The Health Care Provider’s Role in Supporting Positive Health Behavior Change: Developing an Effective and Supportive Communication Approach

Main Article Content

Janet R. Bezner Lisa K. Lloyd Sylvia H. Crixell Tricia J. Burke



Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. Four chronic NCDs, including cardiovascular disease, cancer, chronic respiratory disease, and diabetes are responsible for more than 80% of NCD-related deaths. Unhealthy behaviors, such as physical inactivity, smoking, poor nutrition, and excessive alcohol consumption are significant causes of chronic NCDs. However, even when faced with potentially debilitating effects associated with chronic NCDs, it is difficult for individuals to change their behaviors and adopt more healthful practices, such as being physically active, refraining from smoking, eating a healthful diet, and refraining from excess alcohol intake. Sometimes barriers seem insurmountable, and affected individuals need guidance. A potential resource that can help individuals overcome personal barriers and successfully improve their health behaviors is the health care provider. However, while health care providers are being tasked to address patients’ health behaviors, they often feel ill-equipped to assist their patients to engage in meaningful, sustainable, health behavior change. Promising approaches to providing efficient and effective support for patients’ behavior change revolve around provider-patient communication. Health coaching, for instance, is a process whereby health care providers follow a standardized communication approach in working with patients that integrates health behavior change theories such as the Transtheoretical Model and Self Determination Theory, utilizes conversational tools such as motivational interviewing, and incorporates evidence-based strategies to foster health behavior change. In so doing, the provider’s role shifts from that of an expert to that of a partner, which results in improved satisfaction in the provider-patient relationship for both the provider and the patient, and improved health outcomes for the patient. Communication strategies that build provider-patient partnerships increase patient autonomy and self-efficacy, thereby enabling providers to better support their patients in adopting sustainable behavior change and addressing the burden caused by NCDs.

Article Details

How to Cite
BEZNER, Janet R. et al. The Health Care Provider’s Role in Supporting Positive Health Behavior Change: Developing an Effective and Supportive Communication Approach. Medical Research Archives, [S.l.], v. 5, n. Issue 9, sep. 2017. ISSN 2375-1924. Available at: <>. Date accessed: 17 oct. 2017.
behavior change, health coaching, non-communicable disease, communication


1. Centers for Disease Control and Prevention. (n.d.) Chronic diseases: The leading causes of death and disability in the United States. Accessed January 1, 2017 from

2. WHO. (2014) Global Status Report on Noncommunicable Diseases 2014. doi:ISBN 9789241564854.

3. Hunter, D.J., Reddy, S. Noncommunicable Diseases. N Engl J Med. 2013;369(26). 2562. doi:10.1056/NEJMc1313604.

4. The U.S. Government and Global Non-Communicable Disease Efforts. 2017.

5. WHO. Global status report on noncommunicable diseases 2014. World Health. 2014. 176. doi:ISBN 9789241564854.

6. Centers for Disease Control and Prevention. Facts about Physical Activity | CDC. Accessed April 24, 2017, from

7. Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases. 2011.

8. The U.S. Government and Global Non-Communicable Disease Efforts. 2017.

9. Mozaffarian, D., Benjamin, E.J., Go, A.S., et al. Heart disease and stroke statistics-2016 Update A report from the American Heart Association. Circulation. 2016;133(4), e38-e48. doi:10.1161/CIR.0000000000000350.

10. Wilson, M., Reedy, J., Krebs-Smith, S. American Diet Quality: Where it is, Where it is Heading, and What it Could Be. J Acad Nutr Diet. 2016;22(2), 134-139. doi:10.1177/0963721412473755.

11. Bezner, J.R. Promoting Health and Wellness: Implications for Physical Therapist Practice. Phys Ther. 2015;95(10), 1433-1444. doi:10.2522/ptj.20140271.

12. Bouton, M.E. Why behavior change is difficult to sustain. Prev Med. 2014;68, 29-36. doi:10.1016/j.ypmed.2014.06.010.

13. McLeroy, K.R., Bibeau, D., Steckler, A., Glanz, K. An ecological perspective on promotion programs. Health Educ Q. 1988;15(4), 351-377.

14. Stokols, D. Establishing and maintaining healthy environments: Toward a social ecology of health promotion. Am Psychol. 1992;42, 6-22.

15. Whitlock, E.P., Orleans, C.T., Pender, N., Allan J. Evaluating primary care behavioral counseling interventions. An evidence-based approach. Am J Prev Med. 2002;22(4), 267-284. doi:10.1016/S0749-3797(02)00415-4.

16. Petrella, R.J., Koval, J.J., Cunningham, D.A., Paterson, D.H. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Am J Prev Med. 2003;24(4), 316-322. doi:10.1016/S0749-3797(03)00022-9.

17. Berry, L.L., Flynn, A.G., Seiders, K., Haws, K.L., Quach, S.Q. Physician counseling of overweight patients about preventive health behaviors. Am J Prev Med. 2014;46(3), 297-302. doi:10.1016/j.amepre.2013.12.005.

18. Calfas, K.J., Long, B.J., Sallis, J.F., Wooten, W.J., Pratt, M., Patrick, K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 2000;25(3), 225-233. doi:10.1006/pmed.1996.0050.

19. Agency for Healthcare Research and Quality. Five Major Steps to Intervention (The “5 A’s”). Treat Tob Use Depend. 2012;5.

