Health and wellness coaches have key roles in supporting clients in working toward health behavior change. An important element of implementing health behavior change strategies is identifying ways to sustain them in the long term while also leaving room for the normal changes in lifestyle everyone experiences.
Health Behavior Change Frameworks: A Review
Health behavior change frameworks and models help to provide health, wellness, and fitness coaches with information that describes and explains how and why a person adopts a health behavior.
It can also help clients to understand why they feel a certain way about changing a health behavior, and they can know that it’s all part of a normal process.
Note: We go into greater detail about these models and health behavior change science in general in this article, so if you need a refresher, we recommend starting there.
The Transtheoretical Model of Behavior Change
The Transtheoretical model organizes the behavior change process into five stages: pre-contemplation, contemplation, preparation, action, and maintenance.
The Transtheoretical Model allows coaches and their clients to locate their sequential progress toward the desired health behavior, and it recognizes the possibility of and potential for relapse at any given stage.
The Health Belief Model of Behavior Change
The Health Belief Model (HBM) is one of the most widely used health behavior change models. Researchers have developed several tools to support the application of the model, and there is plenty of data to analyze its effectiveness. The HBM comes from the perspective of cognitive determinants behavior change for health, which is generally where most fitness, health, and wellness coaches have an influence.
Rather than a sequential model of behavior change, the HBM identifies several psychological determinants of health behaviors, namely perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. It also recognized that psychological determinants are only one element that influences health behaviors.
5 Integrative and Holistic Strategies for Coaches to Support Healthy Behavior Change
There are dozens of blogs and articles that propose strategies that coaches and other health professionals can use with their clients and patients. While many of them have anecdotal evidence, few strategies have scientific evidence for their success.
In this article, we summarize five strategies identified by a group of researchers as having the most scientific support for health behavior change success.
The first three of the five strategies are related to action plans, which is a central factor in uniting successful health self-management programs. Action plans are short-term goals that are agreed upon by the individual and the coach and which the client feels confident they can achieve.
Set Specific, Short-Term Goals
The first strategy is to set specific goals that can be achieved in the short term. These goals should be measurable or quantifiable and should be able to be achieved in one to two weeks.
The short-term goals help to build a client’s confidence, knowing that they can set their mind to making a change and achieve it.
Some examples of specific goals that can be achieved in the short term include:
- Reading an article about the benefits of movement
- Writing a journal entry about what it might be like to engage in a target behavior
- Drinking a glass of water first thing in the morning next Monday
- Going for a walk around the block after lunch on Wednesday and Friday
- Smoking one cigarette fewer a day
- Adding half a cup of fruit to breakfast on weekends
- Measuring blood glucose after every meal in the two days following the coaching session
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The difficulty, frequency, and number of goals depend on the client’s motivation, experience, and ability. If you are beginning with a client who doesn’t have much experience in pointed efforts to modify health behaviors, you can choose one specific goal to begin with.
Consider the use of apps and charts to help clients keep track of their goals.
Keep in mind that people often have a tendency to overestimate or underestimate their ability to carry out goals when starting out, so let your client know that together you will find a good rhythm in the weeks and months to come.
This strategy is usually used in conjunction with strategies two and three to construct action plans. Together, they provide a coherent goal management experience for clients.
Set Actionable Goals
An actionable goal is one that is directly tied to a behavior over which your client has direct control.
Goals that may be actionable are those related to exercise, eating, medication, and hydration. They may be actionable because there are often several factors that play into a person’s autonomy over lifestyle choices.
For example, if your client makes the grocery trips and cooks most of the meals, then they have direct control over what they buy and how it is prepared. If your client eats breakfast and lunch in a cafeteria with limited food choices, they have less control over their dietary intake. Another example is exercise if they live in an area where they don’t feel safe while exercising outdoors and cannot afford a gym membership.
Examples of non-actionable goals are those related to body weight or size, blood pressure, mental health, or other physiological or psychological measures.
After your client has set a specific goal, ask them if they have direct and free control over engaging in that behavior. Explore scenarios where they might lose control, and talk through alternative plans. If their goal is to jog a mile outside three times a week, ask them what they will do if it rains or snows. They might decide to do Pilates inside instead or go jogging at another time.
Set Goals Your Clients Are Confident They Can Attain
When clients are motivated to make changes that improve their health, it can be easy to be overambitious. Your client should be confident that they can realize the goal, even if it seems easy to them.
