Behavior change (public health)

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Behavior change is a central objective in public health interventions,[1] with an increased focus on prevention prior to onset of disease.[2] This is particularly important in low and middle income countries, where efficiency of health spending and costs and benefits of health interventions has come under increased scrutiny in recent decades.[3] Behavior change in public health is also known as Social and Behavior Change Communication (SBCC).[4]


Health conditions and infections are associated with risky behaviors. Tobacco use, alcoholism, multiple sex partners, substance use, reckless driving, obesity, or unprotected sexual intercourse are some examples. Human beings have, in principle, control over their conduct. Behavior modification can contribute to the success of self-control, and health-enhancing behaviors. Risky behaviors can be eliminated including physical exercise, weight control, preventive nutrition, dental hygiene, condom use, or accident prevention. Health behavior change refers to the motivational, volitional, and action based processes of abandoning such health-compromising behaviors in favor of adopting and maintaining health-enhancing behaviors.[5][6][7] Addiction that is associated with risky behavior may have a genetic component.[8]

One emerging concept in the American health system is that of small, manageable changes. It is not necessary to make sweeping, drastic alterations to one's whole lifestyle in order to see benefit. Dietary and exercise contexts, in particular show the benefit of moderate, slow changes.[9] For example, behavior change steps to include more physical activity can improve one's life expectancy, control weight, and boost mental health. It is also known to reduce the chance of some diseases such as type 2 diabetes, cardiovascular disease, and some cancers.[10] Healthy behaviors and practices during youth, particularly in school settings, is far more cost-effective than waiting until unhealthy behaviors are entrenched. A study of the Toward No Tobacco program, which was designed to prevent cigarette use among middle and high school students, found that for every dollar invested in school tobacco prevention programs, almost $20 in future medical care costs would be saved.[10]


Behavior change programs tend to focus on a few behavioral change theories which gained ground in the 1980s. These theories share a major commonality in defining individual actions as the locus of change. Behavior change programs that are usually focused on activities that help a person or a community to reflect upon their risk behaviors and change them to reduce their risk and vulnerability are known as interventions. Examples include: "Transtheoretical (Stages of Change) Model of Behavior Change", "theory of reasoned action", "health belief model", "theory of planned behavior",[11] diffusion of innovation",[12] and the health action process approach. Developments in health behavior change theories since the late 1990s have focused on incorporating disparate theories of health behavior change into a single unified theory.[13][14]


  • Care groups are groups of 10–15 volunteer, community-based health educators who regularly meet together.
  • Barrier Analysis is a rapid assessment tool used in behavior change projects to identify behavioral determinants.
  • Community-led total sanitation is a behaviour change tool used in the sanitation sector for mainly rural settings in developing countries with the aim to stop open defecation. The method uses shame, disgust and to some extent peer pressure which leads to the "spontaneous" construction and long-term use of toilets after an initial triggering process has taken place.

Behavior change communication (BCC)[edit]

Behavior change communication, or BCC, is an approach to behavior change focused on communication. It is also known as Social and Behavior Change Communication, or SBCC. The assumptions is that through communication of some kind, individuals and communities can somehow be persuaded to behave in ways that will make their lives safer and healthier. BCC was first employed in HIV and TB prevention projects.[15][16] More recently, its ambit has grown to encompass any communication activity whose goal is to help individuals and communities select and practice behavior that will positively impact their health, such as immunization, cervical cancer check up, employing single-use syringes, etc.[citation needed]


See also[edit]


  1. ^ WHO 2002: "World Health Report 2002 – Reducing Risks, Promoting Healthy Life". Retrieved February 2015.
  2. ^ US Center for Disease Control and Prevention. "National Prevention Strategy". Retrieved February 2015.
  3. ^ Jamison DT, Breman JG, Measham AR, et al., (eds) (2006) Disease Control Priorities in Developing Countries. 2nd edition Chapter 2: Intervention Cost-Effectiveness Retrieved February 2015.
  4. ^ "Why Social and Behavior Change Communication? – Health Communication Capacity Collaborative – Social and Behavior Change Communication". Health Communication Capacity Collaborative – Social and Behavior Change Communication. Retrieved 2016-06-17. 
  5. ^ "SAID project". Private Sector Partnerships.  SAID project focused on increasing the private sector's role in providing high-quality health products and services in developing countries.
  6. ^ "Barrier Analysis website". Barrier Analysis website. 
  7. ^ "Designing for Behavior Change Curriculum". Designing for Behavior Change Curriculum. 
  8. ^ Biliński P, Wojtyła A, Kapka-Skrzypczak L, Chwedorowicz R, Cyranka M, Studziński T (2012). "Epigenetic regulation in drug addiction". Ann. Agric. Environ. Med. 19 (3): 491–496. PMID 23020045. 
  9. ^ Hill, James (2009). "Can a small-changes approach help address the obesity epidemic? A report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council" (PDF). American Journal of Clinical Nutrition. 89 (2): 477–484. PMID 19088151. doi:10.3945/ajcn.2008.26566. 
  10. ^ a b "The Power of Prevention" (PDF). cdc. 2009. Retrieved 7 December 2016.  This article incorporates text from this source, which is in the public domain.
  11. ^ Theory of Planned Behavior
  12. ^ Diffusion of Innovation
  13. ^ Ryan, Polly (2009). "Integrated Theory of Health Behavior Change: Background and Intervention Development" (PDF). Clinical Nurse Specialist. 23 (3): 161–172. doi:10.1097/NUR.0b013e3181a42373. 
  14. ^ Prochaska, James; Velicer, Wayne (1997). "The Transtheoretical Model of Health Behavior Change". American Journal of Health Promotion. 12 (1): 38–48. doi:10.4278/0890-1171-12.1.38. 
  15. ^ "Brazil: Behavior Change Communication for More Effective Tuberculosis Control". John Snow Inc. 2010–2011. Retrieved 2 August 2016. 
  16. ^ "Behaviour Change Communication (BCC)for HIV/AIDS a Strategic Framework" (PDF). September 2002. Retrieved 2 August 2016. 
  17. ^ "Johns Hopkins Center for Communication Programs". 
  18. ^ "DMI – Where we work". 
  19. ^ "Evidence Action Beta".