Table 3.

Common factors influencing behavior change and their implications for intervention design [adapted from WHO European Ministerial Conference on Health Systems (28)].

Factors	Design implication
A desire for change must be present in the audience	There is a need both to create a demand for positive change and to create the conditions to enable people to make positive choices
Participatory involvement leads to greater behavioral change effects	Interactive engagement strategies and the development of coalition approaches to change should be part of all behavior change interventions
People are often motivated to do the “right thing” for the community as well as for themselves and their families	Programs should encourage and incentivize socially responsible behavior and penalize behaviors that are not socially responsible
Social relationships, social support, and social norms have a strong and persistent influence on behavior	Incorporating peer and family support strategies into individual risk change programs increases likely success
Change is usually a process not an event	Programs should be sustained over time and tailored to the needs of different groups
Psychological factors, beliefs, and values influence how people behave	Programs need to address values and beliefs, as well as information and knowledge acquisition
People can be “locked into” patterns of behavior and need practical help to break them	Policy and services need to be designed to meet the specific needs of different communities, in order to help them change engrained habits
Change is more likely if an undesired behavior is not part of an individual’s life situation coping strategy	Create incentives, offer practical support for change, and give positive reinforcement. Provide alternative forms of support and reinforcement to aid behavior change
People’s behavior is influenced by their physical and social environments	There is a limit to a person’s capacity to change, if the environment militates against the desired change; conditions and incentives for change must therefore be created, in addition to giving messages and advice and building personal skills
People’s perception of their vulnerability to a risk and of its severity is key to understanding behavior	There is a need to develop individual and community understanding of risk and vulnerability in relation to major threats
Perceptions of the effectiveness of the recommended behavior change are key factors affecting decisions to act	Programs should seek to ensure that people understand the scale of the rewards associated with positive behavior change
The more beneficial or rewarding an experience, the more likely it is to be repeated	Reinforcing and incentivizing positive behavior in the short term should be part of any change program
People are loss-averse: they will put more effort into retaining what they have than into acquiring new assets	Programs should emphasize the advantages of positive behaviors that enable a continuation of immediate benefits, rather than long-term gains
People often rely on mental short cuts and trial-and-error to make decisions, rather than on rational computation	Programs should develop a deep understanding about what will motivate people to change and how they perceive specific issues