Two days into 2018 and many people have already given up on their New Year’s resolutions.
This failure of willpower is normal human behaviour. Research shows most people forget about their resolutions within 48 hours. Only one in eight people maintain their new health regime, whether this is losing weight, giving up cigarettes, or being more physically active.
Changing unhealthy habits is an ongoing struggle for a majority of the population. The most recent Healthy Ireland survey showed that almost two thirds of adults are trying to lose or maintain their weight. Nearly half of adult smokers attempted to quit in the 12 months prior to the 2017 survey and 57 per cent thought about quitting. Many people spend years trying to change health behaviours as shown by comparing the findings of the three Healthy Ireland surveys carried out in the past few years. The same numbers of people are trying to lose weight in 2017 as in 2015.
Change is difficult because health habits have a powerful influence over behaviour. Hundreds of self-help books appear in bookshops at this time of year, all promising a new, better you. None of them bring about long-term change. The Power of Habit: Why We Do What we Do and How to Change (2012) by Charles Duhigg notes all habits have three elements, forming "habit loops", which start with a "cue" (feeling hungry or thirsty), followed by a "routine" (going to the same place for lunch), then a "reward" (feeling good). According to Duhigg's theory, people who want to change a habit must change the routine that goes with it. Changing the cue or reward, for example saving up the money usually spent on tobacco for a holiday does not work.
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If only it was that easy.
In the 1980s, professors of psychology James Prochaska and Carlo Di Clemente, from Rhode Island University, developed a theoretical model to explain health behaviour called the Stages of Change. According to the theory, there are six stages.
“Pre-contemplation” is when people have no intention of changing their behaviour regardless of the damage it is doing to their health.
The second stage, “contemplation” is when people are aware a problem exists and are thinking about taking action.
“Preparation” is when people are ready to take action and actually make a plan.
“Action” is followed by “maintenance” when new behaviour replaces old.
‘Relapse’
Most people “relapse” – the sixth stage – falling back into old habits during the maintenance phase and either reverting to the contemplation or action stages or staying lapsed.
The Stages of Change model has had a profound effect on health promotion practice and has become one of the most popular conceptual resources in the field. Using the model in practice means health professionals moving from an advice-giving model and telling service users what to do, to ascertaining what stage of change they are at. Asking questions using brief intervention techniques quickly establishes the stage of change.
For example, if the answer to the question “Have you thought about [giving up smoking, losing weight, drinking less] is “No, or I’m not ready”, the patient is clearly in pre-contemplation stage. The health professional simply says “Let me know if you change your mind and I may be able to help” and leaves it at that. If the service user is at the action stage, the health professional helps them to make a plan. Health professionals ask different questions and provide different supports at each stage.
Although the Stages of Change model is an advance on efforts by health professionals to change service-user behaviour through advice-giving and hoping (usually in vain) that healthier habits will follow, the model has been criticised by health promotion experts. One criticism is that outcomes cannot be measured. In addition, the popularity of the model means health professionals spend too much time trying to change individuals and not enough time changing the social determinants of health such as the environments in which people live, work and play. Notwithstanding these drawbacks, the model has been adopted by the HSE. Healthy Ireland in the Health Services: National Implementation Plan 2015-2017 envisages that "health professionals will be trained to incorporate prevention and support for behaviour change as a routine part of healthcare delivery."
This makes total sense.
Thousands of health professionals have already been trained in brief intervention techniques so anyone who is having difficulty sticking to their new year’s resolutions could think about contacting their GP for help.
Brief interventions work so why not give them a try.