Changing health-risk behavior has been shown to decrease morbidity and mortality and enhance quality of life. The present review aims to describe the models and theories that underpin effective interventions and the empirical studies that warrant their successful use with specific health risk-behaviors. Motivational, behavioral enactment and multi-stage models are critically discussed in the context of identifying the ingredients that help translate theories into practice by designing effective behavior change interventions. Future research directions are outlined for continuing the development of a theory and evidence based practice in health psychology and its integration with evidence-based theory and practice of cognitive-behavioral psychotherapies, as both are focused on behavioral change.
Key words: health-risk behavior, models of change, effectiveness, evidencebased interventions.
Human behavior plays a central role in the maintenance of health and the prevention of disease. Health-risk behavior can be defined as any activity undertaken by people with a frequency or intensity that increases risk of disease or injury (Steptoe & Wardle, 2004). The health risk behaviors might cluster together into a risky lifestyle. Much of the mortality and morbidity is caused by individual behavioral patterns, polluted environment or poverty. Statistics show that half of the premature death from the 10 leading causes in developed countries is caused by preventable factors, such as: tobacco use, alcohol abuse, physical inactivity, unhealthy dietary habits, risk sexual practices, non-adherence to effective medication regimens and to screening programs (Gray, 1993). Health risk behaviors also influence cognitive performance, emotions, and the overall quality of life (Hawkins & Anderson, 1996). Although epidemiologic data on the relationships between these behaviors and various health outcomes were available in the early 1980s, many refinements in knowledge have occurred since then. Causal conclusions have been strengthened by more sophisticated research designs, and program implementations. The impact of these risk behaviors on health is of such magnitude that it has become one of the priorities of the most important national and international health organizations (Rutter & Quine, 2004). To advance in the field of risk behaviors change, the Behavior Change Consortium (BCC) was created as a collaborative network of institutions and specialists. BCC reviews currently informs about links between health and behavior, about the influence of the social environment on these behaviors, and about interventions to improve quality of life through modifying behavior. It also addresses what must still be learned in order to answer questions and to discover and share what works, and what does not regarding health and behavior (Prochaska, 2005).
There are some important issues regarding the field. First, there is an overlapping of constructs among social cognition models of health and illness. Bandura (2000) criticizes the way the proliferation of models of health behavior determines "cafeteria style research" where a mixture of theoretical concepts are used and unnecessarily multiply predictors in the name of theoretical integration. For instance, the self-efficacy concept from Social Cognitive Theory (SCT) overlaps with perceived behavioral control from the Theory of Reasoned Action and the Theory of Planned Behavior (see below) or the barriers concept from SCT overlaps with the barriers concept from Health Belief Model. More studies are needed in order to provide evidence for discriminant validity among these constructs, and their integration with already validated theories of cognitivebehavioral practice in the clinical field (David, Miclea, & Opre, 2004), as both target health promotion and/or behavioral treatment. Second, interventions in the clinical field can be considered theory and evidence-based when (1) the theory that is used for data interpretation fulfills two criteria: (a) it provides a clear account of the hypothesized underlying psychological mechanisms that generate behavior change following the intervention; (b) the theory has been empirically tested before being used with behavior modification interventions (Michie & Abraham, 2004); researchers argue for the use of evidence obtained with specific populations and particular circumstances in order to build and improve behavior change theory, and (2) research in health psychology includes randomized control trials (RTC), elaboration and process evaluations in order to measure the impact of interventions and help identify the strategies that work in health behavior change. …