Theories Of Behavior Change

Behavior change is one of the primary aims of wellness programs. These initiatives utilize various strategies to encourage employees to switch from unhealthy habits to healthy ones to improve their well-being.

Achieving goals related to behavior change can be difficult. In many cases, individuals struggle to maintain the change or to initiate it the first place. For organizations looking to improve employee health, this can be frustrating and disheartening.

Fortunately, companies are not stuck relying on their own intuitions and experiences to implement more effective programs. For years, organizational leaders and academic researchers have been working on cracking the code of human behavior change. Though no single explanation has been agreed upon, insights from leading theories can help organizations remove the barriers that prevent employees from adopting healthier behaviors. To do so, employers must become familiar with some of the most significant contributions to the study of human behavior change.

In the following sections, five prominent theories of behavior change are explained with the help of an imaginary character named Adrian, who repeatedly finds themself deciding between healthy and unhealthy food habits. The decisions Adrian makes are simplified to clarify the theories, but the basic principles of each theory still apply to more complicated scenarios.

Though it is most widely known in economics as a tool for making rational decisions, expected utility theory as an explanation of behavior and decision-making states that whenever one makes a decision under conditions of uncertainty, their behavior is impacted by two key factors.

1. Values: What the agent wants or finds important about the outcomes that may follow from the actions available to them.

2. Expectations: The beliefs an individual has about the actions available to them and the outcomes they are likely to produce..

With these factors in mind, the individual will pick the action with the highest expected utility score, calculated by (subconsciously) multiplying the value assigned to each outcome by the probability of its occurrence if the action is performed.

Adrian is trying to decide whether to order a quick but unhealthy meal for dinner. They believe that they’ll either feel satisfied or unwell after the meal. Adrian assigns a high positive value to the satisfying feeling they expect to experience with the unhealthy option and believes they are unlikely to feel unwell afterward. As a result, Adrian orders the unhealthy meal.

Adrian may have other values that are not coming to mind when he considers his options. For example, he may care about his health, the opinions of his friends, or the enjoyment he feels when preparing a meal for himself. Whatever the case may be, an employer must know what Adrian cares about when it comes to eating habits in order to encourage healthy eating behaviors. Surveys are a great way to accomplish this.

Once Adrian’s employer has learned about their relevant values and concerns, they can highlight how their unhealthy eating habits are likely to impact something they care about, thereby changing Adrian’s values and expectations.

The health belief model was designed to explain and predict the adoption of healthy behaviors, focusing extensively on the use of health services. The model points to six factors that impact whether behavior change is likely to occur. Specifically, it states that an individual will act based on:

1. Perceived susceptibility: How likely one feels they are to experience the adverse outcomes associated with an unhealthy habit.

2. Perceived severity: The degree to which an individual feels they will be impacted by the potential negative consequences of their behavior.

3. Perceived benefits: How strongly one values the payoff for adopting the healthier habit.

4. Perceived barriers: Personal or environmental factors believed to make the initiation or maintenance of the healthy behavior difficult.

5. Cues to action: Internal or external factors that prompt one to act or remind them of the need to change.

6. Perceived self-efficacy: The degree to which one believes they are capable of successfully maintaining the health habit.

Several of Adrian’s relatives suffer from many conditions attributable to unhealthy eating (e.g., cancer, cardiovascular disease, diabetes, etc.). Knowing this, Adrian considers seeing a nutritionist to learn how to make healthier choices. However, they soon focus on their unshakeable belief that the damage is already done, as they have been making unhealthy food choices since they were a child. They also think that changing their unhealthy habits would cause them great stress and require a level of willpower they don’t possess. As a result, they avoid making an appointment and continue eating unhealthily.

There are several ways employers can use the insights of the health belief model to motivate individuals like Adrian. First and foremost, they should focus on education. Adrian has incorrect beliefs about the benefits of changing his behavior. By providing Adrian with persuasive educational materials demonstrating that healthy eating is beneficial even after a lifetime of unhealthy habits, it’s possible to rectify their false perceptions.

