space/improved parks

Community Gardens

  • Increased access to free fruits and vegetables

LiveWell San Diego

Tagline: Love Your Heart

  • Increased access to blood pressure screenings

Multilevel Interventions

Targets more than one level of the Social Ecological Model (e.g., community, school, and workplace) through a coordinated effort.

High-Risk and Special Populations

Groups within a larger population that are at greater risk for health problems (e.g., marginalized groups, lack of access to care, involvement in illegal activities, existing health conditions).

Why Target These Groups?

  • Different motivators
  • Different influences
  • Different circumstances

Considerations for Intervention

  • Building trust
  • Finding the right way to communicate
  • Willingness to learn
  • Honesty

Harm Reduction

Changing behavior to reduce risk rather than requiring complete cessation of the behavior.

Evaluation Methods

Tools to help you make a case that your intervention works.

Evaluations can help you answer: if an intervention worked (outcome), why it worked or did not work (process), and if it ultimately benefited health or well-being (impact).

Types of Evaluation

  • Process: Did the intervention go as planned?
  • Outcome: Did the target behavior change?
  • Impact: Did health improve (due to change in target behavior)? Was there a benefit to the community?