The following (very comprehensive) article is written by Justin Kompf.
In this article you will learn the process and scientific rationale behind a tailor-made behavior change intervention assessment. To go along with this article is an open access step-by-step manual that you can download HERE.
Science is an activity; a process of systematic study through observation of phenomena and experimentation of ideas. A good scientific idea is generally based off of observations and then incorporated into an existing theoretical framework to some extend linked. A good idea also needs to be testable. But ideas never come fully formed. They come from observation or a vague sense of unrest about why certain observations are as they are.
Science, then is the process that helps a person to refine their ideas.Once the scientist sees the problem, identified the variables, and finds a framework for study a hypothesis can be made.
Good personal trainers and coaches engage in the same systematic thought process when helping clients reach their goals. They gain information from their client, test interventions, gather more data and re-test.
Coaching then is an art and a science. The problem that I study is the gap between human behavior that is optimal for achieving a goal and what we actually do. For the most part, people have sufficient knowledge to make healthy decisions. In fact, a lot of times they have a good plan in place. But they don’t act on their plan or knowledge or they don’t act sufficiently or consistently enough to see results.
So, why don’t they?
Different People Are Different
Some basic scientist might scoff at behavioral science. They can look in a microscope, and with pretty good accuracy, predict what will happen when a chemical agent or catalyst is introduced. They might say that you can’t predict how a person will behave. But they would be wrong.
Human behavior is very challenging to predict, but not impossible and it’s a lot easier to do in aggregate. Meaning, for one person it would be hard to predict what they will do but if we know all the variables that contribute to behavior we can predict what most people would do.
The problem is, is that there are so many internal variables (motivation, attitude, confidence) and external variables (physical environment, social environment) that change on a consistent basis. Because everything is consistently changing it is challenging to make a prediction unless we are aware of all these variables. All personal trainers can agree that just because one style of coaching works for one person doesn’t mean it will work for everyone because different people are different.
Let’s do a simple example:
Scenario 1: Client Joe doesn’t have strong motivation to eat vegetables and he doesn’t have favorable attitudes towards vegetables. He is in his in apartment with his roommate, where naturally, they have no vegetables. Client Joe’s roommate also hates vegetables.
Is Client Joe going to eat vegetables? Pretty easy to predict behavior. But let’s keep the person and change the environment.
Scenario 2: Client Joe doesn’t have strong motivation to eat vegetables he doesn’t have favorable attitudes towards vegetables. Joe has a girlfriend who he loves very much, she eats very healthy. He goes to her parent’s house to meet them for the first time. They serve salad at first and everyone at the table is eating salad.
Is Joe going to eat vegetables? More than likely yes.
One more example, let’s keep all the variables similar except we’ll change the behavior in question to exercise.
New Scenario: Joe doesn’t have strong motivation to exercise or really move at all. He also doesn’t really have confidence in his ability to do any form of exercise. But his girlfriend loves Brazilian Jiu Jitsu. In fact, it turns out the whole family loves BJJ. Joe visits the family for the first time and they ask him to go to the gym to do some rolling.
What is Joe going to do? Unlike eating a salad, this is an activity that requires skill and thus confidence in ability is going to come into play. With everything we know about the scenario we can say with high probability that Joe is not going to be doing any BJJ or at best will give a mediocre attempt.
Variables to Know to Create a Customized Behavior Change Program
Psychological researchers love to confuse us. There are a multitude of theories that attempt to explain human behavior. Without having to know too much about these theories here is a list:
- Behavioral theories: Social Cognitive Theory, Theory of Planned Behavior
- Behavioral change theories: Transtheoretical Model
- Motivational Theories: Self-Determination Theory
- Coaching change styles: Motivational Interviewing, Acceptance and Commitment Coaching, Cognitive-Behavioral Coaching
There are also multiple levels of behavioral influence. In Client Joe’s case I was describing interpersonal factors, which along with individual factors is what this article will focus on, but there are more including:
- Individual factors: knowledge, attitudes, beliefs, personality, values, confidence, motivation
- Interpersonal factors: social identity, social support.
- Institutional factors: laws, regulations
- Community factors: social networks norms
- Public policy level: laws
It is easy to see that with so many different variables, human behavior is challenging to predict and to change. But it’s not the case that we cannot do it, it’s the case that there are many variables to evaluate and there is also so much that changes on a consistent basis.
