Changing Health Behaviors

¶ … health behavior theories,' what comes to mind? When I surveyed my nursing colleagues regarding their knowledge of health behavior theories, I encountered a very diverse range of responses. Some of them were aware of specific theories pertaining to health behaviors such as Nola Pender's Health Promotion Model or the Stages of Change Model.

A few were not aware of specific theory names but had a general sense of theories which impacted their practice, such as the notion of 'contemplation' in the Stages of Change Model which suggests that first people must contemplate change before they are capable of enacting it. In general, the practitioners that were most cognizant of specific health behavior theories had the most positive feelings about these constructs.

Even if they did not use them consciously on a regular basis, they said that they did at times unconsciously influence their practice. One nurse who worked with young adolescent girls specifically said that she did find Nola Pender's Health Promotion Model to be useful in her practice since it is specifically designed to encourage weight loss, healthy eating, and exercise behaviors to empower girls.

Given that girls at this age are often resistant to direction by an adult in regards to personal wellness behavior such as eating and leisure time activities, Pender's stress upon presenting the need to enact change in a way which was empowering but not overly didactic to young girls was extremely important. Nurses who were not approving of the use of health behavior theories seemed to be most resistant to the idea of using theory in general, not health behavior theories in particular.

Upon discussion with many of them, however, they agreed that the stage-based theory of the Stages of Change Model was very typical of that of many of patients who did enact major life changes. Change comes incrementally, and patients must first visualize the change and recognize the need for change before being willing to enact it. Despite the mistrust of theory that many practitioners feel, overall, the evidence I was able to accumulate supported the notion that theory is still critically linked to practice.

Health behaviors can be some of the most difficult ones to change, given the extent to which they have been a part of the individual's routine from a young age and are often strongly linked to the individual's sense of him or herself. "In the Precontemplation and Contemplation stages, temptation to engage in the problem behavior is far greater than self-efficacy to abstain. As individuals move from Preparation to Action, the disparity between feelings of self-efficacy and temptation closes, and behavior change is attained" ("The transtheoretical model," 2015).

Fostering a sense of self-efficacy is critical, according to the model. It is not enough to merely give the patient information; the patient must have a sense that he or she can put that information into action. Health behavior theories also do not have to be confined to those of the nursing profession. Many nurses might find it useful to study Bandura's social modeling theory, which stresses the usefulness of modeling positive behaviors to enact change.