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Effecting positive health and health behavior change
Behavior change is a complex process that is mediated by multiple factors. Information on health benefit and risk reduction alone is inadequate to effect behavior change. Because psychosocial factors impact lifestyle conditions and people’s responses to these (Hudson and Pope, 2006), both directly and indirectly, psychosocial approaches to management are supported (Nater, Gaab, Rief, and Ehlert, 2006). Because of the complexity of behavior change, various health professionals are involved with this process and complement each other’s efforts. Physical therapists can be sole agents of change for a given individual or work with other team members to support the individual in achieving health goals.
The prominent theories and models related to health behavior change are summarized in Table 3. These include Social Cognitive Theory in which self-efficacy is a central component (Bandura, 1977, 1986, 1997; Baranowski, Perry, and Parcel, 2001; Whitehead, 2001); the Theory of Reasoned Action or Planned Behavior (perceived behavioral control construct) (Ajzen, 1991; Armitage and Connor, 2001; Glanz, Lewis, and Rimer, 1991); Self-determination Theory (Deci and Ryan, 1985; Ryan and Deci, 2000; Sheldon, Williams, and Joiner, 2003); the Transtheoretical Model of Change (Prochaska and DiClemente, 1982; Prochaska and Velicer, 1997); behavior modification (Skinner, 1988; Wierenga and Oldham, 2002); and the Health Belief Model (Becker, 1974; Rosenstock, Strecher, and Becker, 1994; Strecher and Rosenstock, 1997). The fundamental features of these leading theories of health behavior change are shown.
Knowledge of these theories and models enable physical therapists to understand the factors contributing to the development of both positive and negative health behaviors and why those behaviors are being sustained in a given individual, and in the case of negative health behaviors, the challenge of effecting a positive health behavior change that is sustained in the long term. Each theory and model has a unique construct and basis for assessment and inter-vention of each health behavior. Examples are shown of the health behaviors that have been successfully addressed by using interventions based on each theory or model.
Education that is tailored to the individual or tailored to a group is perhaps the most important component of the expertise of the contemporary physical therapist to effect health behavior change along with the individual’s motivation to effect such change. Preventive health messages from a health care provider can be powerful and a strong predictor of health behavior change (Nisbeth, Klausen, and Andersen, 2000; Thomas et al, 2002; Tresch and Aronow, 1996; Winslow, Bohannon, Brunton, and Mayhew, 1996). Currently, pre-health messages, however, tend to be delivered to a relatively small number of patients, unsystematically, from their health care providers, if at all. Thus, lifestyle recommendations warrant being delivered as a holistic management priority to every patient, in a structured, conscious manner comparable to the precision of a prescribed treatment program. The cumulative time each physical therapist spends with each patient over each day, each week, and each year translates into hundreds of teachable moments. The potential for societal impact and global assault on the lifestyle conditions is substantial.
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