It’s not a simple math equation or something you can observe under a microscope.
Below is a hypothetical motivation chart. Let’s use the framework from Self-Determination Theory. According to this theory people are motivated when they feel competent (they have the ability to do the behavior), experience autonomy (choices aren’t forced upon them) and when they feel related (people care about them and support the behavior they are doing).
Let the smallest circle represent competence, the second represent autonomy, and the third representing relatedness.
Just as a quick note, I will be presenting a framework for change later where the scores are different (i.e. not on a 1-12 scale). I am simply using this 1-12 score to express an idea.
A person who scores high on all of these measures might be considered an ideal client. They are confident they can change, they want to make the change, and people support their change. They are sufficiently motivated.
But in reality, a client might look more like this:
The client feels moderately competent about their ability to do the behavior. They want to do the behavior. BUT they don’t feel like they would be supported for this behavior.
How you cater to that person? Is your intervention going to be completely different than the client who scores high on all of these measures?
More on Motivation
Competence, autonomy, and relatedness are all things that a coach can immediately help a client control. They can give them mastery experience with exercise to increase competence, they can give them choices on what behaviors or exercises they want to do and the coach can show that they care about the client.
What the coach can’t so readily do is change motivational orientation. Individuals are motivated for behavior for certain reasons. A person may want to exercise because they feel guilty about not doing it, they might be doing it for money, or they might be doing it because they love doing it.
There are different forms of motivation, ranging from extrinsic to intrinsic. People who have controlled goals have external or introjected forms of motivation. On the other hand, people with autonomous goals have identified, integrated, or intrinsic regulation.
People who have autonomous goals (i.e. do a behavior because it is important, reflects their values, or is enjoyable) are more likely to expend effort towards their goals compared with extrinsically motivated people.
So, if you have a client that has a weak motivational foundation it doesn’t make much sense for them to actually make a plan to do anything. Odds are they might start but will fail to be successful in the long run. More on this later.
Different people are going to have different backgrounds and different barriers to optimizing their own health.
Take a look at these three barriers to weight loss in the image above. The Y axis represents the number of people who responded to a barrier as either impossible, highly unlikely, unlikely, neutral, likely, highly likely or certain. A large percent of people said stress would increase their odds of failing to lose weight (likely or higher). But emotional issues didn’t share such a perfect relationship. Some people said it would be certain while others didn’t perceive this as a problem. Falling into shopping temptations demonstrated great variability as well.
I hope by now I have demonstrated the need for customized interventions. But what does not need to change is your style of coaching. All trainers should be authentic and coach with unconditional positive regard. This is a concept I was first introduced to a couple of years ago and have stressed it ever since.
To coach with unconditional positive regard is to withhold judgment for the behaviors of a client. It is to work under the assumption that the client is always trying their best despite outside behaviors.
If a 30-year old woman comes to you who wants to lose 30 pounds you have to realize that this person has 30 years of experiences and memories that are impacting their behavior.
Whatever they are doing or are failing to do does not reflect the person they are at their core. To believe this would be to fall into what is called the fundamental attribution error, or the belief that a person’s outside behavior is due to internal characteristics (i.e. laziness or lack of discipline) rather than outside circumstances.
Recall that relatedness is a key component to motivation. A client feels relatedness when they are cared for and supported.
Theory Based Assessment Protocol
For the assessment portion, the framework that I present for use by personal trainers closely replicates Self-Determination Theory and the Theory of Planned Behavior.
This protocol begins with unconditional positive regard representing the overall coaching atmosphere. A coach can have all the correct assessment protocols and plans but if the client doesn’t believe they care it could all be for nothing.
Each of the cognitive variables I am going to introduce is going to be very specific to different goal related behaviors.
A person might have a weight loss goal and lack the confidence that they can lift weights but may feel very confident that they can go for a walk.
Because of this it would be useful to examine specific weight loss barriers. A coach could put together a survey that looks like this*:
Once specific problematic behaviors have been identified the assessment can begin.