20. Krist, A.H., Woolf, S.H., Frazier, C.O., et al. An Electronic Linkage System for Health Behavior Counseling. Effect on Delivery of the 5A’s. Am J Prev Med. 2008;35(5 SUPPL.), 16-18. doi:10.1016/j.amepre.2008.08.010.

21. Sforzo, G.A., Kaye, M.P., Todorova, I., et al. Compendium of the Health and Wellness Coaching Literature. Am J Lifestyle Med. 2017. doi:10.1177/1559827617708562.

22. Glanz, K., Rimer, B.K., Viswanath, K. Health Behavior. Theory, Research, and Practice. Vol 5th ed. Jossey-Bass. 2015.

23. Deci, E.L., Ryan, R.M. Handbook of Self-Determination Research. The University of Rochester Press. 2002.

24. Prochaska, J.O., Velicer, W.F. The transtheoretical model of health behavior change. Am J Heal Promot. 1997;12(1), 38-48.

25. Prochaska, J.O., DiClemente, C.C. Transtheoretical therapy: Toward a more integrative model of change. Psychother Theory, Res Pract. 1982;19(3), 276-288. doi:10.1037/h0088437.

26. Marcus, B.H., Forsyth, L. Motivating People to Be Physically Active. Vol 1st ed. Human Kinetics. 2003.

27. Zimmerman, G.L., Olsen, C.G., Bosworth, M.F. A “stages of change” approach to helping patients change behavior. Am Fam Physician. 2000;61(5), 1409-1416.

28. Marcus, B.H., Selby, V.C., Niaura, R.S., Rossi, J.S. Self-Efficacy and the Stages of Exercise Behavior Change. Res Q Exerc Sport. 1992;63(1), 60-66. doi:10.1080/02701367.1992.10607557.

29. Prochaska, J.O., Diclemente, C.C., Norcross, J.C. In Search of How People Change Applications to Addictive Behaviors. Am Psychol. 1992;47(September), 1102-1114. doi:10.3109/10884609309149692.

30. Janis, I., Manning, L. Decision Making: A Psychological Analysis of Conflict, Choice and Commitment. New York Free Press. 1977.

31. Rimer, B.K., Kreuter, M.W. Advancing tailored health communication: A persuasion and message effects perspective. J Commun. 2006;56(SUPPL.), S184-S201. doi:10.1111/j.1460-2466.2006.00289.

32. Bandura, A. Social Foundations of Thought and Action. Upper Saddle River, NJ: Prentice-Hall, Inc. 1986.

33. Strecher, V.J., McEvoy, DeVellis, B., Becker, M.H., Rosenstock, I.M. The Role of Self-Efficacy in Achieving Behavior Change Health. Health Educ Q. 1986;13(1), 73-91. doi:10.1177/109019818601300108.

34. Olander, E.K., Fletcher, H., Williams, S., Atkinson, L., Turner, A., French, D.P. What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: A systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2013;10(29), 29. doi:10.1186/1479-5868-10-29.

35. Ryan, R., Deci, E. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55, 68-78.

36. Ryan, R.M., Deci, E. Intrinsic Motivation and Self-Determination in Human Behavior. Plenum Publishing Company. 1985.

37. Segar, M.L., Richardson, C.R. Prescribing pleasure and meaning: Cultivating walking motivation and maintenance. Am J Prev Med. 2014;47(6), 838-841. doi:10.1016/j.amepre.2014.07.001.

38. Rollnick, S., Miller, W.R., Butler C. Motivational Interviewing in Health Care. The Guilford Press. 2008.

39. Segar, M.L., Guerin, E., Phillips, E., Fortier, M. From a Vital Sign to Vitality: Selling Exercise So Patients Want to Buy It. Curr Sports Med Rep. 2016;15(4), 276-281. doi:10.1249/JSR.0000000000000284.

40. Brehm, J. Responses to the Loss of Freedom: A Theory of Psychological Reactance. General Learning Press. 1972.

41. Perloff, R.M., Brock, T.C. And thinking makes it so: Cognitive responses to persuasion. In: M. Roloff & GM, ed. Persuasion: New Directions in Theory and Research. Vol Beverly Hills: Sage. 1980, 67-99.

42. Pollak K.I., Alexander, S.C., Tulsky, J.A., et al. Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med. 2011;24(6), 665-672. doi:10.3122/jabfm.2011.06.110025.

43. Moore, M., Jackson, E., Tschannen-Moran B. Coaching Psychology Manual. Vol Second. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2016.

44. Toll, E. Back to the Heart of the Matter. 2015;313(18), 1829-1830.

45. Schattner, A. The Silent Dimension. JAMA. 2009;169(12), 1095-1099.

46. Shanafelt, T.D. Enhancing Meaning in Work. JAMA. 2009;302(12), 1338-1340. doi:10.1001/jama.2009.1385.

47. Epstein, R.M. Mindful Practice. JAMA. 1999;282(9), 833. doi:10.1001/jama.282.9.833.

48. Wolever, R.Q., Simmons, L.A., Sforzo, G.A., et al. A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare. Glob Adv Health Med. 2013;2(4),38-57. doi:10.7453/gahmj.2013.042.

49. Exercise is Medicine. Accessed July 17, 2017.

50. Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2),191-215. doi:10.1037/0033-295X.84.2.191.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.