Behavior Change Theories

NUTR06102 Natural Therapies:

Herbology and Detoxification
Logan University
Recap and Overview
So far, we have gained an overview of some of
natural therapy approaches.
We have learned about some of the history related
to herbal medicine.
And, we have investigated the application of
evidence-based medicine in natural therapies.
Along with using evidence-based medicine as a
framework for provision of care, practitioners can
also benefit from the use of behavior change theory.
Have you ever been frustrated
because a patient, friend, or
relative simply won’t heed the
advice you have provided?

Behavior change theory might

help improve your
communication strategies….
 Learning Objectives:
After reading the assigned materials and
reviewing this presentation, students should be
able to:
Discuss the benefits of theory use in nutrition-related
counseling/education
Describe the main constructs of the Health Belief
Model, Stages of Change Theory, and Social Learning
Theory
Determine at least 3 ways to effectively use the above
theories in nutrition-related counseling/education
Nutrition Education
Any set of learning experiences designed to
facilitate the voluntary adoption of eating
and other nutrition-related behaviors
conducive to health and well-being
Behavioral change is the ultimate
determinate of effective nutrition education
• Position of the American Dietetic Association: Nutrition Education
for the Public. J Am Diet Assoc. 1996:96:1183-1187.
But what makes it effective?
Effective Nutrition Education…
CREATES BEHAVIORAL CHANGE!!
Features information people want, in a form
they want, where they want it
Peters, 1994
Uses theoretical frameworks/models
Involves a multiple reinforcing strategy
What is Theory?

Set of interrelated concepts, definitions, and

propositions that present a systematic view
of events or situations by specifying
relations among variables in order to
explain and predict the events or situations
-NIH
Why Use Theory in
Nutrition Education?
Theory answers WHY, WHAT, and HOW
It provides a predictable framework
It offers a means to explain and justify the
intervention
It gives a blueprint to replicate successful
education interventions
It offers a systematic process to analyze
success or failure
Fitting Theory to Practice
How to choose a theory:
Start with the population/topic/question of
interest
Determine the type of behavior(s) in questions
Look at research/literature
Examine your philosophy of nutrition
education/behavior change
You can use aspects of more than one theory
Fitting Theory to Practice
(continued)
Things to consider:
Is the theory clear-cut, comprehensive?
What concepts does it address?
Are the concepts that are central to your
population/topic also central to the theory?
Does it fit with your view of the world,
philosophy of nutrition education etc.?
 With an understanding of the benefits of applying
theory in nutrition education/counseling, let’s now
explore three theories that could be applied.

The Health Belief Model

Things to Consider About the
Health Belief Model (HBM)
The HBM has been applied to all study all
types of health behavior.
Places a strong emphasis on individual
beliefs
Can be used as framework for diet
counseling/education
HBM can be used as a whole, or in parts
Constructs of the HBM
Threat
Perceived susceptibility
Perceived seriousness/severity of condition
Outcome expectations
Perceived benefits of specified action
Perceived barriers of taking that action
Modifying Factors
Self Efficacy
Cues to Action
More on the Construct of Threat
Perceived susceptibility is highly subjective
Low
• Deny the possibility of disease/condition susceptibility
Moderate
• Admit to a statistical possibility of disease
susceptibility.
High
• Feel there is a real danger that they will experience an
adverse condition/disease.
Threat (continued)
Perceived Severity: subjective evaluation of the
severity of the consequences of the disease or
associated complications
Pain and discomfort, loss of work time, financial
burdens.
Difficulties with family, relationships, and
susceptibility to future conditions.
Important to include emotional and financial burdens
when considering the seriousness of a
disease/condition.
Take Home Points…