We are going to look at three cognitive variables that can give a rough estimate of how motivated a client is to perform a specific behavior. These variables are
- Confidence: measured on a scale of 1-10
- Support for behavior: measured on a scale of 0-10
- Autonomy: measured on a scale of 0-5
Confidence is going to be pretty straight forward. Take a specific behavior and ask a client on a scale of 0-10 how confident they are that they can do the behavior, 1 representing very low confident and 10 representing very high confident.
Support for behavior, which captures relatedness is a little more complex. Even though the scale is from 1 to 10 the values for the score will be recoded.
Here is why, while subjective norms/relatedness components of motivation are important, they might only be important up to a certain value and they might not be as important as other values (1).
Explained another way, if a person has a peer group that actively sabotages their health efforts then their effect will reduce a person’s motivation. Because of this, scores of 0-3 will be coded as a score of .5.
The magnitude of the impact of turning saboteurs into non-saboteurs is going to be greater than changing non-saboteurs into active supporters (1). Because of this, the algorithm for support scores are as follows:
- 0-3= saboteurs = .5 points
- 4-6 = neutral/non-saboteurs= 1.25 points
- 7-10 = active supporters = 1.5 points
We score Autonomy on a scale of 0-5 with 0 representing no desire to try the behavior and 5 representing a high desire to try this behavior.
This is the only scale that has a true 0 value because if a client has no desire to try to make a behavior change the coach shouldn’t make them. There are plenty of other behaviors they can perform.
What to do With the Data
In the interest of full disclosure, my proposition only has logical validity. This means it has yet to undergo scientific validation. No one has examined the reliability (is it repeatable) or validity (does it measure what it says it measures). But here is what I propose; we take the multiplicative score of all the variables to categorize motivation for behavior as either low, medium, or high.
(confidence)*(relatedness)*(autonomy) = motivation score
Thus, we can get data for a variety of behaviors.
We can score as low as 0 because of the autonomy score and as high as 75.
- 0-25 = low motivation
- 26-50 = moderate motivation
- 51 to 75 = high motivation
Let’s say a client said a barrier was lack of exercise. You brought up resistance training or aerobic training two times per week for 30 minutes.
For aerobic training, they scored a 7 on confidence, a 6 on relatedness, and a 1 on autonomy. For resistance training they scored a 6 on confidence, a 3 on relatedness, and a 4 on autonomy
The aerobic training motivation score is 10.5. The resistance training score is 12.
Neither score is perfect, but the client is more motivated towards performing resistance training*.
What if The Client Isn’t Motivated?
I’m a pretty firm believe in a libertarian coaching style. Don’t make the client do things they don’t want to do. That being said, what if a client isn’t motivated for anything?
What we can do is look at the individual scores on confidence, relatedness, and autonomy. Confidence is one of most easily modifiable aspects of motivation and there are two things a coach can do.
The first is to present a less challenging option. For example, if a client scored a 4 on resistance training two times per week for 30 minutes they would logically score higher for one time per week for 30 minutes, and even higher for 1 time per week for 15 minutes.
The other thing the coach can do is provide ‘mastery experience’. Confidence increases with experience so if you can put the client in a position to be successful confidence will increase. Based on the measurements the coach can ask some open-ended questions to gain insight into the client’s motivation.
Let’s use the resistance training example again.
You notice that the client was neutral in their desire for performing resistance training. You say
“I noticed that you scored a 2 on the resistance training autonomy questionnaire despite being confident that you can do it. Can you tell me a little more about that?”
The client might express that after work he wants to get home to his family. So, while he is confident his time with his family is more valuable.
As a coach you might say something like this:
“Thanks for sharing all of this information with me, and it’s completely understandable that you want to spend time with your family. But did you know that you don’t have to be in the gym to do resistance training or resistance exercise? You can actually do some fun routines and even incorporate your kids with some body weight exercises. I remember you telling me you had some dumbbells at home too. Would you be open to me showing you some exercises you can do at home?”
In this case, by widening the options and understanding what drives the client the trainer can help the client come up with options that they are more motivated to participate in.
Motivation for the Goal: Finding the Why
We just measured motivation for certain behaviors, but what about a client’s motivation for the overall goal?
Individuals can be motivated to lose weight for various reasons, some motivational foundations are stronger than others.
If a person is externally regulated they may want to lose weight to gain a prize or recognition. They may have introjected regulation and believe that they need to lose weight because they feel bad about themselves.
Or they might be motivated to lose weight because they value the outcome.
