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Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.
Michael Jordan, American professional basketball player
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Facilitating positive behaviour change in patients is one of the biggest challenges facing clinicians on a daily basis. Why are some patients resistant to change, even if the change is in their best interests, such as exercising regularly or following a nutritious diet? Why don’t patients act rationally and do what they know is logical, after a critical appraisal of the facts? And why can’t they find a level of motivation for change that matches that of basketball great Michael Jordan?
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The underlying psychology of behaviour change is complex, and can be difficult to navigate among different, constantly changing sociocultural contexts. As Nutbeam et al. explain,1 an individual’s desire to change is determined by a fluid interplay between their knowledge and understanding of health and disease, the personal meaning and relevance of that knowledge, their confidence in their ability to make changes, and a range of other factors acting as facilitators and barriers to change.
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Building on Chapters 3 and 4, if clinicians are to join the global efforts on the war against physical inactivity, they must be equipped with the essential skills and tools for motivating and supporting behaviour change in all patients, from professional athletes to sedentary office workers. It is not enough to have the knowledge and simply pass on information. Clinicians must learn how to counsel patients effectively, implementing evidence-based practices that drive change from within and empower patients to take more control over their own health and over their environments.
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In this chapter we explore:
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behaviour change theories that offer keys to supporting patients in adopting healthier lifestyles
motivational interviewing as an effective counselling method for behaviour change
supporting patients to maintain their healthy lifestyle habits.
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BEHAVIOUR CHANGE THEORIES
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When patients receive advice to adopt healthier lifestyle habits, it can be frustrating for clinicians when their advice is seemingly ignored or even contested. A clinician who encounters such resistance may try to reiterate their advice with greater authority, or perhaps adopt a more paternalistic and coercive style of counselling. When these methods do not succeed, clinicians label patients as ‘unmotivated’ and often lose motivation themselves to persist with lifestyle counselling.
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Motivation can be defined as ‘the internal state that activates behaviour and gives it direction’.2 It is a dynamic state that changes frequently and can fluctuate as a result of a clinician’s counselling style. What motivates one individual may not motivate another, and what motivates someone today may not motivate them tomorrow.
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Behaviour change theories attempt to explain these complexities, providing a rationale for the irrationality ...