There are many ways to treat Adrian’s feelings of low self-efficacy. Employers can accomplish this is through gratitude and praise for their regular work. Because feelings of self-efficacy can spill over from one area to another, employers can increase Adrian’s perceived ability to stick to a healthier diet by creating systematic processes that allow managers and peers to express gratitude and recognize employees’ hard work.

The social cognitive learning theory highlights the critical role that social observation plays in decision making. Specifically, the theory describes the interplay between an observer’s behavior and the cognitive and situational factors involved in observation.

1. Cognitive factors: The probability of behavior change after observation depends on several “cognitive” aspects of the observers (e.g., their personality, values, beliefs, etc.). One of the more significant cognitive factors is self-efficacy, which refers to one’s perceived ability to master or effectively adopt an observed behavioral change.

2. Environmental factors: Both the environment of the observer and the model are relevant for behavior change. For the model, one of the primary environmental factors is the reward structure for their behavior (i.e., whether they are rewarded or punished). For the observer, social cognitive learning theory emphasizes the importance of their upbringing and whether they were surrounded by individuals performing and being rewarded for healthy behaviors.

These factors interact with each other and with the observer’s behavior in several ways. For example, environmental factors can alter an observer’s motivations by causing them to associate rewards with the action in question, while an observer’s values can affect whether they care about the rewards in the first place. Similarly, a cognitive factor like high self-efficacy can increase the chances of imitation, while successfully imitating an action can increase self-efficacy.

While at dinner with some friends, Adrian notices everyone else ordering something healthy. While watching friends enjoy healthy meals, Adrian questions their decision to order something unhealthy. Unfortunately, environmental and cognitive factors prevent Adrian from imitating their friends’ behaviors. Adrian grew up watching their parents and siblings eat unhealthy foods for nearly every meal. They viewed the habit as a virtue and praised one another for their unhealthy choices. As a result, Adrian’s early experiences led them to consider these harmful behaviors in a positive light. Additionally, because Adrian’s relatives were never able to change their behaviors, Adrian believes they wouldn’t be able to either. Because of the way these factors altered Adrian’s observations, they decide not to change their unhealthy habits.

The social cognitive learning theory points to a variety of strategies that employers can implement to change Adrian’s behavior. Given the significance of environmental factors, organizational culture is one of the more important tools a company can use. With a strong culture of health where employees frequently voice their positive feelings towards healthy eating, organizations may be able to counteract Adrian’s early childhood experiences and change his attitudes towards healthy eating. When Adrian sees another employee modeling healthy eating, they’ll be more likely to imitate them.

Culture can also impact self-efficacy. For example, if Adrian were to view his employees consistently sticking to healthy diets, they would be more likely to believe in their ability to do the same.

The social cognitive learning theory highlights the critical role that social observation plays in decision making. Specifically, the theory describes the interplay between an observer’s behavior and the cognitive and situational factors involved in observation.

The theory of planned behavior states that all behaviors—or more specifically, behavioral intentions—are determined by three factors.

1. Attitude: How an individual feels about performing the behavior.

2. Subjective norms: The perceived social pressure to engage in or avoid the behavior.

3. Self-efficacy: The sense that one can master or effectively adopt a behavioral change.

Adrian is trying to decide whether to cook something healthy with friends or order something unhealthy. Though Adrian is confident that the unhealthy option will taste better, they harbor a negative attitude toward the idea of making the unhealthy choice. Adrian also believes that many of their friends would view the act negatively. The opposite holds true for eating something healthy. However, because Adrian does not think they have the degree of self-control needed to follow through with the healthy option, they intend to order the unhealthy alternative.

