How Health Coaches Can Use Lifestyle Medicine Theories to Support Clients’ Behavioral Change

Health coaches use evidence-based strategies to support clients who are looking to improve their health status. Coaches help clients facilitate lifestyle and behavioral changes through personalized planning and coaching skills. Health coaching strategies are rooted in a variety of health and lifestyle medicine theories that help facilitate the client’s learning and development.

This article will shed insight into two prominent theories within lifestyle medicine and will share strategies for how health coaches can implement these theories in their work with clients.

First Theory: The Health Belief Model 

What is The Health Belief Model? 

The Health Belief Model was developed in the 1950s by social psychologists employed by the United States Public Health Service – Irwin M Rosenstock, Godfrey Hochbaum, Stephen Kegels, and Howard Leventhal. Their jobs were to determine the factors that influence people’s decisions to prevent, screen for, and control illness. The psychologists found that they could explain and predict individuals’ health-related behaviors by focusing on six factors – perceived susceptibility to disease, perceived severity of disease, perceived benefits and barriers to taking action, self-efficacy, and cues to action.

The Six Factors

1. Perceived susceptibility to disease: Whether an individual believes that they are at risk of contracting the illness or disease.
2. Perceived severity of disease: Whether an individual believes that the consequences of contracting the illness or disease would be severe enough to warrant doing something to prevent it.
3. Perceived benefits: The belief that taking action would benefit the individual from the standpoint of reducing the risk of contracting the disease or facing severe consequences.
4. Perceived barriers: Does the individual believe that the benefits of taking action outweigh the costs?
5. Self-efficacy: Is the individual confident in their ability to successfully perform the action that would help reduce susceptibility and/or severity of disease?
6. Cues to Action: Exposure to factors that prompted or reminded the individual to take action.

Applying The Health Belief Model as a Coach

Health behaviors can range from smoking cessation to safe sex, healthy eating, increased physical activity, vaccinations, health screenings, and more.

The Health Belief Model can help coaches educate and co-create interventions to improve the client’s health. When clients understand and accurately assess the personal factors that influence their health-related decisions, the coach and client can partner to identify ways to reduce barriers and promote positive action.

Here are prompts (and example questions) that health coaches can use with clients when working through The Health Belief Model:

 

Perceived susceptibility/ Perceived severity   

• Coach shares the most recent, evidence-based information on health risks & consequences of inaction related to the client’s behavior of focus. 

• The coach explores the client’s belief/awareness of risks and severity.
  
  • Example questions: 

• • • What are the risks of (x behavior)? 

• • • How severe are the consequences of not addressing (x behavior)? 

• • • What are the benefits of ceasing (x behavior)? 

• • • How would life improve if you were able to address (x behavior)?

• Coach inquires about client’s beliefs re: falling victim to/experiencing consequences related to behavior of focus.
  • Example questions: 

• • • In what ways does (x behavior) negatively impact you, mentally/physically/psychologically/emotionally/socially? 

• • • How do you think (x behavior) will impact your health in the next 6 months/ 1 year/ 5 years?

•  Coach partners with clients to develop an accurate assessment of risk.
  • Example questions: 

• • • Given (evidenced-based information), how likely are you to experience the negative or debilitating effects of (x behavior)? 

• • • Why do you believe this to be the case? 

• • • What proof do you have that supports your conclusion?

 

Perceived benefits/Perceived barriers  

• Share most recent information on the benefits of addressing lifestyle health factors. 

• Explore client’s beliefs about benefits and impact of taking action.
  

• • Example questions: 

• • • What is motivating you to take action around (x behavior)? 

• • • How will your life improve when you address (x behavior)? 

• • • Why is it important to improve your health right now? 

• • • What are the ways your overall health will change when you address (x behavior)?

• Identify client’s perceived barriers and resources/strategies to address them.
  

• • Example questions: 

• • • What obstacles are in the way of taking action around (x behavior)? 

• • • • Why do you believe these barriers exist? 

