A summary of behavioural change: What typically works?
Research shows that healthy eating and fitness programs that teach behavioural change techniques are more effective than standard fitness programs in terms of:
- changing participants' attitudes about healthy eating and fitness activities
- increasing their confidence about food shopping, food preparation and physical activity
- reducing dropout rates
- motivating them to maintain a healthy lifestyle.
You may recognize or even have used some or all of the following behavioural change techniques. Success in using these techniques depends on how you use them. When a group of complementary behavioural change techniques are used together, they can facilitate change in different types of behaviour, including: choosing to adopt healthier eating habits and participating in physical activity. While many healthy eating and fitness programs exist, unfortunately not all them consider the need for behaviour change in sustaining new lifestyle changes.
Behavioural change techniques do work, but you must know when and how to apply them. Skill, timing and repetition are all important. By sharing the following information with mental health consumers, you can support their behavioural change process as they work toward making lifestyle changes that include healthy eating and physical activity.
Five Techniques to Help Change Behaviour
To use these five techniques successfully, you must involve consumers in the planning process. Research clearly shows that passive recipients are less likely to persist in trying to change their behaviour, and often drop out. Conversely, when participants design their own plan, they are more likely to follow through. Active involvement is critical to commitment and success. As a “healthy lifestyle leader,” you need to be a good listener and an “impartial mirror."
The Minding Our Bodies toolkit focuses on two types of people:
- the contemplator or "I'm thinking about it" person
- the preparer or "I just signed up for your 12-week program" person.
For both the contemplator and the preparer, the following five techniques work best when used together. Please note that these techniques can be used in private consultations with consumers or in small group settings. Small group settings are often more effective; participants tap into group energy, mutual support and a sense of common purpose.
1. Looking in the mirror and looking for patterns (self-monitoring)
You need to know what your actual eating habits and level of activity are before you can appreciate what needs to be changed. Monitoring your own progress allows you to experience positive feedback, feel more confident and set new goals as you improve.
Identifying patterns in our own food and physical activity habits can help us prepare to make lifelong changes. Many of us have triggers that influence our behaviours. Often these triggers can be identified and strategies can be established to help deal with them. Track your behaviour, whether with food or activity, to identify these triggers and patterns. Consider using journals, logs or checklists.
2. Keeping the end in sight (goal setting)
While most of us are familiar with the concept of setting goals, many of us do not realize that successful goal setting depends on choosing the right goals. Goals must be attainable. If someone lacks the skills needed to reach a goal, then a more appropriate goal would be to first learn the necessary skills.
After all, you must crawl before you can walk, and walk before you can run. As with self-monitoring, the participant must be involved in goal setting and must perceive each goal as personally valuable, realistic and attainable.
A goal should also:
- be fairly specific — stating how much, when, where, how fast or how frequently
- be reasonably challenging — it must exceed the previous goal by an amount that requires more than a one-time try to achieve
- clearly specify which behaviours reflect progress — participants must be able to monitor their own progress
- include specific, performance-progress feedback.
Research shows that using these goal-setting guidelines and providing positive feedback gives participants a sense of control over their behaviour and helps keep them involved in fitness programs.
3. Completing the loop (corrective feedback)
Although most of us believe that we know how to provide constructive feedback to others, we frequently overestimate our skills. A person who has recently adopted a new lifestyle behaviour can easily be turned off by poorly presented feedback. Poorly presented feedback is unclear, too general or not focused on a specific person or behaviour.
You need to understand three aspects of helpful feedback:
- First, helpful feedback must contain useful information. This includes praise if the activity has been performed correctly, steps have been taken toward a goal, or the goal has been achieved. Untargeted, generalized praise is not effective. For praise to be motivational, the recipient must be able to recognize what it was that he or she did to deserve the praise.
- Second, feedback must be systematic and regular. Participants should receive clear and frequent messages that they are moving in the right direction, and if they aren’t, they need feedback that will help them get there.
- Third, feedback that focuses on success, no matter how small, gives participants a sense of control. However, feedback that ignores mistakes and failures is a serious omission. You must reassure them that this is part of a normal learning process to which they can learn from their mistakes and overcome obstacles to success.
The most important part of feedback is self-feedback that is non-judgmental. Encourage consumers to notice:
- what is working
- what is not working
- what still needs to be done to improve.
4. Sticking to it (building commitment)
A consumer's commitment to behavioural change can be reinforced by being involved in planning, by doing self-monitoring, and by conducting frequent "self-awareness checks." These activities strengthen commitment because each check draws attention to various cues that heighten self-awareness of behavioural changes.
5. Boosting performance (reinforcing behavioural change)
Positive reinforcement can help change behaviour, but change will not be lasting if you do not have an environment that supports fitness along with the internal motivation to make fitness a lifelong lifestyle. When these elements are present, reinforcement strategies are useful. Rewards, praise and public acknowledgement of successes are all ways of reinforcing behaviours.
Reinforcement should be used to recognize desirable behaviours — behaviours that get someone to be active or stay active. Negative reinforcements, such as assigning a cost to behaviour (e.g., charging fines for missing classes), can also be used but should be balanced by offering a gain (e.g., a fee reduction for regular attendance). Negative reinforcements should be used selectively and only with the participant's agreement. Parents, friends, spouses or activity buddies can also provide reinforcement, as long as they can agree with the participant on how this will be offered.
The ultimate goal is for consumers to understand reinforcement principles and to learn how to reinforce their own efforts. By teaching self-reinforcement, individuals' learn to adopt personally meaningful reinforcements.
The above techniques — used in combination with an overall physical activity or healthy eating plan — lead to positive change, pride in success, more rewarding goals, and increased self-confidence in consumers' ability to make healthy living activities part of their life.
This resource from The Health Communication Unit describes and provides examples for the eight conditions required to change personal health behaviours.