Changing behaviour: using motivational interviewing techniques.

Behaviour is the result of the interaction between what we believe and how we feel. If we want to change behaviour it is necessary to change the underlying beliefs and feelings related to that behaviour. We are all creatures of habit and purposeful behaviour change is both difficult to achieve and even more difficult to maintain. There are many factors that influence whether we achieve behaviour change in a health context, of which the level of intrinsic motivation or intention to change that behaviour is but one. Other significant factors that influence behaviour change include the beliefs underlying the behaviour; the value of it; the perceived costs and benefits of changing; the barriers to changing; beliefs about our ability to perform the behaviour change; and not least the support and reinforcement of others. Until recently it was assumed that if people were informed about the risks associated with unhealthy behaviour this would be sufficient for them to change to a healthier pattern. The large amounts of investment in the health education movement for relatively little return proved this was not the case. People’s beliefs are not based simply on what they are told to believe. Contemporary models of health promotion are a good deal more sophisticated and take account of beliefs about health and illness and how those beliefs relate to behaviour. Large-scale interventions to produce change in health behaviour at the population level are gathering apace and a significant proportion of population health activity is focused on changing risk behaviours for, most notably, heart disease, stroke or diabetes. There is evidence that health behaviours can be influenced by health promotion techniques at the population level,1,2 but significant proportions of patients with health problems do not achieve change in health risk behaviour, and even fewer maintain changes to risk status. It remains a significant problem for health care planning.