As with the health belief model, culture remains a critical tool in motivating Adrian. Colleagues who adhere to healthy eating norms can exert social pressure to eat healthy foods that may be strong enough to outweigh the attitudes of Adrian’s friends. Given that Adrian spends so much time with his co-workers, a subjective workplace norm that praises the healthy behavior while discouraging the unhealthy one may have a considerable effect on Adrian’s choice.

Similar to the health belief model and social cognitive learning theory, self-efficacy can be influenced in at least two ways. First, an employer of Adrian could utilize praise and gratitude for their regular workplace performance. Second, they can highlight other employees who have successfully initiated and maintained the intended behavior change in the hopes that the vicarious experience of achievement will impact Adrian’s sense of self-efficacy.

According to the transtheoretical model of behavior change, there are six phases that all individuals go through when developing a new habit.

1. Precontemplation: People at this stage do not intend to adopt a new health behavior for the foreseeable future and may be unaware that a change is needed.

2. Contemplation: Individuals at this phase have formed the goal of adopting a healthy behavior within the next six months. However, they are often ambivalent about the benefits of making the change.

3. Preparation: At this stage, individuals are ready to act within the next 30 days.

4. Action: People at this stage have changed their behavior within the last six months and are working hard to maintain the new behavior.

5. Maintenance: During this phase, habits have started to solidify, but individuals are still at risk of falling back into their old patterns, especially during stressful situations.

6. Termination: In the final stage, individuals feel no temptation to return to old habits.

Adrian doesn’t see the negative health consequences of their unhealthy food habits and has no intention of changing their behavior. However, after reading a study suggesting that heart disease is more common among those who eat heavily processed foods, Adrian intends to do things differently somewhere down the line. Though they have formed this goal, Adrian repeatedly puts it off. Finally, after several months of contemplating, Adrian tries out their new healthy food habit once their friend offers to pay them $50 to go a week without fast food. Adrian remains uncertain of their own ability to maintain the behavior, but support from friends and family keeps Adrian going. Over time, Adrian becomes more confident and no longer feels tempted to eat unhealthy food.

Adrian’s success story highlights several ways that organizations can make use of insights from the transtheoretical model of behavior change to motivate employees to engage in healthier habits. For example, Adrian moved out of the pre-contemplation stage because he learned about the cons of continuing to eat unhealthily. By supplying employees with educational materials that highlight the pros of behavior change and the cons of unhealthy habits, it’s possible to move them from pre-contemplation to contemplation stage.

Research has shown that incentives can be powerful at the preparation and action stages. That’s why Adrian’s friend was able to get them to start eating healthily by offering them $50. By providing incentives to employees at the same stages, employers can increase the odds their workers will try out the healthier behavior.

Social support is critical at the maintenance stage. To help employees who are unsure of their ability to stick with a newly acquired healthy behavior, employers should organize support groups where workers can help each other stay committed to their healthy habits.

Utilizing the wide range of insights found in each of the five theories may seem like a tall order. Fortunately, these insights share several key themes and takeaways. By and large, each view can be seen as highlighting the importance of one or more of the following six factors.

1. Incentives: Does the individual associate rewards with the desired behavior? What positive outcomes do they believe will come from performing the action?

2. Knowledge: Is the individual aware of the consequences of their choices? Do they know how their habits are affecting them physically and emotionally? Do they know of better alternatives and how to implement these changes effectively?

3. Norms: Is the healthy behavior widespread? Have the individual's friends, family, and immediate acquaintances adopted the habit? Would they judge them for changing their behavior?

4. Perceived Barriers: Does the individual feel personal or environmental factors prevent them from adopting the healthier behavior?

5. Self-Efficacy: Do they believe they can successfully adopt the new behavior?

6. Values: Do they care about the positive outcomes associated with the healthy behavior and the negative effects associated with the unhealthy one?

With these factors in mind, organizations can develop more effective behavior change programs and initiatives that incorporate personalized educational materials, tailored rewards, social support systems, a culture of health, and value identification through surveys and questionaries.