Behaviour change principles and theory

Behaviour Change

Behaviour change can include addressing lifestyle factors such as physical activity, smoking, alcohol intake, weight management, nutrition and sleep (Victorian Musculoskeletal Clinical Leadership Group, 2018) This reference is cannot be found in the Essential, Optional Reading or other resources page

Behaviour change generally requires a process over time, and hence it is difficult to achieve within an OAHKS assessment. However, strategies within an OAHKS assessment that may be useful to facilitate this is goal setting. A recent systematic review of behaviour change techniques used by physiotherapists to promote physical activity in people with lower limb OA concluded that patient-led goal setting, behavioural contract, self-monitoring of behaviour, social support (unspecified), and non-specific reward were the most effective at optimising physical activity adherence across time points (Willet et al., 2019).

To understand and facilitate a change in behaviour in an individual, it’s important to begin with understanding the principles and theories behind it.

The 5 stages of behaviour change.

Various principles, theories and models exist surrounding the topic of behaviour change.

 

One model describes the process of changing a behaviour into 5 stages. It starts from the beginning where the individual may have no intention to change at all, or may not even be aware that a change is needed. It progresses through the process where they are ready to change, make the change, and finally, maintain the change.

Click on each stage below to learn more about the 5 stages of behaviour change

EAST

The 5 stages of behaviour change is useful in identifying the client’s readiness to change. There are also principles that can assist in making the change effortless for your clients. The “EAST” framework is one of these principles.

To change an ingrained behaviour, you need to make the plan Easy, Attractive, Social and Timely.

Click on each letter in the acronym below to learn more about the EAST principles.

COM-B

 

Another principle that can be utilised to assist in behaviour change is the COM-B

It is an acronym that identifies three factors that contributes to behaviour change and needs to be there for this to occur. These factors are capability, opportunity and motivation.

Click on each letter of the acronym below to learn more about them.

The COM-B model recognises that these 3 factors influences the behaviour(B) of an individual, therefore behaviour change can be facilitated by modifying one, two or all three of these interplaying components.

How to motivate health behaviour

Traditionally, clinicians believed that informing the individual on “why” they should change their behaviour would motivate a change in their deeply ingrained routine. However, this method does not seem to work as decisions are affected by emotions, biases, social context, past experiences, beliefs and values. A well-known example of this is the difficulty of assisting a client to quit smoking despite educating them on the various harms it causes.

Hence, different approaches have been developed. Some of these approaches are:

  1. Motivational interviewing: which assist in recognising and influencing the factors around an individual’s behaviour, rather than just educating the individuals on facts.
  2. Cognitive behavioural therapy: which focuses on changing unhelpful or unhealthy thought and behaviours. Cognitive behavioural therapy has been recommended in the RACGP guidelines and can involve seeing a professional such as a psychologist, counsellor, or online programs such as This Way Up

References

Essential reading 

Bennell, K. L., Ahamed, Y., Jull, G., Bryant, C., Hunt, M. A., Forbes, A. B., . . . Keefe, F. J. (2016). Physical Therapist–Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial. Arthritis Care Res (Hoboken), 68(5), 590-602. doi:10.1002/acr.22744

Caneiro, J. P., Sullivan, P. B., Roos, E. M., Smith, A. J., Choong, P., Dowsey, M., . . . Barton, C. J. (2019). Three steps to changing the narrative about knee osteoarthritis care: a call to action. Br J Sports Med, bjsports-2019-101328. doi:10.1136/bjsports-2019-101328

The Royal Australian College of General Practitioners. (2018). Guideline for the management of knee and hip OA 2nd edition. In (2nd ed.). East Melbourne: The Royal Australian College of General Practitioners.

Victorian Musculoskeletal Clinical Leadership Group. (2018). Victorian Model of Care for Osteoarthritis of the Hip and Knee.

 

Optional Reading: 

Willett, M., Duda, J., Fenton, S., Gautrey, C., Greig, C., & Rushton, A. (2019). Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review. PloS one14(7), e0219482. https://doi.org/10.1371/journal.pone.0219482

Other Resources: 

Online resources for pain self management and behaviour change for patients and health professionals

Better Health Victorian Government-Physical Activity -overcoming the barriers website/handout

Better Health Victorian Government Cognitive behaviour therapy (CBT) website/handout

Pain trainer: Patients register and can then access 8 modules that take 30-45 minutes each, accompanying workbook; developed by University of Melbourne  https://www.paintrainer.org/

Myjointpain: Developed by Arthritis Australia, free to register and use,, introductory video and website https://www.myjointpain.org.au/

Section on education and self management

Pain health: website with multiple links to various modules, some pain and some condition specific including osteoarthritis 

-pacing and goal setting

-moving with pain-advice on ADLs and starting exercise

Tasmanian DHHS motivational interviewing overview

Tools for motivition interviewing brief guide

Cognitive behavioural therapy overview