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Supporting behaviour change

Supporting behaviour change

Supporting people to change their behaviour to improve their health and wellbeing is part of the continuum of supported self-management and health-coaching approaches.

Interventions in primary care can be brief or extended, but using specific techniques and skills can make a real difference to patients making changes in behaviour that can influence both mental and physical health. This article is constructed from a range of resources including BMJ 2010;340:c1900 and Journal of Holistic Healthcare 2019;16(2):19.

This article was updated in April 2025.

We need to choose our moment! People will not always be open or ready to make a behaviour change that involves a major commitment or effort. Capturing this moment is sometimes called a ‘teachable moment’, but is perhaps better thought of as an ‘inspirational moment’. It’s the time that you capture the person’s imagination and inspire them to recognise that change is possible.

Have you ever had the feeling of ‘banging your head against a wall’ when suggesting that people make changes in their lives? The stages of change model (also called the transtheoretical model) can be used to think about whether a person is ready to make any kind of life change.

While there is no clear evidence that people follow this process of change in a linear or step-by-step way, this model can still be helpful in deciding what kinds of interventions are likely to be useful for a particular patient, depending on what stage they are currently in.

For example, if a person is in the pre-contemplation stage, attempting to set goals or targets for change is likely to fall on deaf ears and lead to frustration on both sides. 

The following table gives some ideas of what we can do at different stages in the process (Transtheoretical model of behaviour change: Cambridge Handbook of Psychology, Health and Medicine (Cambridge University Press; 2007:228)):

NICE recommends that all healthcare staff be supported to use brief intervention strategies in their day-to-day interactions with patients to help improve their wellbeing (NICE 2014, PH49).

• Brief interventions are succinct, one-to-one engagements that aim to prompt behaviour change by informing individuals of the risks associated with unhealthy habits and providing practical strategies for change (Health Soc. Care Community 2023;2928228).

NICE recommends using an ‘ask, advise, assist’ structure that draws on core behaviour change techniques such as providing personalised feedback, encouraging the individual’s own responsibility for change and boosting self-efficacy.

The intervention might last anywhere from 30 seconds to 30 minutes. It might be as simple as raising awareness of risks and signposting to further information, or may involve referral for further interventions or more intensive support.

• Brief interventions targeting smoking behaviour have shown modest improvements in abstinence rates, ranging from approximately 3.9% to 5.7% at 6-month follow-up (Health Soc. Care Community 2023;2928228).
• Practitioner-delivered and digital brief interventions have both demonstrated statistically significant reductions in alcohol consumption in patients from lower socioeconomic backgrounds (Curr Addict Rep 2018;5:265).

The standalone impact of brief interventions may be limited when compared with more intensive strategies, but they are a cost-effective and pragmatic approach to behaviour change in a busy world. Each brief intervention conversation presents an opportunity for us to catch that elusive ‘inspirational moment’ for real change, when we can perhaps move towards one of the more intensive models outlined below.

There is a limited evidence base for us to turn to when looking for a structured approach to behaviour change. Below, we have outlined two useful models developed within the UK which the Red Whale team have found helpful.

The STOPIT model is a structured framework designed to guide coaching conversations in a systematic, client-centered way. Originally developed by Peak Health Coaching Ltd, it helps practitioners lead clients from recognising the need for change to taking concrete steps toward their goals. The model is especially useful in medical education and health coaching, where clear, empathetic communication is key.

Below is an easy-to-understand breakdown of the STOPIT model, along with sample coaching questions for each phase:

For healthcare professionals, incorporating the STOPIT model into practice can help in the following ways:

• Enhancing patient engagement by using open-ended questions, which encourages patients to explore their own motivations for change.
• Improving outcome clarity by defining clear, measurable goals, which ensures that patients and healthcare providers are aligned in their efforts.
• Addressing barriers effectively by exploring obstacles and assumptions, which helps pre-empt potential setbacks and leads to more sustainable health behaviour changes.

David Unwin’s GRIN model provides an alternative approach to facilitating making changes such as lifestyle or other behaviour.

Making change is not easy! Even if we believe that a change is very important, it can be difficult to follow through with it and stick to it over time. We have all struggled to stick to a healthy diet or a new exercise regimen. There are many factors, both personal and environmental, that can get in the way of making successful changes in behaviour. These include:

• Not understanding or agreeing with the reasons to change.
• Financial barriers.
• Lack of time.
• Being around other people who make it difficult to change.
• Not having the skills or knowledge to make the change.
• Emotional factors such as low mood, anxiety or lack of motivation.
• Lack of confidence in our ability to change.

