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Table 1 Summary of the main theoretical models of behavioural change in primary care

From: Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers



Key variables and constructs

Individual level: knowledge, beliefs, attitudes, personality traits, past experiences and change processes

Health Belief Model [17, 18]

Healthy behaviour is the result of perception of disease susceptibility and severity, perception of the benefits of the behaviour required for disease avoidance or management, exposure to stimuli promoting the action, and personal confidence in the capacity to successfully implement the behaviour.

Perceived susceptibility

Perceived severity

Perceived benefits and barriers

Cues to action


Theory of Reasoned/Planned Action


Behavioural intention determines the performance of a given behaviour through the influence exerted by beliefs, attitudes, subjective norms and perceived control on intention and behaviour itself.

Behavioural intention

Subjective norms

Attitude toward behaviour

Perceived behavioural control

Information Processing Model [22]

The capacity of the person to understand and react to information and communication sources influences his/her behaviour.

Who provides the information

How information is created, transmitted, received and assimilated

Transtheoretical Model of Stages of Change [23]

Willingness or intention to change behaviour varies among individuals and within an individual over time. Relapse is a common event and part of the change process.

Stages of change: (1) Precontemplation, (2) Contemplation, (3) Preparation, (4) Action, (5) Maintenance. Change processes: Cognitive and behavioural; Self-efficacy

Precaution adoption process [24, 25]

Adoption of a new behaviour requires a process, consisting of 7 stages or steps, from ignorance of the problem, through the decision to perform the action, to the final change in behaviour.

Stages: (1) No risk awareness; (2) Aware of risk, but considers oneself not susceptible to it;

(3) Decision-making process, which may be: (4) No action; (5) Ready for action; (6) Action; (7) Maintenance

Interpersonal level: role of environment and social support network

Operating Learning Model [26]

The probability of performing a behaviour is dictated by the history of consequences (environmental changes, stimuli) contingent to its performance. Behaviours should be defined based on the variables that control them: antecedents (stimulus situation prior to behaviour performance) and consequences (change in environment or stimulus situation immediate to behaviour performance).

Antecedent stimuli; Consequences; Reinforcement principle (positive or negative reinforcement); Principle of punishment (positive or negative punishment); Stimulus control; Reinforcing cultural contingencies

Social Learning or Social-Cognitive Model [27, 28]

Behaviour is dictated by dynamic interaction of personal factors, environmental influences and behaviour: reciprocal determinism.

Observational learning

Outcome and self-efficacy expectations

Behavioural capacity; Reinforcement

Self-regulation models [29]

Effectiveness in long-term behavioural change depends on the degree of control the individual has on his/her process of change.

Self-management skills; Self-monitoring; Self-evaluation; Self-reinforcement

Interpersonal and social support theories [30]

Effective interpersonal communication between the provider and patient, taking into account the significance of the environment surrounding the individual, is essential for the change to occur.

Informative support

Emotional support

Environment collaboration

Community level

Community-based intervention approach [31]

Community well-being may be promoted by identification of common problems and objectives, resource mobilisation and development and implementation of strategies to reach such collective objectives, including the creation of structures and policies supporting healthy practices and lifestyles.