Health Promotion and Behaviour Change

Health promotion is the process of enabling people to increase control over and improve their health, working both on individual behaviour and on the social, economic, and environmental conditions that shape it. Behaviour change — supporting people to adopt and maintain healthier patterns of diet, physical activity, tobacco and alcohol use — is a central means by which health promotion reduces the modifiable risk factors that drive chronic disease.

Definition

Health promotion is the process of enabling individuals and communities to increase control over the determinants of health and to improve it; behaviour change is the set of strategies, often grounded in behavioural-science theory, used to help people adopt and sustain health-protective behaviours.

Scope

This topic covers the conceptual basis of health promotion, the principal theories and models used to understand and influence health behaviour, and the distinction between approaches that target deliberative (reflective) decision-making and those that target automatic processes and the choice environment. It is reference-educational and gives no individualised behavioural prescription.

Core questions

• How do behavioural-science theories inform the design of health interventions?
• What distinguishes reflective from automatic determinants of health behaviour?
• Why do individually focused approaches risk widening health inequalities?
• How does health promotion combine individual and environmental strategies?

Key concepts

• Health promotion
• Modifiable risk factors
• Behavioural-science theory
• Reflective versus automatic processes
• Choice architecture and nudging
• Social and environmental determinants
• Maintenance of behaviour change

Key theories

Transtheoretical (stages of change) model

Describes behaviour change as movement through stages — precontemplation, contemplation, preparation, action, and maintenance — and matches intervention strategies to a person's stage of readiness.

Mechanisms

Behaviour-change interventions draw on theory to specify what to change and how. Reflective approaches target conscious motivation, intentions, and self-efficacy — as in the transtheoretical model, which matches strategies to a person's stage of readiness — while a complementary view emphasises that much health behaviour is driven by automatic, cue-dependent processes that are better influenced by altering the physical and social environment. Health promotion in the Ottawa Charter tradition therefore couples individual capability-building with action on the conditions (food environment, marketing, pricing, urban design) that make healthy choices easier, consistent with the prediction that environmental defaults reach more people with less individual effort.

Clinical relevance

Health-promotion and behaviour-change principles underpin smoking-cessation support, dietary and physical-activity counselling, and community programmes delivered across health systems. Familiarity with the underlying theories helps practitioners understand why some interventions succeed and others do not. This entry describes the science of behaviour change and is not a prescriptive behavioural plan for any individual.

Epidemiology

Because a large share of chronic-disease burden is attributable to a few modifiable behaviours, effective behaviour change has substantial preventive potential. Evidence indicates that interventions relying solely on individual information and motivation tend to have modest and unequally distributed effects, whereas combining them with environmental and structural change tends to reach more people more equitably — a pattern central to current thinking on NCD prevention.

Evidence & guidelines

The Ottawa Charter (WHO, 1986) remains the defining statement of health-promotion principles. Behavioural-science reviews map the theories used in intervention design, and analyses of automatic versus reflective determinants inform contemporary strategy. Evidence on the effectiveness of specific behaviour-change techniques varies by behaviour and setting and is synthesised in topic-specific reviews rather than here.

History

Health promotion emerged as a distinct field in the 1970s and 1980s, moving beyond health education toward a broader concern with the determinants of health, crystallised in the 1986 Ottawa Charter. Behavioural-science models such as the transtheoretical model were elaborated through the 1980s and 1990s, and a later shift toward dual-process thinking emphasised automatic as well as deliberative drivers of behaviour, broadening the toolkit beyond individual persuasion.

Debates

Reflective versus automatic targets of intervention

Much health-promotion practice has assumed that informing and motivating people changes behaviour, yet a substantial body of work argues that automatic, environmentally cued processes drive many health behaviours and that changing the choice environment may be more effective and more equitable than appeals to conscious choice.

Key figures

• James Prochaska
• Karen Glanz
• Theresa Marteau

Seminal works

• who-ottawa-1986
• prochaska-velicer-1997
• glanz-bishop-2010

Frequently asked questions

What is the difference between health promotion and health education?

Health education focuses on giving people knowledge and skills to make healthier choices; health promotion is broader, also addressing the social, economic, and environmental conditions that shape whether those choices are possible.

Why is information alone often not enough to change behaviour?

Many health behaviours are driven by habit and by automatic responses to environmental cues rather than by deliberate reasoning, so providing information may not change them unless the surrounding environment and incentives also change.