How do we influence health behaviour change?

Have you every wondered why an individual might make healthier choices over someone else? Did you know “60% of adults and 88% of seniors in Canada are not health literate” (Public Health Agency of Canada, 2014). Health literacy or being health illiterate can lead individuals in these choices. Health promotion is important as it enables an individual to make healthier life choices by providing information that allows an individual to have control over their health. As we have explored over that last few weeks, understanding the concept of health and determinants of health is the first step of health promotion. Health promotion has been defined as “the process of enabling people to increase control over the determinants of health and thereby improve their health” or “enables people to increase control over their own health… and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure” (Stanhope & Lancaster,2011, p. 599; WHO, 2016). Taking the next step is applying health promotion initiatives across a multi level of influences to address the determinants of health. In order to bring about change through health promotion, one may look at “Health behavior models and theories help to explain why individuals and communities behave the way they do” (Simpson, 2015). Through out this blog I will explore three models to bring about health behaviour changes.

Social Ecological Model

The social ecological model considers behaviour change at five levels of influence (Simpson, 2015). These levels of influences included: individual, interpersonal, organizational, community and public policy (Glanz & Bishop, 2010). As Glanz & Bishop (2010) explain, “the principles of social ecological models … suggest that creating an environment conducive to change is important to facilitate adoption of healthy behaviors”. Simpson (2015) stated “using this model allows a program planner to consider factors from multiple levels that can impact health” as each level of influence is influenced by the other levels. The following video by Koskan Public Health provides an overview of the social ecological model.

Transtheoretical Model

This model is constructed with states of change and “describes the process of behavior change and accounts for an individual’s readiness to make and sustain behavior changes” (Simpson, 2015). This model consists of five stages: precontemplation, contemplation, preparation, action and finally maintenance (Glanz & Bishop, 2010). It is important to realize that this process may not be linear and could be more cyclical with people moving between stages and recycling through stages (Glanz & Bishop, 2010; Simpson, 2015). This model is helpful in assisting individuals in making a sustained behaviour change, for example when “trying to break a habitual/ addictive behaviour” (Simpson, 2015; Lowery-Lehnen, 2014). The slide below by Lowery-Lehnen (2014) shows a visual of the stages in the transtheoretical model.

Health Belief Model

The Health Belief Model (HBM) is one of the oldest models but is still widely recognized (Glanz & Bishop, 2010). It was originally developed in 1950s to assist in understanding why or why not people utilized public health services and has evolved to address more current concerns regarding prevention and detection (Glanz & Bishop, 2010). “The HBM theorizes that people's beliefs about whether they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action” (Glanz & Bishop, 2010). The key beliefs of this model are: 1) Perceived susceptibility, 2) Perceived severity, 3) Perceived benefits, 4) Perceived Barriers (Simpson, 2015). In addition to these four beliefs, this model includes cues to actions and self- efficacy (Simpson, 2015). As Glanz and Bishop (2010) stated “The HBM has been applied most often for health concerns that are prevention-related and asymptomatic”. The following video is an overview of the HBM by Matthew Schimenti.

Choosing a theory

“The choice of a suitable theory or theories should begin with identifying the problem, goal, and units of practice, not with selecting a theoretical framework because it is intriguing, familiar, or in vogue” (Glanz, n.d.). After reviewing these three models, I look forward to applying the Health Belief Model to my next blog post exploring improved hospital outcomes in older adults in a rural medical unit. I am going to apply this model to my work place and passion for senior friendly care.

References

Glanz, K. (n.d.). Choosing the Right Theory. Social and Behaviour Theories. http://www.esourceresearch.org/eSourceBook/SocialandBehavioralTheories/8ChoosingtheRightTheory/tabid/743/Default.aspx

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health, 31, 399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604

Lowery-Lehnen, T (2014, Febuary 10). Prochaska & DiClemente Trans-theoretical Modoel of

Change [PowerPoint Slides]. Slideshare. https://www.slideshare.net/lehnent/prochaska-and-di-clementes-transtheoretical-model-of-change

Public Health Agency of Canada. (2014). Health Literacy. http://www.phac-

aspc.gc.ca/cd-mc/hl-ls/index-eng.php#tabs-2

Simpson, V. (2015, Mar). Models and Theories to Support Health Behaviour Intervention and Program Planning. https://extension.purdue.edu/extmedia/HHS/HHS-792-W.pdf

Stanhope, M., & Lancaster. J. (2011). Community Health Nursing in Canada (2nd Canadian ed.). Toronto: Mosby Elsevier

World Health Organization. (2016). What is health promotion. http://www.who.int/features/qa/health-promotion/en/