Behavior change is hard work. Anyone who has fought an addiction or dramatically changed his or her eating habits and lifestyle habits knows how hard it can be. It is even harder to help spur someone else into behavior change and yet this is the great challenge of our time. Including college, it takes between 11-15 years to train a physician with board certification, depending on specialty, and yet sadly the amount of time dedicated to helping that physician learn how to skillfully counsel behavior change can likely be counted in a small number of hours or days.
The reasons for this are numerous, but faced with lifestyle-related illness after lifestyle-related illness, clinicians can no longer afford to ignore behavior change techniques. We know the factors that will make it more likely for an individual patient to succeed. Taken from Whitlock, et al.1, these patient factors that predict success are:
- Strongly wants and intends to change for clear, personal reasons.
- Faces a minimum of obstacles (information processing, physical, logistical, or environment barriers) to change.
- Has the requisite skills and self-confidence to make a change.
- Feels positively about the change and believes it will result in meaningful benefits(s).
- Perceives the change as congruent with his/her self-image and social group(s) no6. rms
- Receives reminders, encouragement, and support to change at appropriate times and places from valued persons and community sources, and is in a largely supportive community/environment for the change.
So how do we support and grow these factors to encourage success? There are many theories and models, and our upcoming material will show you how to begin to think about motivational interviewing, self-determination theory, and human motivation using an evidence-based approach.
Behavioral counseling interventions address complex behaviors that are integral to daily living; they vary in intensity and scope from patient to patient; they require repeated action by both patient and clinician, modified over time, to achieve health imporvement; and they are strongly influenced by multiple contexts (family, peers, worksite, school, and community).
- Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. American journal of preventive medicine 2002; 22:267-84.