Behavior Change: Fact or Fiction?
Physical therapy practitioners promote behavior change.
We ask patients to exercise more; we educate patients about the type of activities to do (or to avoid). We might even talk about diet, weight loss, smoking, stress, and sleep. I feel that patients care way less about the anatomy & physiology and instead care way more about how they can make changes in their lives.
If you’re like me, then you have noticed how hard it is to change attitudes and behavior. You might also relate with how hard it is to change habits or to make dramatic changes for the sake of your own health. This is where we have so much to learn from psychologists about health behavior change — the focus of this Physio Weekly.
Turn and Face the Strange.
There are many health behavior theories. The goal of these theories is to try to predict and understand health actions so that we can try to promote healthier actions. Health behavior theories are subtly different from each other, but they usually address three major constructs:
- Attitudes — the appeal and consequences of certain behaviors.
- Social norms — how other people view behaviors and how often others actually engage in those behaviors.
- Self-efficacy — how well one can complete the requirements to engage in behaviors.
Health behavior theories address these three constructs because of what’s called the intention-behavior gap. The intention-behavior gap is the discrepancy between someone’s plans for their behavior and their actual behavior. In fact, intentions to perform a behavior explain about 50% of actual behavior.
In other words, whether or not someone increases their physical activity is only halfway explained by their intentions to do so.
I see this all the time in the clinic, and you probably do too. The usual intention-behavior gaps that I see are related to exercise and diet. Most people want to walk more and to eat better, but it’s hard to change.
Train in Vain?
One of my biggest fears about clinical practice is the possibility that people don’t really change. If we can’t change behavior, then much of our efforts are in vain, right?
A recent meta-analysis found strong evidence that we can facilitate change. The authors examined the effects of interventions based on health behavior theories, including social cognitive theory, the transtheoretical model, the theory of planned behavior, and others. The study examined many health behaviors such as physical activity, smoking cessation, getting vaccinated, and dietary changes.
The study found that interventions that intended to change attitudes, norms, or self-efficacy actually do change both intentions and behavior. Since this meta-analysis analyzed only longitudinal designs, this study provides experimental evidence of the causal role of changing beliefs in order to change behavior.
Our efforts are not in vain. In fact, perhaps without our encouragement, many of our patients wouldn’t make it through.
Stronger Than Yesterday
So how can we encourage change?
One meta-analysis of experimental studies shows the value of monitoring progress toward goals. Merely tracking and reflecting how we are doing increases our odds of success. This is liberating for healthcare professionals. Rather than lecture about the importance of changing diet or exercise, what would happen if we merely ask patients to monitor their diet or exercise?
In the clinic, one of my favorite ways to encourage monitoring is printing a blank calendar for the current month or an achievement worksheet so that patients can track their activity and place the paper somewhere as a reminder. For those who are more technologically inclined, use apps like Google Keep or Wunderlist.
When it comes time to review progress with patients, are you the “tough love” type or the “warm and fuzzy” type? One recent study shows the importance of positivity when reviewing progress. The researchers assigned two groups to think about their eating choices.
One group reflected about only “good” choices and the other group reflected about only the “bad” choices. One week later, the group that focused on the “good” choices reported stronger intentions to eat healthy food, and the “good” choices actually felt like they were closer than the “bad” choices group to achieving their goal of healthy eating.
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