• • • How could those obstacles impede your goal of improving your health? 

• • • Who can support you as you take action around (x behavior)?  

• • • • How can they support you?
        

• • • What resources do you have available right now to deal with the obstacles in your way? 

• • • How can you implement (coping skill or strategy) to overcome those obstacles?

 

Self-efficacy/Cues to Action  

• Unconditional positive regard: express belief in client’s ability to succeed. 

• Explore past successes/failures and how the client can leverage them to inform the strategy.
  

• • Example questions:  

• • • What are some past strategies you’ve used to help you overcome something similar in the past? 

• • • • How were those strategies helpful? 

• • • • What can you do to improve on these strategies to address (x behavior)?

• Explore successful cues to action for the client/ Coach to develop action plans 
  

• • Example questions: 

• • • What is one step that you can take this week to make progress towards your goal of changing (x behavior)? 

• • • • How will you take that step? 

• • • • What do you need as you take that step? 

• • • Who in your life/environment can you look to as a role model as you embark to change (x behavior)? 

Second Theory: The Theory of Planned Behavior

What is The Theory of Planned Behavior?

The Theory of Planned Behavior was developed by Icek Ajzen in the 90s and is one of the most applied theories in the social and behavioral sciences. It links beliefs to behavior outcomes, and assumes that all behavior is rational, conscious, and planned based on three main factors.

Main Factors in The Theory of Planned Behavior

The Theory of Planned Behavior states that human behavior is guided by three types of considerations:

• Behavioral beliefs: Refers to the likely consequences of a behavior. This influences human attitudes, positive and negative, toward the behavior.
• Normative beliefs: Refers to the normative expectations of others and how they influence social pressure or norms around the behavior.
• Control beliefs: Refers to perceived behavioral control, which is the believed ease or difficulty encountered when carrying out the behavior.

 

What Health Coaches Should Know about The Theory of Planned Behavior

An individual’s attitude and perceived social pressure contribute to the strength of one’s intention to follow through with the behavior or not. The stronger the intention, the greater the likelihood of following through with the behavior.

 

Perceived behavioral control is MORE POWERFUL than attitude and social pressure combined. It’s a moderating factor for both of those influences on intention. If the individual has enough perceived behavioral control, they will not need an intention to carry out the behavior. It can become an unconscious choice.

Example: If I have a negative attitude about taking a walk after a meal, and I don’t have social pressure in my life to make me want to walk post-meal, BUT I believe that going for post-meal walks is easy enough for me to do well and consistently, I am more likely to take those walks, despite my attitude and lack of social pressure.  

 

Coaching Takeaways

• The most powerful intervention is perceived behavioral control.
  • Coach the client to identify and assess control beliefs around the health promoting behavior.
    • Example questions:
      • What is an easy way for you to engage in (health promoting behavior)? 
        • Why is that easy for you?
        • How would you do it?
        • How would it make you feel?
      • What is challenging about engaging in (health promoting behavior)?
        • Why do you think it’s challenging?
        • What is a resource or strategy you could use to overcome that challenge?
  • When perceived behavioral control is not high, address beliefs, attitudes, social pressures, and social norms surrounding the health promoting behavior.
    • Example questions:
      • When (health promoting behavior) comes to mind, what are your initial thoughts and feelings about carrying it out?
        • Why do you think that?
        • Why do you think you feel that way?
      • What do you believe to be true/false about (health promoting behavior)? 
        • How do you know that is the case? 
        • What experiences have you had that reinforce that belief? 
      • What can motivate you or encourage you to carry out (health promoting behavior)?
        • Why is that a motivating factor?
        • Scale from 1-10 how much that factor would motivate you.
      • How do the people in your life feel about/engage with (health promoting behavior)?
        • How do you think their attitudes impact you?
      • Who in your life or environment do you admire that does (health promoting behavior)?
        • Why do you admire them?
        • How do you think they do it? 
        • How could you use them as a role model to inspire you?

 

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