How do you change your behaviours? Do you meticulously plan, set goals, and take small steps, or do you just “do it”? A commenter on my previous blog post examining iPhone apps for smoking cessation noted that the “the most common method of quitting smoking reported by successful quitters is by simply stopping“. And yes, as reported by West et al, 2006, about 50% of smokers do quit “cold turkey” without planning. The evidence even suggests that this is more successful over the long term than planned attempts to stop smoking (1). So how do observations of unplanned behaviour change fit into the common theoretical models of behaviour change and how can we use this knowledge to support behaviour change more effectively?
Resnicow and Vaughn (2) propose that we need a new paradigm to conceptualize behaviour change. They argue that traditional models of behaviour change impose a linear, deterministic approach on a complex and chaotic system. Failing to account for the complexity of behaviour change may limit the usefulness of interventions based on these theories. They suggest that a new framework, founded in complex systems thinking and chaos theory, will provide new opportunities to support behaviour change and enhance outcomes of interventions.
Most traditional theories of behaviour change only partly acknowledge complexity. While they recognize the multiple factors that contribute to behaviour change, only some view these factors as being interdependent and connected via feedback loops, two important characteristics of complex systems. For example, applying the Health Belief Model to weight loss would identify variables such as availability of healthy food choices, access to opportunities to be physically active, and heredity and how these interplay with an individual’s perception of the risks of being overweight (perceived seriousness), media messages about body weight (cues to action), as well as other factors to determine the likelihood the individual will change their behaviours. However, most traditional theories go no further in embracing complexity.
Traditional behaviour change theories fail to acknowledge the non-linearity of the relationships between the variables involved. According to these models, behaviour change results from small planned changes over time. Some models explain behaviour change as a result of shifts in cognition (how we think about things), while other models focus on intentions, motivation, knowledge and action or a combination of these factors. These models describe the relationship between these variables as linear, such that a small change in one variable leads to a small change in the outcome. This linear progression does not account for chaotic (random) processes, such as ‘sudden insights’ or ‘mystical epiphanies’ (3).
Most theoretical models also do not account for stochastic (random) change. Resnicow and Vaughn suggest that chaotic patterns may elicit behaviour change through external triggers (e.g. a conversation, divorce, public service announcement) or an internal process where pre-existing knowledge and motivation interact to form a “motivational storm”. Behaviour change also exhibits emergence, such that collective behaviours or behaviour change cannot be simply predicted from the behaviour of the individual variables that influence behaviour change – in other words, the whole is greater than the sum of the parts. This property too is commonly overlooked by traditional frameworks.
Applying the lenses of complex systems and chaos theory can help expand traditional theories to better address the complex and chaotic nature of behaviour change. How can these new perspectives be incorporated into practice? In the same journal issue, Baranowski (4) responds to Resnicow and Vaugh by wondering if it is possible to identify individuals who experience an “aha!” moment and capture that experience through qualitative study; while Brug (5) suggests the practical implications are limited. I think the analogy to lottery balls described by Resnicow and Vaughn speaks clearly to this issue – how do we keep the balls tumbling to maximize their interactions?
“In the complex system approach, the role of health communications may be analogous to the spinning of ping pong balls in a lottery machine. Say that each ping pong ball represents a chunk of knowledge, attitude, efficacy, or intention. On each ball lies a few strips of Velcro; the soft side. Inside the human psyche lies strips of the opposite, hard side of Velcro, which serve as potential motivational “receptors”. Some of the motivational ping pong balls may have resided in the system for years while others may have been more recently implanted through a health education program, clinical counseling encounter, or health communication campaign. Rather than attempting to predict which piece or pieces of motivation may “tip” the individual, from the chaotic perspective, the role of the health professional is to ensure the balls are kept spinning at various intervals and velocities to maximize the chances that they adhere to their receptors. When sufficient balls have adhered a tipping point may occur. Which balls or combination of balls may trip the motivational switch as well as when and why they may stick, are chaotic events that defy accurate prediction. From a non-linear perspective, the goal of health professionals may be to encourage wing flapping.”
1. West R, and T Sohal. (2006) “Catastrophic” pathways to smoking cessation: findings from national survey. BMJ 332:458-460 PMCID: PMC1382540
2. Resnicow K, & Vaughan R (2006). A chaotic view of behavior change: a quantum leap for health promotion. The international journal of behavioral nutrition and physical activity, 3 PMID: 16968551
3. Miller WR. (2004) The phenomenon of quantum change. Journal of clinical psychology. 60(5):453-60. PMID: 5048692
4. Baranowski T. (2006) Crisis and chaos in behavioral nutrition and physical activity. The International Journal of Behavioral Nutrition and Physical Activity. 3(1):27 PMCID: PMC1574342
5. Brug J. (2006) Order is needed to promote linear or quantum changes in nutrition and physical activity behaviors: a reaction toʼA chaotic view of behavior change’ by Resnicow and Vaughan. International Journal of Behavioral Nutrition and Physical Activity. 3(1):29. doi: 10.1186/1479-5868-3-29
Image from Just I and Myself