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Changing Behaviours: A Practical Framework



Introduction



There are many social science theories that attempt to explain behaviour change. If you want to learn the intricate details of behaviour change theories, there are many textbooks and other resources that provide thorough information on each model. Typically, however, practitioners are more interested in quick, easy ways to apply theories and research.



One excellent example of a user-friendly behaviour change framework is the following list that was developed at a consensus conference of prominent behavioural scientists. The scientists endorsed eight conditions, one or more of which must be true, for a person to perform a given behaviour (1). Virtually all mainstream behaviour change theories (including stages of change/transtheoretical model, health belief model, social learning theory, theory of planned behaviour, and diffusion of innovations) are represented in this framework. The first three conditions are considered "necessary and sufficient" for adopting a behaviour, and the remaining five affect the intensity and direction of the intention.



To make this framework more practical, we have briefly explained each condition, provided some strategies for meeting each condition, and given examples of how to apply each strategy. Because some of the strategies for meeting one condition are the same as strategies for other conditions, we have numbered the strategies to avoid unnecessary repetition.

Though there isn't space here, there are many online applications of these strategies. If you would like to see a list of some of the many online examples exemplifying these strategies (assembled by Shawn Chirrey - Coordinator of the Canadian Health Network Youth Affiliate) please go to http://www.thcu.ca/hpss.html A selection from Shawn's list will be provided in the resources message that will follow this feature.




A. CONDITION FOR BEHAVIOURAL CHANGE: The person has formed a strong positive intention (or made a commitment) to perform the behaviour.



EXPLANATION: Person/audience believes they are at risk for the problem, that the consequences are severe, and that the proposed behaviour will lower the risk or prevent the problem.



APPLICABLE STRATEGIES:



#1 Provide clear information about the population at risk and the recommended behaviour.

Examples: Pregnant women who smoke should quit; Anyone who is exposed to the sun should cover up and use sunscreen; IV drug users should use clean needles.



#2 Increase audience awareness about the need for change.

Examples: communication campaigns (such as smoking ads shown at http://www.hc-sg.gc.ca/real/smoking); show a smoker the result of their blowing in a CO monitor



#3 Provide details of outcome if existing behaviour continues.

Examples: death; disability; death/injury of friend/family; premature aging; American Lung Association Wall of Remembrance http://www.lungusa.org/bin/wall/wallview.pl (shows personal experience of loss from lung cancer).



#4 Personalize information on risks and benefits.

Examples: show young girls (who care about appearances) how sun exposure will cause early aging; show smokers how other smokers who resemble them have been affected by smoking



#5 Incorporate information about likely positive results of adopting recommended behaviour, into advice.

Examples: discuss all benefits of quitting smoking (more energy, longer life, etc. see http://www.allhealth.com/conditions/abuse/0,4264,377,00.html for example); explain how much sunscreen reduces the risk of early aging and skin cancer.



B. CONDITION FOR BEHAVIOURAL CHANGE: There are no environmental constraints (barriers) that make it impossible for the behaviour to occur.



EXPLANATION: Barriers can be tangible (e.g. not enough time or money, no access to facilities or programs, etc.) or psychological (anxiety, discomfort, social pressure, etc.) and supportive environments can be created at many levels (e.g. society level policies, workplace or organizational policies, home environments, personal social support networks, etc.).



APPLICABLE STRATEGIES:



#6 Determine audience barriers to action and attempt to rectify.

Examples: reduce or eliminate fees for exercise program; adjust workplace policy so that benefits cover the nicotine patch; increase staff at mammography clinic so waiting lists are short; make digital (easy to use) blood pressure monitor available rather than traditional (difficult to use) stethoscope model; provide transportation to program/facility; produce low literacy information materials; provide a mobile unit where condoms, clean needles, HIV tests are readily available; ensure low risk/trialability (e.g. provide one-time free cessation seminar - no commitment to continue coming)



#7 Create supportive environments whenever possible.

Examples: community/workplace non-smoking policies; incentives (prizes, refundable deposit when successful behaviour change); provide reassurance; set up support groups that are easy to access (e.g. http://www.ivillage.com/diet/ ); get company to offer low-fat food choices; build walking/bicycle paths in community; build low income housing; put stickers in beach washrooms reminding to check skin and apply sunscreen



C. CONDITION FOR BEHAVIOURAL CHANGE: The person has skills necessary to perform the behaviour.



EXPLANATION: Person/audience has knowledge and ability to take steps to make behaviour change easier and success more likely. This also involves doing the behaviour properly so that the desired outcome is achieved (e.g. improper exercise can result in injury, or no effect rather than improvement in cardiovascular health).



APPLICABLE STRATEGIES:



#8 Provide specific how-to information/training.

