When we think about interventions intended to result in behaviour change, we often focus mainly on what the benefits of such interventions might be. Mostly, the purpose behind the intervention is to try to increase adherence to treatment therapies. This leads us into a consideration of the needs patients might have to successfully put the intervention into practice.
Common interventions revolve around the common causes of disease and illness in the modern world, such as:
- Lack of exercise
- Eating too much or eating unhealthy foods
Lifestyle concerns, ingrained habits, emotional crutches, trigger responses to stressful situations, are all aspects that need consideration before any intervention has a hope of hitting the right note with patients. Changing behaviours that are long established, sometimes performed automatically and without thought, takes concentrated effort on the part of the individual, and concentrated effort is impossible without both motivation and confidence.
Motivation refers to the reasons why we perform an action, and has complex forces relating to conscious and subconscious decision-making as well as goal setting and intention.
While there has been much work done to identify the various concepts relating to motivation, there hasn’t been much effort to synthesise different elements or theories, of which there are many. The Health Belief model is one theory, suggesting that motivation stems from general health values, perceived health risks and likely severity. The Theory of Reasoned Action is another, attaching importance to the outcomes of changing behaviours, while also recognising perceived social pressure as a motivating factor.
Confidence plays a big role in behaviour change. People must believe they can succeed, having self-confidence in their capabilities. This concept is sometimes called the Social Cognitive theory, or the Self-efficacy in Health-Belief model.
Many factors can undermine confidence, and disrupt attempts at behaviour change interventions:
- Fear of failure
- Fear of adverse consequence (such as a fear that exercise may bring on a heart attack).
- Feelings of depression or anxiety
Patients also need to believe in the effectiveness of an intervention, including social influences and norms. Individuals want to feel in control over a behaviour or action, and be able to maintain a behaviour through all circumstances or contexts.
How confidence and motivation interact
The twin forces of confidence and motivation can either support or undermine each other, and it’s difficult to say which comes first since both are needed to impact and sustain behaviour change:
- Before an individual can be motivated to make a change, they need confidence that they can undertake the necessary action.
- Having decided to take action, confidence and self-efficacy are needed if the individual is to maintain the motivation needed to carry on with the new behaviour despite challenges or barriers.
There are potentially two phases: a motivational phase during which an intention to change is developed, and a volitional phase in which changing behaviours are planned then initiated and maintained. At both stages, self-efficacy is vital to build the confidence that turns intentions into action.
Other theories exist which attempt to explain how motivation can be translated into changing behaviours, in which the patient is no longer a passive player. These revolve around concepts such as self-regulation, goal theory, and control theory. The concepts focus on the actions individuals can take to determine their own behaviour, such as an awareness of standards they have set themselves together with self-monitoring.
The various theories attempt to underpin our thought processes and resulting behaviour patterns, and should therefore be used to guide the development of behaviour change interventions.