Health Beliefs and Behaviour
Health beliefs are firmly held opinions or convictions about how to maintain, attain, or regain good health or prevent illness. Health behaviours are actions taken to achieve those goals, such as exercising regularly, eating a balanced diet, and obtaining necessary inoculations. Often health beliefs guide health behaviours,1,2 which is why physiotherapists spend time educating their patients. The connection between health beliefs and health behaviours is also the foundation of public-health educational interventions that aim to change health behaviours by informing health beliefs with best available evidence.
When Behaviours Don't Match Beliefs
While people's health behaviours often clearly reflect their health beliefs, the connection is not always so direct. People may believe an activity or product is healthy, yet choose not to participate in the activity or use the product; they may believe a behaviour is unhealthy, yet still continue it. Health behaviours depend on many other personal factors besides health beliefs, including ability, self-efficacy, financial resources, addiction, habit, and choice.3
When an individual's behaviours do not match his or her health beliefs, changing behaviour becomes a challenging and complex task. Change will depend partially on a realization that the positive health benefits from the new behaviour outweigh the burdens of changing the old behaviour, but it will also depend on a supportive social, environmental, and political context.3,4 One well-known example is smoking cessation. A sizeable proportion of people believe that smoking is bad for their health yet continue to smoke.5 For this reason, most public-health interventions aimed at helping people stop smoking combine educational messaging on the health detriments of smoking with other tobacco-control strategies such as legislative changes (e.g., laws against smoking in public areas, higher taxes on tobacco products).6,7 Regular exercise is another example of a health behaviour that has been targeted through combined personal, social, environmental, and legislative strategies.8–10 Health care providers, including physiotherapists, can play an important role in public-health initiatives and help foster a healthy and supportive context.
Physiotherapy Engagement in Knowledge Translation for Changing Beliefs and/or Behaviour
Public-health strategies aimed at changing health beliefs or behaviours based on best available evidence are a form of knowledge translation (KT) – a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health (definition from the Canadian Institutes of Health Research).11 Over the next 2 years, Physiotherapy Canada will be running a special series of articles that consider novel KT approaches aimed at changing health behaviour. The realm of KT relevant to physiotherapy will be specifically explored, including how physiotherapists are engaged in novel KT strategies aimed at fostering positive changes in health behaviour. The series will cover three levels:
Patients: What strategies are most effective for changing the health behaviours of individuals treated by physiotherapists? How can physiotherapists increase or ensure patients' compliance with exercise and other advice given? What do we do if patients don't want to change their behaviour, despite known adverse effects on their health?
Providers: What strategies are most effective for changing the practice behaviours of physiotherapists to foster improved health outcomes for patients? How can therapists be influenced to practise in a more evidence-based fashion? How should therapists be trained to ensure that they have the skills they need to remain current on best practice and research evidence?
Populations: How can physiotherapists promote change in people's health behaviours related to optimal levels of physical activity, participation in regular exercise, and healthy diet? What strategies are most effective for changing health behaviours among the general public? What are the roles of the mass media, government, and healthy public policy, and how can physiotherapists be involved in each? How should health services and payment schemes be designed to foster optimal clinical outcomes?
Physiotherapy Canada is currently requesting submissions directly or indirectly related to the above topics; submissions will be accepted now and throughout 2012, for publication in 2013/2014. All submissions will be refereed in the usual way for Physiotherapy Canada and should follow the journal's style guidelines. If you have questions about the relevance of a project you are working on, or require more detail, please contact Doug Gross at doug.gross@ualberta.ca or (780) 492-2690.
References
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