Once they realize the goal, they improve their self-confidence in their ability to set and achieve health behavior goals. After they have achieved the goal, you can work with them on setting the next goal that is slightly more ambitious but still highly attainable.
Let’s take an example to illustrate. You have a client who is committed and motivated to improve their fitness levels. They come to you saying their goal is to run and do resistance training every day in the week following the session. But, after inquiring, you learn that your client has been largely sedentary for five years.
While you can commend their motivation, encourage them to start small, and suggest they set a goal they are confident they can achieve, such as running on the treadmill for twenty minutes twice in the next week.
To gauge their confidence, you can ask your client to rate their confidence on a scale of 0-10, where ten is totally confident and zero is not confident at all. As a general guideline, your client should rate their confidence at least seven before making the commitment.
Regardless of your client’s experience with health coaching, you can encourage them to progressively adjust the goal while they are working toward it. If they feel that achieving the goal was too easy, they can set a higher goal immediately following. If they realize they overestimated their ability to achieve the goal, they can adjust the goal down to something more realistic for them. This strategy helps to promote self-efficacy.
Use Cues to Action to Prompt Behaviors
Cues to action are events or stimuli that prompt or stimulate clients to perform the desired behaviors. Cues to action could be as simple as receiving a reminder from the coach or an app to take part in an activity or drink water.
Prompts can also be internal, such as feeling pain or discomfort linked to the body’s condition, such as anxious thoughts, elevated blood glucose, or pain.
A health coach can help individuals reinterpret internal cues to prompt them to carry out behaviors. For example, pain in the lower back from sitting at the desk can prompt clients to stand up and take a short walk.
You can work with your client to identify these cues during your sessions. Ask them about how not carrying out their targeted health behavior makes them feel. Then ask them how the feeling changes after carrying out the targeting behavior. Finally, suggest that the next time they feel that way, it can serve as a reminder to carry out their desired activity.
This process helps clients feel like they have control over their internal cues rather than ignoring them or fearing them.
Allow Clients to Increase Self-Understanding Through Small-Scale Experiments
Small-scale experiments are a way for individuals to intentionally try out how certain behaviors affect their body and mind. It helps build awareness about how their body responds to stimuli and concrete actions while simultaneously opening an opportunity for intentional action.
Small-scale experiments are a key component of a program called Blood Glucose Awareness Training (BGAT). In this program, individuals conduct small-scale experiments on blood glucose levels, such as thirty minutes of exercise or skipping. Through these experiments, people with metabolic disorders are able to understand their health condition and how specific events and actions affect it so that they can anticipate certain changes and aim to ameliorate their negative effects.
Small-scale experiments can be used for all people who want to gain a better understanding of their bodies and to test out assumptions and predictions. The effects don’t necessarily need to be measurable (i.e., blood glucose levels or blood pressure). They can also be subjective, like how they feel and what they are thinking.
Some examples of small-scale experiments can be:
- Doing yoga in the morning vs. at night
- Spending an hour outside in the morning
- Slightly changing the interval between meals
- Going to sleep an hour earlier than usual
- Adding more of a certain food group to meals
- Taking medication exactly on time for a day
- Opting not to take a smoke break with co-workers (if they want to quit smoking)
- Drinking water first thing in the morning
A Reminder: Be Flexible and Have Empathy
The strategies presented here have research to support their effectiveness. But that doesn’t mean that they will work for everyone. Be flexible and open to resetting and recalculating goals. Showing empathy when a goal wasn’t achieved is important to create a safe space for your clients and helps them feel motivated rather than shamed when they hit bumps in the road to leading a healthier lifestyle.
When your client is struggling to achieve a goal of any sort or expresses discomfort even after achieving a goal, it is a good opportunity to ask questions about how they are feeling, including what is going on in their body, mind, and environment that may be impeding progress. This will, in turn, open the door to have a conversation about new goals.
Health, wellness, fitness, and nutrition coaches have an important role in supporting clients in learning about themselves and adopting behaviors that support their health. Having a good understanding of health behavior science helps to build a greater sense of empathy while also providing you with tools to work with clients.
This article provides five integrative and holistic research-backed health behavior change tools that can be implemented in your practice to support clients in shifting health behaviors toward those that make them feel healthy, calm, and balanced.
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