Health Behavior Theories and Health Behavior Changes
- Define "health behaviors" and distinguish between behaviors that can either contribute to or detract from health.
- Explore health behavior theories to grasp why individuals might partake in actions harmful to their health.
- Examine theories on health behavior change and the application of these theories across various contexts.
Introduction
Understanding health behaviors is key for community health workers (CHWs) in helping patients improve their lifestyles. Recognizing the underlying causes of harmful health behaviors is essential for understanding patients' perspectives and more efficiently facilitating their desired changes.
The second half of this lesson will present various models of health behavior change. Together, these theories give CHWs language and structure for understanding readiness, motivation, and the levers for change.
Defining health behaviors
Numerous factors impact health — surroundings (neighborhood, physical environment), education, economic status, access to quality healthcare, and social/community setting. Health behaviors — the actions individuals take — play a significant role in outcomes too.
These behaviors can either contribute to health promotion (maintaining a healthy diet, being physically active, seeking preventive care, getting sufficient sleep, adhering to prescribed treatments) or be detrimental (smoking, excessive alcohol consumption, unhealthy eating, risky sexual activities).
Health behavior = actions, activities, or habits undertaken by individuals that directly influence their physical, mental, or emotional well-being.
Two main categories of health behavior
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Introduction to health behavior theories
Traditional views simplify health behavior as solely the result of individual choices, leading to the common approach of merely telling people to stop or start certain actions. In reality, health behavior is much more complex — influenced by various factors beyond an individual's own aspirations.
We'll cover three theories of health behavior:
- Social Learning Theory / Social Cognitive Theory (SLT/SCT)
- Self-Determination Theory (SDT)
- Health Belief Model (HBM)
Theory #1: Social Learning / Social Cognitive Theory
SLT/SCT is an interpersonal theory emphasizing the dynamic among people, their behavior, and their environment. Learning behaviors occur in a social context — including past experiences, the actions of others, and environmental factors.
The six key concepts
Six key concepts of SLT/SCT
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Limitations of SLT/SCT
Theory #2: Self-Determination Theory
SDT is a theory of motivation. We all want to be healthy and often know the steps — so why don't we always take them? SDT argues the central issue is motivation: the amount of energy we direct toward a goal.
Sources of motivation
Reward
People may try to lose weight because their employer offers cash incentives.
Two types of motivation
SDT distinguishes two types of motivation: Controlled Motivation and Autonomous Motivation; both concepts being crucial to fully grasping how individuals are driven to engage and pursue behavioral changes.
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The three psychological needs
Autonomy
The need to feel that you can make your own choices, as opposed to feeling compelled or controlled.
Think of these like physiological needs — hunger, thirst, sleep. If any are unmet, well-being suffers and motivation drops. When all three are satisfied in a particular area of life (e.g., physical activity), autonomous motivation tends to flow.
Theory #3: Health Belief Model
HBM started in the 1950s. It states that people's actions regarding health depend on how they perceive the risk of a disease and the pros and cons of taking preventive measures. It's particularly useful for prevention before symptoms appear — explaining why some people skip regular mammograms or don't get the flu shot.
According to HBM, individuals balance two central components:
- The desire to avoid illness or recover if already sick.
- The belief that a particular health action will prevent or treat illness.
The six key elements of HBM
Limitations of HBM
Overlooks personal attitudes
Doesn't fully account for personal attitudes, beliefs, or other factors influencing willingness.
Match each Health Belief Model element to its description.
A patient knows smoking is harmful and wants to quit, but says she keeps smoking because all of her friends smoke and she enjoys it socially. Which Self-Determination Theory concept best describes the motivation she would need to quit for her own values?
Understanding behavior vs. changing it
Understanding why patients behave as they do can make us eager to suggest changes. But true, lasting change happens when individuals feel in control of their own decisions. Pushing for change too soon can backfire.
Next we'll apply two models — the Transtheoretical / Stages of Change Model and Fogg's Behavior Model — to customize our support to a patient's readiness for change.
Theory #4: Stages of Change Model
Behavior change isn't a single decision — it's a gradual journey through stages: precontemplation, contemplation, preparation, action, maintenance, and rarely, termination. People progress at their own pace and may revisit earlier stages along the way.
This model originated in a 1970s study on quitting smoking. Its core insight: success depends on a person's readiness. Understanding where someone is in the journey is crucial before introducing change efforts.
The six stages of change
Precontemplation
- ✦Lack of awareness
- ✦Resistance to change
- ✦Defensive attitude
- ✦Procrastination
- ✦Lack of readiness
"I don't see a problem with my diet. I don't have diabetes yet and I haven't had a heart attack." / "I've always been a meat-and-potatoes kind of gal. That's how it's always been, and I've gotten this far in life."
Theory #5: Fogg Behavior Model
Developed by Stanford psychologist BJ Fogg, this model says behavior is influenced by three primary factors: motivation, ability, and triggers (prompts). By assessing these three factors, healthcare providers can adapt their strategies to further benefit the patient and their readiness/longevity for a change in behavior.
The three factors
Three core concepts of the Fogg Behavior Model
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Motivation × Ability — the quadrant
Both motivation and ability need to be sufficiently high for a behavior to happen. The model is a 2D space — and where someone falls in that space tells us what kind of support they need.
Fogg Behavior Model — flu vaccine examples
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Triggers — the third ingredient
Even with high motivation and high ability, behavior doesn't happen without a trigger. Three types matter, each suited to a different situation.
Facilitator
For high motivation + low ability. Simplifies the behavior by removing obstacles — time, money, complexity. *Example:* A public health program offering the flu shot free or at reduced cost could bridge James's ability gap.
Ginnie tells her CHW: "I know my diet isn't good for me. I should probably do something about it, but my house is full of snacks and I'm not sure I can resist ice cream every night." Which Stage of Change is Ginnie in?
James really wants the flu vaccine but has no insurance and can't afford it out of pocket. According to the Fogg Behavior Model, which type of trigger would best help him act?
🌟 Lesson takeaways
We covered five theories: three about why people behave as they do (Social Learning / Social Cognitive Theory, Self-Determination Theory, and the Health Belief Model) and two about how change happens (the Transtheoretical / Stages of Change Model and the Fogg Behavior Model). Each has limitations, and no single model captures every patient — but together they give CHWs language and structure for understanding readiness, motivation, and the levers for change. A foundational knowledge of these theories is crucial for facilitating change.
Great work! At the end of this module, you'll join a live discussion with your cohort and an instructor to practice applying these theories to real patient situations. We'll see you there.