Health-Related Behaviours: Acquisition, Maintenance and Modification
Health-related behaviour is any action or pattern of action that influences health, illness, prevention, treatment, recovery or quality of life. This note explains how behaviours are formed, why people maintain them, and how doctors can support safe and lasting change.
Define health-related behaviour; classify protective, preventive, illness and risk behaviours; explain biological, psychological, social and cultural influences; apply major behaviour-change theories; and design a patient-centred behaviour-modification plan.
1. Meaning and importance
Health-related behaviours include eating, physical activity, sleep, hygiene, sexual practices, tobacco and alcohol use, medicine-taking, immunisation, screening, seeking care, attending follow-up and responding to symptoms. Some behaviours promote health, some increase risk, and many have both benefits and harms depending on context.
2. Types of health-related behaviour
- Health-promoting behaviour: balanced nutrition, exercise, sleep, hand hygiene, breastfeeding and stress management.
- Preventive behaviour: vaccination, antenatal attendance, screening, safer sex, mosquito-net use and early testing.
- Illness behaviour: noticing symptoms, interpreting them, deciding whether they are serious and choosing where to seek help.
- Sick-role behaviour: accepting treatment, resting, following restrictions and cooperating with rehabilitation.
- Risk behaviour: tobacco, harmful alcohol use, unsafe sex, inactivity, unsafe driving and medicine misuse.
3. How behaviours are acquired
Behaviour develops through observation, imitation, reinforcement, habit, emotion, knowledge, social expectations and the opportunities available in the environment. Children learn from parents and peers. Adolescents are strongly influenced by identity and peer acceptance. Adults may use behaviours to cope with stress, pain, loneliness or economic insecurity.
3.1 Learning and reinforcement
A behaviour that produces a rewarding result is more likely to be repeated. Relief after taking a sedative, social approval after drinking, or immediate pleasure from sugary food can reinforce behaviour even when long-term health effects are harmful. Behaviour change therefore requires alternative rewards and practical coping skills.
3.2 Social learning
People learn by observing role models and by judging whether they are capable of performing the behaviour. Confidence, or self-efficacy, is central. A patient who believes that exercise is impossible because of pain, poverty or lack of safety needs a graded and realistic plan.
4. Influences on health behaviour
| Influence | Examples | Clinical implication |
|---|---|---|
| Knowledge and beliefs | Perceived causes, benefits, risks and traditional explanations | Correct misinformation respectfully and connect advice to the patient's understanding. |
| Emotion and mental health | Stress, depression, trauma, anxiety and coping | Screen for psychological drivers before labelling behaviour as non-compliance. |
| Family and peers | Support, pressure, modelling and stigma | Involve supportive relatives with consent and protect confidentiality. |
| Culture and religion | Food rules, healing traditions, gender roles and beliefs about illness | Use culturally safe communication and negotiate rather than ridicule. |
| Environment and resources | Food prices, transport, safe spaces, work schedules and medicine availability | Make the plan achievable in the patient's real setting. |
| Health services | Trust, waiting time, cost, communication and continuity | Improve access and service experience, not only patient education. |
5. Health Belief Model
The Health Belief Model proposes that action is influenced by perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy.
- A patient may not test for HIV if they feel not susceptible.
- A patient may delay hypertension review if the disease feels harmless.
- A reminder, family encouragement or a symptom can act as a cue.
- Transport cost, fear of stigma and side effects are barriers.
Doctors should address each belief instead of giving a general lecture.
6. Theory of Planned Behaviour
Intention is influenced by attitude toward the behaviour, perceived social expectations and perceived control. A patient may intend to stop smoking but feel unable to do so because friends smoke, stress is high and treatment is unavailable. Strengthen intention and practical control together.
7. Stages of Change
- Precontemplation: the person is not considering change.
- Contemplation: the person is ambivalent.
- Preparation: the person plans a change.
- Action: the person is actively changing.
- Maintenance: the new behaviour is sustained.
- Relapse: the old behaviour returns; this is a learning opportunity, not proof of failure.
Advice should match readiness. Motivational interviewing is more useful than arguing with a person who is not ready.
8. Social Cognitive Theory
Behaviour is shaped by reciprocal interaction between the person, behaviour and environment. Key ideas include observational learning, self-efficacy, outcome expectations, goals, self-regulation and reinforcement. A doctor can help the patient set a small goal, monitor progress, anticipate barriers and reward improvement.
9. Behaviour modification in clinical practice
- Ask permission to discuss the behaviour.
- Assess what the patient does, when, where, with whom and why.
- Identify benefits and costs from the patient's perspective.
- Explore readiness and confidence on a 0–10 scale.
- Agree on one or two specific changes.
- Use SMART goals: specific, measurable, achievable, relevant and time-limited.
- Provide skills, alternatives, reminders and follow-up.
- Review progress without shame and adapt the plan.
10. Motivational interviewing principles
Use open questions, affirmations, reflective listening and summaries. Express empathy, develop discrepancy between goals and current behaviour, avoid direct confrontation, support autonomy and elicit the patient's own reasons for change.
Instead of saying “You are careless because you do not take your medicines,” ask: “What makes it difficult to take them every day?” This may reveal cost, shift work, side effects, forgetfulness or misunderstanding.
11. Common behaviours and clinical applications
Check access, dosing complexity, beliefs, side effects, memory, literacy and family support before changing treatment.
Assess food security, culture, income, cooking facilities and the patient's goals; avoid unrealistic diets.
Screen non-judgementally, assess dependence and safety, offer brief intervention and referral where needed.
Explain absolute benefits, address fear and access barriers, and use reminders for vaccination and screening.
12. Barriers and relapse
Relapse may follow stress, illness, social pressure, treatment side effects, financial crisis or loss of support. A prevention plan identifies high-risk situations, coping alternatives, emergency contacts and a rapid return to care. Avoid language that increases shame, because shame can drive concealment and further risk.
13. Doctor's role
- Model respectful and healthy professional behaviour.
- Screen for risk behaviours routinely and privately.
- Link behaviour to the patient's own health goals.
- Address social determinants that make change difficult.
- Use brief interventions, counselling, medication and referral appropriately.
- Document agreed goals and review them at follow-up.
14. Summary
- Behaviour is learned and maintained through biological, psychological, social, cultural and environmental influences.
- Education alone rarely changes behaviour when barriers remain.
- Match counselling to readiness and use patient-centred communication.
- Small, specific goals with follow-up are more effective than vague advice.
- Relapse should trigger reassessment and support, not condemnation.
15. References
- World Health Organization. Health promotion.
- World Health Organization. Ottawa Charter for Health Promotion.
- National Cancer Institute. Theory at a Glance: A Guide for Health Promotion Practice.
- National Institute for Health and Care Excellence. Behaviour change: general approaches.
Educational note: Use current clinical guidelines and local protocols when applying this material.
