Theoretical Models and Behaviour Change

• Theoretical models provide the foundation for selecting nursing interventions to support behaviour change in chronic illness. The following are selected theoretical frameworks that nurses can use to facilitate behaviour change and to promote adherence in clients with hypertension.

  Stages of Change (Transtheoretical) Model:

• The transtheoretical model (Prochaska & DiClemente, 1983; Prochaska & Velicer, 1997; Prochaska et al., 1994), also referred to as the Stages of Change model (SOC), provides nurses with a framework for selecting interventions that correspond with each of the stages through which individuals progress as they change behaviours.

To view a more detailed summary of the Stages of Change Model click here.

Decisional Balance Model

• The decisional balance model by Horne and Weinman (1999) is a framework that suggests that medication adherence is related to a client’s perceptions of the necessity (perceived benefits or the pros) of the medication/treatment modality and the concerns (perceived risks or the cons) about potential adverse effects and the way in which an individual balances these perceived risks (concerns). The decisional balance consists of identifying the pros and cons of the proposed/actual behaviour change.

  Self-Efficacy Model

• Self-efficacy is an individual’s belief that she or he is capable of dealing with a specific problem. Low self-efficacy results in avoiding changing behaviour, whereas, high self-efficacy promotes change in behaviour (Betz & Hackett, 1998).
• Self-Care/Self-management Model
• Self-care/self-management is situation and culture specific; involves the capacity to act and make choices; is influenced by knowledge, skills, values, motivation, locus of control and efficacy; and focuses on aspects of healthcare under the control of the individual. Orem’s Self-Care Deficit Theory of Nursing (1991) delineates three main roles for nurses:

1. to compensate for a person’s inability to perform self-care by doing it for him/her;

2. to work together with the client to meet his/her healthcare needs; and

3. to support and educate the client who is learning to perform his/her own self-care in the face of illness or injury. This is the key role in facilitating clients’ adherence to maintaining self-care.

• Interventions/Strategies for Change
  • In addition to the models and theories discussed above, there are interventions that nurses can use to facilitate behaviour change in their clients. Some examples include:

    Motivational interviewing – systematically directs the client toward motivation for change; offers advice and feedback when appropriate; selectively uses empathic reflection to reinforce certain processes; and seeks to elicit and amplify the client’s discrepancies about their unhealthy behaviour to enhance motivation to change (Botelho & Skinner, 1995).

To view information about Motivational Interviewing click here.

Behavioural strategies – observable change strategies, such as simplifying medication regimens, utilizing dosettes, etc. These strategies are outlined in the practice recommendations related to promoting adherence.