Many people often experience ambivalence to change. They feel uncertain about the change, and may have conflicting feelings about the process and outcomes of making a change.

If we simply give advice and tell people what to do without acknowledging or discussing their ambivalence to change, we are likely to trigger resistance and lead to people finding even more reasons why they are unable to change:

Motivational interviewing involves a set of communication skills designed to enable health professionals to effectively talk to people about change. It recognises that ambivalence to change is normal, and has the aim of helping people develop their own desire to make change (internal motivation). When faced by resistance to change, motivational interviewing might ask patients to consider their own arguments for making a change, rather than informing or telling them what to do – which risks triggering further resistance.

A systematic review and meta-analysis exploring the impact of motivational interviewing to support increased physical activity levels found that it was superior to other behavioural interventions, both in terms of increased activity and reduced sedentary time, but its effects attenuated over time; there was little evidence of continued impact after 1 year (BMJ 2024;386:e078713). This suggests the importance of longer-term engagement if we are to see sustained behaviour change.  

Some of the core principles of motivational interviewing:

• The process of change involves listening to and understanding the individual’s own perspective.
• People should be actively engaged in the process of change, and find their own answers for solving problems.
• Directive approaches such as giving advice, convincing or telling people to change are ineffective, and likely to generate increased resistance to change.
  • Advice can act as a ‘vice’, stopping the patient from generating their own ideas. Instead, consider using the TOY framework, outlined in the table above, when looking to generate actionable ideas.

Remember, when facilitating behaviour change, we are carrying out strategies that might ignite a spark that encourages the patient to make their own changes. Even if the person is not quite ready to make a change immediately, this type of conversation may still have long-term benefit when they do feel ready to commit to change.

There are many different models used to describe motivational interviewing. Some of the core communication skills used are listed in the following table:

Here is a resource we can use to assess readiness to change and start the process:

Now think about the advantages and disadvantages of making the change:

How ready or confident do I feel about carrying out this step?

NICE issued guidance on digital and mobile health interventions, including online trackers, apps and wearable devices (NG183, 2020). It looked at these in relation to diet and physical activity, smoking, alcohol intake and unsafe sexual behaviour.

NICE said that using digital or mobile interventions has the potential to:

• Address health behaviour and make positive changes to help reduce the risk of chronic diseases.
• Help people self-manage, self-monitor or improve behaviours, and improve mental, emotional and social wellbeing.

NICE acknowledged a real evidence gap in assessing the benefits of these interventions and which groups specifically may benefit the most. We explore the current evidence in our article Technology to support health and wellbeing.

Supporting behaviour change Be vigilant for an ‘inspirational moment’ when a patient may be more open to making a life change. The stages of change model helps guide choice of intervention, depending on how ready an individual is to make the change. The STOPIT model is a useful approach to facilitating change: Signs: identify and articulate the cues or ‘nudges’ that signal the need for change. Tell: encourage clients to imagine supportive perspectives from trusted individuals regarding the change. Outcome: define clear, positive and realistic goals. Ensure that the desired outcomes ae specific and within the client’s control. Prevent: explore potential obstacles that might hinder progress and examine any assumptions that could be limiting change. Ideas: brainstorm various strategies or solutions. This phase is about generating multiple ideas to achieve the outcome. Time: prioritise and select an idea to start with and establish a realistic timeframe for action. An alternative is the GRIN model: Goals: define clear, meaningful health or life aims that align with your values. Resources: identify your strengths and supports that empower your change. Increments: break your journey into small, manageable, actionable steps. Noticing: acknowledge and reflect on every success to guide further progress. Giving advice and telling people what to do is ineffective and likely to trigger resistance. People should be actively engaged in the process of change, and find their own answers for solving problems. Highlight change talk by noticing and reflecting back when the person expresses any form of desire, reason, ability or need to make a change. Discussing the personal relevance and importance of change to the individual patient will help with the process of developing internal motivation. You can use a cost–benefit analysis to build motivation by exploring the advantages and disadvantages of making a change.

Useful resources: Websites (all resources are hyperlinked for ease of use in Red Whale Knowledge) Making Every Contact Count