Examples: teach how to identify possible skin cancer lesion; provide pamphlets on type of condoms that work best and how to use them; promote physical activity guide



#9 Assist with setting quantifiable, realistic, graduated and moderately difficult goals.

Example: start by walking slowly ten minutes per day and work up to vigorous walking 30 minutes per day; reduce smoking before quitting



#10 Identify/provide role models to emulate.

Examples: newspaper article on prominent community member who made big lifestyle changes (in healthy ways); campaign with young movie stars talking about how they avoided drugs.



#11 Provide suggestions/teach how to find own solutions for barriers.

Examples: cut up a big bowl of carrots to eat when others will be eating chips; change morning routine to avoid wanting to smoke



#12 Teach how to critically and realistically assess past failures/current relapse so that lessons can be learned and progress continues rather than stops.



D. CONDITION FOR BEHAVIOURAL CHANGE: The person believes the advantages (benefits, anticipated positive outcomes) of performing the behaviour outweigh the disadvantages (costs, anticipated negative outcomes).



EXPLANATION: Benefits/costs can be tangible (e.g. increased endurance, financial savings, weight gain, medication side effects, etc.) or psychological (e.g. anxiety, discomfort, sense of approval, etc.).



APPLICABLE STRATEGIES:



#5



#13 Increase benefits through incentives, assistance.

Examples: exercise or quit smoking challenge with prizes (e.g. http://www.onyx-group.com/Rapcontest1.htm anti-Smoking Rap Song Writing Contest)



#14 Emphasize positive and downplay negative consequences of recommended behaviour.

Examples: Convince that minor side effects of medication are worth the positive health outcomes



#4



#15 Assure visibility of positive results of people who have adopted recommended behaviour.

Examples: media campaign; support group discussion/presentations



E. CONDITION FOR BEHAVIOURAL CHANGE: The person perceives more social pressure to perform the behaviour than to not to perform the behaviour.



EXPLANATION: The person/audience perceives that people who matter to them (friends, family members, community/social network opinion leaders, celebrities, physicians, etc.) support/encourage the recommended behaviour (e.g. As long as a young girl believes that the norm among her friend is striving for a dark tan, she is not likely to use sunscreen. As long as a person believes that they will be rejected if they suggest condom use, they are not likely to engage in the behaviour)



APPLICABLE STRATEGY:



#16 Determine who is important to person/audience and either increase their support for behaviour or increase audience perception that the people important to them support the behaviour.

Examples: leaders who have already adopted recommended behaviour; Provide statistics on percentage of people (like themselves) who have already adopted recommended behaviour; Run a campaign promoting behaviour using spokespeople like the audience themselves or spokespeople who the audience admires/looks up to/emulates PractitionerNet



F. CONDITION FOR BEHAVIOURAL CHANGE: The person perceives that the behaviour is consistent with their self-image and does not violate their personal standards.



EXPLANATION: The problem and the recommended solution/behaviour must be relevant and appropriate to culture, lifestyle, beliefs, etc.



STRATEGIES:



#4



#17 Tailor idea/program/behaviour for the intended audience's values, norms, or situations.

Examples: teach low-fat cooking in culturally relevant ways; ensure that media campaigns show people who look and act like the intended audience; acknowledge unique schedules and lifestyles such as shiftwork



#18 Set goals within context of audience's pre-existing goals.

Examples: if a person does not want to quit smoking because they are frightened of gaining weight, emphasize how quitting will improve ones appearance in many other ways (plus weight gain is unlikely to remain)



G. CONDITION FOR BEHAVIOURAL CHANGE: The person's emotional reaction to performing behaviour is more positive than negative.



EXPLANATION: A person's emotional reaction will be affected by how they are rewarded for their behaviour. Rewards can be tangible or psychological and can be provided by others, or by self. It is important that rewards are meaningful, so person/audience should participate in choosing appropriate rewards when feasible.



STRATEGY:



#19 Set up systems of reinforcement tailored to intended audience.



Examples: decide how a person will reward themselves when they achieve a goal; establish support groups; provide information for significant others on how to be supportive; provide feedback and praise; provide incentives such as token rewards, refundable deposits (return when goal reached); publicize (article, photo, award) success



H. CONDITION FOR BEHAVIOURAL CHANGE: The person believes (has confidence) they can execute the behaviour under a number of different circumstances (i.e. the person has the perceived self-efficacy to execute the behaviour).



EXPLANATION: Person/audience has confidence in their ability to take action and persist in action through difficulties and barriers including relapse. For example, a person must have strength of confidence in themselves to state their wishes to use a condom clearly before or during an intimate encounter.



STRATEGIES: # 8, #9, #11, #12, #19


Footnote



(1) Fishbein, M., Bandura, A., Triandis, H.C., Kaufer, F.H. & Becker, M.H. (1991). Factors influencing behaviour and behaviour change. Final report prepared for NIMH theorists workshop, Washington, D.C.