Work with clients to identify their

perceived susceptibility to a
condition/disease and their perceived
severity of the condition/disease
They are more likely to change if they have
a high perceived susceptibility/severity
More on the Construct of
Outcome Expectations
Perceived Benefits: beliefs regarding the
effectiveness of various actions in reducing
the threat of a certain disease and associated
complications
The direction of action that a person
chooses will be influenced by the beliefs
regarding the action.
Outcome Expectations
(continued)
Perceived barriers: perceptions of negative
aspects of a preventative, changed or more
healthy lifestyle
Take Home Points…
Work with clients to identify meaningful
benefits to making the change and personal
barriers to making the change
Work with clients to identify meaningful
and personal ways to overcome the barriers
More on the Construct of
Modifying Factors
Self Efficacy
The conviction that one can successfully execute
the behavior to produce the outcomes
One’s perceived ability to modify the specific
behavior
Cues to Action
Events, either bodily (e.g., physical symptoms of a
health condition) or environmental (e.g., media
publicity) that motivate people to take action.
Take Home Points
An individual's perception of the levels of
susceptibility and seriousness provide the force to
act.
Benefits (minus barriers) provide the path of
action.
However, it may require a modifying factor for
the desired behavior to occur.
As a counselor, you can help clients increase self-
efficacy or recognize cues to action.
PRACTICE: Identify the
Constructs of the HBM
I know that overweight people are at higher
risk for diabetes, so my risk is increased
I will have to buy “special” low sugar foods
and won’t be able to eat with my family
Diabetes isn’t a big deal, you can’t even
FEEL high blood sugars, so who cares?
I just don’t think I am smart enough to
remember all of the details of my meal plan
ANSWERS
I know that overweight people are at higher risk for diabetes, so my
risk is increased
Perceived threat (susceptibility)
I will have to buy “special” low sugar foods and won’t be able to eat
with my family
Outcome Expectations (Perceived Barrier)
Diabetes isn’t a big deal, you can’t even FEEL high blood sugars, so
who cares?
Perceived threat (severity)
I just don’t think I am smart enough to remember all of the details of
my meal plan
Perceived self efficacy
Limitations of HBM?
Cognitions do not always = behavior change
The theory tends to “blame victim”
Lack of quantification/difficult to test
Difficult to design appropriate tests of the HBM and
to compare results across studies.
Factors other than health beliefs also heavily
influence health behavior practices.
special influences, cultural factors, socioeconomic status,
and previous experiences.
Health Belief Model Summary
Two major factors influence the likelihood
that a person will adopt a recommended
preventive health action
They must feel personally susceptible to a
disease/condition with serious or severe
consequences
They must believe that the benefits of taking the
preventive action outweigh the perceived
barriers to (and/or costs of) preventive action
The Stages of Change
(Transtheoretical Model)
What is Stages of Change Theory?
Proposed by Prochaska and DiClemente
Concepts:
Views behavior changes as an ongoing process
rather than a single event
Contends that people move through a series of 5
stages when changing or adopting a behavior
Video Lesson
Watch this video (5:54) on the model. Please take notes.
https://www.youtube.com/watch?v=oO80XyBDrl0
Implications of the
Stages of Change
People in more advanced stages of change are
more likely to be successful in changing a
VARIETY of lifestyle behaviors
Relatively few people within a population will be
in the action stage, ready to change
Different strategies should be used for the
different stages
Moving from one stage to the next is just as
importance as the actual change in behavior
2 Questions to Use in Assessing
Stages of Change

Have you thought about (fill in the

behavior) in the next six months?
Are you planning to (same behavior) in the
next 30 days?
 Assessing Stages of Change
Next 6 months Next 30 days Stage of Change
no no Pre-
contemplation
yes no Contemplation
yes yes Preparation
Presently trying to Action
Already doing it Maintenance
Stages of Change and Effective
Nutrition/Health Counseling
Determine stage of change for the behavior
of interest
Depending upon the stage, ask appropriate
follow-up questions
Use information obtained to tailor
counseling
Social Learning Theory
(Previously called Social Cognitive Theory)
Social Learning Theory (SLT)
Albert Bandura first began publishing his
work on SLT in the early 1960's.
Emphasizes
The interaction between the individual and the
social environment
What people think (cognitions) and the effect
on their behavior
Main Concept: 3 types of interacting
factors determine human behavior
Major Constructs of
Social Learning Theory
Reciprocal Determinism
Socio-environmental, personal, and behavioral
factors are continually interacting and
influencing each other
Major Constructs of
Social Learning Theory
Expectations
Outcome expectation
• One’s expectation that a certain behavior will lead
to a desired outcome
Major Constructs of
Social Learning Theory
Perceived Self-efficacy
A belief in one’s ability to make a specific
behavior change
Constructs of
Social Learning Theory
Behavioral Capability
To perform a particular behavior one must:
• Know what the behavior is (knowledge)
• Know how to perform it (skill)
Development of behavioral capability is a result of
training, intellectual capability and learning style
Mastery learning is a behavioral training technique that
provides knowledge of what is to be performed, practice
in performing, and feedback about what is successful
Constructs of
Social Learning Theory
Reinforcement
A. Direct
• Similar to operant conditioning, Pavlov’s dogs, ring
the bell get food
B. Vicarious
• See others getting the reward and learn to do the
behavior
C. Self
• self control, self-reward
More on Reinforcement
Health educators must be careful not to provide external
rewards for all health promotion activities to ensue that the
internal appeal remains
External rewards can be used for behaviors that are part
of a behavior change program while they emphasize the
intrinsic rewards of the behavior change itself
Individuals are more likely to act if a positive reinforcement
is anticipated
more likely to anticipate positive reinforcement if one
sees other people receiving positive reinforcement for a
similar behavior
Concepts of
Social Learning Theory

Observational Learning
observes the reinforcements that
another person receives
role models
Assessment of
Social Learning Theory
Attractive because it deals with the dynamics
(environment, people, behavior) of
individual behavior
Sometimes is oversimplified
Sometimes interventions use one construct and
this is unrealistic, you must consider multiple
variables
Using SLT
1. Specify the desired behavioral outcome and
identify the SLT variables that are most likely to
influence changes in the specified behavior
2. Match interventions with the variable targeted
for change to influence the desired behavior
outcome
3. Translate the theory into practical and
meaningful intervention strategies that can work
in real life settings
To Bring it All Together
What effective nutrition interventions for
behavior often boil down to is simply
identifying, “How may I help you?”
See this in action by watching the video
(11:36) on the following slide:
https://youtu.be/pgedACNto1I?list=PLsRNoUx8w3rO5vwrXaSniu25L0gdqTwtU
Content Review
Can you
Discuss the benefits of theory use in nutrition-related
counseling/education?
Describe the main constructs of the Health Belief
Model, Stages of Change Theory, and Social Learning
Theory?
Determine at least 3 ways to effectively use the above
theories in nutrition-related counseling/education?
A Look Ahead
Our next presentation will continue in our
exploration of effective nutrition
counseling/education.
We will focus on topics
of safety and
dosage guidelines.