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  • Writer's pictureBarbara J. Mayfield, MS, RDN, LD, FAND

How do our decisions impact health behaviors? Which theories can guide us?

A pair of green sneakers with 3 arrows pointing in different directions

When you are deciding on an action to take, are you aware of the decision-making process you go through? Why do you do what you do?


In a previous post, we described the stages of behavior change. However, knowing these stages doesn’t tell us how or why we change behavior. To explore the answer to that question, we looked at the wide variety of factors that influence behavior.


Now, we are ready to ask: How do these factors impact our behavioral decisions… shall I do this… or this? In other words, why do I do what I do?


In today’s post, we will look at behavior change theories that describe how we make the decisions that impact health behaviors, continuing our series covering the concepts from Chapter 12 in Communicating Nutrition: The Authoritative Guide.


What theories describe how our decisions impact health behavior?

The most common behavior change theories used in health-related fields to describe behavioral decisions include the Health Belief Model, the Integrated Behavioral Model, and the Social Cognitive Theory. Let’s look at what each one tells us about behavior.


Health Belief Model

The Health Belief Model, pictured below, suggests our health behaviors are determined by the interaction of the following factors: internal resources (knowledge, etc.), the perceived threat of disease (including susceptibility and severity), outcome expectations (benefits of taking a course of action), barriers, self-efficacy, and cues to action.

Health Belief Model
Source: “Use Behavior Change Theories to Create Effective Communication” by Carol Byrd-Bredbenner and Virginia Stage, Communicating Nutrition: The Authoritative Guide, Chapter 12, Page 190, ©2020

Integrated Behavioral Model

The Integrated Behavioral Model, pictured below, suggests that our behaviors are determined by the interaction of the following factors: our internal resources, attitudes, social norms, personal agency, and barriers.

Integrated Behavioral Model
Source: “Use Behavior Change Theories to Create Effective Communication” by Carol Byrd-Bredbenner and Virginia Stage, Communicating Nutrition: The Authoritative Guide, Chapter 12, Page 191, ©2020

Social Cognitive Theory

The Social Cognitive Theory, formerly known as the Social Learning Theory, suggests that our behaviors are determined by the interaction of our personal characteristics and our social and physical environments with a focus on outcome expectations, self-regulation, self-efficacy, internal resources, observational learning, and environmental facilitators.


How can we use these theories to make a positive impact on behavior?

The three theories described above are more similar than they are different. All three recognize the spheres of influence discussed previously, including personal characteristics, social environment, and physical environment.


These theories illustrate and describe how these factors exert influence on each other and result in a particular action or inaction.


To continue our example of promoting the decision to breastfeed, the Health Belief Model encourages communicating benefits that match an audience’s personal characteristics, addressing potential barriers, and providing support to build self-efficacy.


Regarding the components of the Health Belief Model addressing severity, susceptibility, and threat, these are best addressed in the context of the benefits of breastfeeding, avoiding drawbacks related to artificial feeding, such as the cost or potential intolerances.


The Integrated Behavioral Model encourages additional focus on building positive attitudes toward breastfeeding, promoting social norms in favor of breastfeeding, enhancing perceived control (I can feed my baby), and promoting an intention to breastfeed.


The Social Cognitive Theory encourages all of the above as well as taking advantage of observational learning and environmental facilitators. For example, utilizing experienced breastfeeding peer counselors and promoting breastfeeding-friendly practices in the workplace.


Now that we agree…

in our final post in the series, we will explore a theory that puts it all together.


“The quality of your life is built on the quality of your decisions.” ~ Wesam Fawzi


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