Health Behaviour Change
Helping people adopt healthy lifestyles
We believe everyone has a part to play in creating a healthier UK, including the government, businesses, employers more generally, health professionals and the public. We particularly want to encourage action to make healthy choices the easy choices for people. At the same time we recognise the importance of helping people adopt healthier lifestyles.
A healthier generation of young people to build on?
With this in mind we have conducted research into health behaviour change, in partnership with King's College London, Goldsmiths University of London and Kingston University - including research into Student Health Behaviour Change. One encouraging finding is that today's university students appear to be more physically health conscious than their predecessors. This fits with data from the Office for National Statistics and the NHS, which shows 18 - 24 year olds as the age group least likely to smoke or drink alcohol and the most likely to exercise and eat a healthy diet.
Making healthy choices - turning what we know into what we do
We all know we should do more of the things that are good for us. For example, we know that exercise and a healthy diet are good for our health, while smoking and too much alcohol are bad. The challenge is often turning what we know into what we do. Knowing which approaches have been proven to help change our behaviour can be a good starting point. You can see some examples here.
A good starting point is to recognise the many benefits of choosing a healthier lifestyle.
Let's then consider what we can do to successfully adopt a healthier lifestyle, for example by quitting smoking, avoiding drug and alcohol abuse, eating more healthily, being more physically active or losing weight.
Some Practical Implications for Health Campaigns
We describe here some of the main health behaviour change models and theories, with thanks to Sumira Riaz for all her help with this – as well as some practical implications for public health campaigns.
The Biopsychosocial Model
This suggests that good health is influenced by three interconnected factors i.e.
- Biology (what is going on in our bodies)
- Psychology (what is going on in our minds)
- Sociology (our place in society - including how rich/poor we are, whether we have a job, the culture we have been brought up in, technology and religion)
This correlates with extensive research by Sir Michael Marmot, which suggests that reducing social inequalities is likely to improve health, in part because the psychological impact of inequality seems to have biological/health consequences.
Health Belief Model – Am I at risk? How great is the risk? How serious are the consequences? What barriers to taking action do I perceive? Do I have confidence in my ability to take action to reduce the risk? What cues might prompt me to take action? Do the benefits outweigh the costs?
So, as health campaigners we should explain the threat is real and relevant – who is vulnerable, how serious this is and the effects. We should explain what behaviour change is needed, how this can be achieved and what difference this will make. And show how barriers can be reduced – through reassurance, incentives and assistance.
Growth mindset i.e. belief that capabilities are something you can develop, Self Efficacy i.e. belief in your ability to succeed in taking a course of action (an important element in the Health Belief model) and ‘Grit’/Resilience
One practical option here is case studies showing someone people can identify with has successfully made behaviour change - to boost their confidence that they can also make that change. It also helps to provide evidence that specific behaviour change (e.g. losing weight or stopping smoking) is achievable.
Normative Beliefs – what we perceive as being the social norms, including what we believe others will expect us to do (family, friends, society etc.) Social norms strongly influence behaviour.
There are two aspects here. We need to provide evidence that people like me do this/behave in this way, when it comes to healthy lifestyles (Normative Appeal). We also need to avoid referring to negative trends, statistics or averages, to avoid ‘normalising’ unhealthy lifestyles.
Stages of Change Model
5 stages of motivational readiness to change a problem behaviour or adopt a healthy behaviour i.e. precontemplative, contemplative, preparation, action, maintenance, relapse.
9 major processes of change i.e. awareness raising; an emotional response; reflection on the consequences of our behaviour for other people; self re-evaluation; confidence to commit to new behaviour; seeking to help others in a similar situation; help from others; developing internal and external rewards for the behaviour; weighing the pros and cons of behaviour change, to tip the balance in favour of making positive changes.
To encourage these stages of change it helps to explain and provide evidence for the consequences of our behaviour for other people (like partners, family and friends). And show the benefits of behaviour change exceed the disbenefits.
Cognitive Behavioural Therapy (CBT)
Can help you change how you think (Cognitive) and what you do (Behaviour) to help you feel better.
When reviewing what has happened to us, replace negative thoughts and interpretations by positive thoughts and interpretations. 4 stages i.e. self examination, cognitive reappraisal, coping skill development and acceptance and commitment therapy.
Providing a case study or an example of CBT can help here, where it relates to behaviour re: the health topic being covered. Goal setting and diaries can also help here.
We tend to undervalue long term investment in favour of immediate gratification (enjoy now, pay later).
However, we are often more motivated by the prospect of LOSING something we already value than by possible future gain – so can use this to counteract the tendency to seek immediate gratification.
So we need to focus more on what people might lose if they continue unhealthy behaviour - which might include their independence and quality time with friends and family.
Environmental Cues e.g. portion size, design of tableware, price, and proximity (e.g. what type of food is available near where you work). This explains e.g. the idea of an obesogenic environment.
‘We overestimate how much of our behaviour is under intentional control and underestimate how much is cued by environment.’ Professor Theresa Marteau
If people become more aware of what is triggering their behaviour it may be easier to avoid environmentally cued unhealthy choices. We should also encourage ‘if then’ responses to likely environmental cues (e.g. if going somewhere with friends who smoke, remember to take an e-cigarette?)
Also, at Health Action Campaign we seek to influence businesses and government to create an environment where healthy choices are the easy choices - and reduce barriers to accessing healthy choices e.g. through social prescribing.