Using Evidence-based Principles To Achieve Sustained Behavior Change

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Nichola Rumsey, VTCT Professor of Appearance Psychology

Abstract: This narrative review outlines the potential benefits of supporting clients to successfully change existing patterns of behavior in the context of wound care. In acknowledging the complexities involved in changing deeply ingrained patterns of behavior, the case for developing interventions based on evidence is presented. The evidence-based psychological targets, which are recommended for inclusion in behavior change interventions, are outlined together with their theoretical derivatives. An example of an intervention developed using evidence-based techniques is presented. The challenges of progressing understanding and developing successful interventions in the context of wound care are discussed.

Address correspondence to:
Nichola Rumsey, VTCT
Centre for Appearance Research, Dept. of Psychology
University of the West of England
Bristol, UK B516 1Q4
Phone: +44 117 32 83989

     The potential benefits of promoting successful behavior change in the context of wound care are considerable. An example of this is the challenge of optimizing outcomes for patients with a diabetic foot ulcer. The road to recovery and the maintenance of good health require the patient to modify many aspects of behavior, which can include patterns of eating, smoking cessation, or the maintenance of the most recent attempt to quit, the need to engage in regular self-examination, attendance at podiatry check-ups, and wearing the necessary protective footwear.

     Intuitively, it would be reasonable to expect that people would value their health highly, and consequently, would be responsive to straightforward messages about the benefits of behavior change and the serious health risks associated with existing patterns of behavior. However, reality is much more complex,1 and the low rate of success associated with most approaches to health behavior change has preoccupied researchers recently.

     As long ago as 400 BC, Hippocrates is credited with noting that “Everyone has a doctor in him or her; we just have to help it in its work.”1 It was not until relatively recently, however, that the true complexity of behavior change and the costs associated with failing to achieve it have been recognized and highlighted in policy documents (eg, the UK Government White Paper “Choosing Health” published in 2004).2

     Although an acceptance of this complexity is a recent phenomenon in the research literature, it is well recognized among practitioners in wound care and those who manage chronic conditions. These professionals know better than most that for the majority of patients simple approaches (eg, the provision of information about the benefits and risks of certain behaviors) are not sufficient to influence and maintain change in target behaviors.

     Some of the factors identified as contributing to existence of patterns of health-related behaviors that lead to greater levels of risk for morbidity and mortality, and also to the likelihood that behavior change interventions will succeed, are not amenable to change.3 These factors include sociodemographic variables (eg, gender, age, socioeconomic status, culture), and environmental barriers to change (eg, lack of availability, or cost of healthy foods). A change in a range of psychological factors relevant to health-related risk behaviors, which include beliefs and cognitions, is both possible and achievable. Although it is widely accepted that optimal outcomes would result from simultaneous interventions at population, local community, and individual levels, it is also accepted that this is rarely possible or achievable.


1. Armitage CJ. Is there utility in the transtheoretical model? Br J Health Psychol. 2009;14(Pt 2):195–210.
2. Department of Health. Choosing Health: Making Healthy Choices Easier. London: Department of Health; 2004.
3 Bowling A. Research Methods in Health: Investigating Health and Health Services. Buckingham: Open University Press; 2002.
4. Boyce T, Robertson R, Dixon A. Commissioning and Behavior Change: Kicking Bad Habits. The King’s Fund; 2008.
5. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioral determinants to behaviour change techniques. Appl Psychol Int Rev. 2008;57:660–680.
6. National Institute for Health and Clinical Excellent (NICE). Guidelines for Behavior Change at Population, Community, and Individual Levels (Public Health Guidance 6); 2007. Available at: Accessed: October 1, 2009.
7. Abraham C, Kelly MP, West R, Michie S. The UK national institute for health and clinical excellence public health guidance on behaviour change: a brief introduction. Psychol Health Med. 2009;14(1):1–8.
8. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the Health Belief Model. Health Educ Q. 1988;15(2):175–183.
9. Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–508.
10. Bandura A. Health promotion from the perspective of social cognition theory. Psychol Health. 1998;13:623–649.
11. Marlatt GA, Donovan DM, eds. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. 2nd ed. New York, NY: The Guildford Press; 2005.
12. Austin J, Vancouver J. Goal constructs in psychology: structure, process and content. Psychol Rev. 1996;120:338–375.
13. Skinner BF. About Behaviorism. New York, NY: Knopf; 1974.
14. Prochaska J, Di Clemente C. The Transtheoretical Approach: Crossing the Traditional Boundaries of Change. Homewood, IL: Dorsey Press; 1984.
15. Wilson GT, Schlam TR. The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clin Psychol Rev. 2004;24(3):361–378.
16. West R. Time for a change: putting the Transtheoretical (stages of change) Model to rest. Addiction. 2005;100(8):1036–1039.
17. White C, Edgar G, Siegler V. Social inequalities in male mortality for selected causes of death by the National Statistics Socio-economic Classification, England and Wales, 2001–03. Health Stat Q. 2008;38:19–32.
18. Smith J, Gardner B, Michie S. Regional Hub Leads Annual Summary Report, 2008–2009. Internal Document, NHS Health Trainer Central Team. Department of Health; 2009.
19. Department of Health. NHS Health Trainers. London: National Health Service; 2009. Available at: Accessed: October 1, 2009.
20. Michie S, Abraham C. Advancing the science of behaviour change: a plea for scientific reporting. Addiction. 2008;103(9):1409–1410.

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