You can go to http://selfdeterminationtheory.org/ for a variety of different measurement tools for exercise and healthy behaviors. Below is a motivation chart for 4 different people. You can see that their motivational foundations are different.
If a client has a poor motivational base, a planning phase might be challenging. A useful coaching exercise is a values exploration conversation. Ask the client about what their life values are. Ask them about what their life goals are. How can losing weight and getting in better shape help with their life goals?
This will necessitate a longer conversation. You can check out this value based video I send to clients if they need to change their motivational orientation.
Planning and Volition Phases
There are two phases to behavior, a motivational phase involving all the cognitive processes that happen in the brain and a volitional phase. The volitional phase is the planning phase where motivation is translated into action.
For behaviors that involve effort and some level of behavioral control motivation is going to be important. It wouldn’t make sense to go into a planning phase for people who don’t have motivation for a behavior. If you did the conversation would sound like this:
Client Joe: “I don’t really want to do cardio”
You: “Great, let’s plan out when you’ll do cardio”
See, nonsensical. But once you identify a behavior a client is motivated to do you can begin the planning phase.
When planning to begin a motivated behavior there are action plans and there are coping plans. Action plans describe what I call GO behaviors. They are plans to do behaviors you want to do.
Coping plans describe how to overcome what I call STOP behaviors. They entail identifying barriers (which we have already done) and making plans to work around them.
Both plans specify the when, where and how behaviors occur.
If a client was motivated to begin resistance training they would make an action plan that says something like this:
“When I am done with work, I will stop at the gym on the way home and lift weights for 30 minutes”
If a client was motivated to avoid late night snacking they would make a coping plan that says something like this:
“When it is late at night and I want to eat chips, I will have a seltzer water instead”
Alternatively, a client could even make a plan where they avoid buying chips in the grocery store. Their plan might sound like this:
“When I am going grocery shopping I will not go down the snack isle that has chips”
How Does it Work and How can I Make it Work Better?
Implementation intentions work by identifying a specific stimulus to enact goal relevant behaviors. Here is an example:
“When my coffee is brewing in the morning (stimulus) I will have a piece of fruit (behavior)”
Implementation intentions make behaviors more automatic. But they work only when the intention is fresh in memory.
Again, in full disclosure I am still working on the best ways to implement this but research does show that when people receive text message reminders they are more likely to act on their intentions (2).
What a coach can do is set up a shared document for clients to track their implementation intentions (see below).
As a note, some of these implementation intentions are much better than others.
The examples on 9/15 and 9/16 are very strong examples whereas 9/18 could have been stronger by identifying an alternative behavior.
I still have questions on the best way to implement this planning strategy.
Here are some questions a coach could test out to see what leads to the best results:
- Choose only one GO behavior and one STOP to do consistently and at a consistent time. This might translate to habit more rapidly.
- Sometimes clients don’t fill out the specific day. At noon send them their goal or a reason why they want to reach their goal if they don’t write down an implementation intention.
- Try variable text messaging schedules: maybe the client gets text message reminders every other week so they don’t rely on the text messages to do the behavior.
A coach can use the website ohdontforget.com to set up automatic text message reminders to make this process easy and time efficient.
My current programming goes as such:
- Measure motivation for behaviors and goals. If this is sufficient or when this is sufficient move to a planning phase.
- I let the client pick behaviors they would like to do, we polish the behaviors into implementation intentions, picking specific times and places to do behaviors. Then we make a schedule like the one below:
Restructuring the physical environment can also help with STOP and GO behaviors. Implementation intentions can even be made to ensure an environment that is more conducive to reaching goals.
For example, if a client’s GO behavior was to eat more fruit an implementation intention with environmental restructuring would look like this:
“When I get home tonight I will fill my fruit bowl with 5 apples and put the bowl near my keys so I grab a piece of fruit before I leave the house in the morning”.
Similarly, a person may put gym clothes in their car at night so they serve as a reminder to exercise. The text message reminder might come in at 7:30 at night and say
“It’s time to put my gym shorts and sneakers in the car!”
For stop behaviors the client could restructure their home.
There are a multitude of behaviors that can contribute to healthier living just as there are a multitude of behaviors that contribute to less than optimal health.
The coach should assess motivation for change by examining autonomy, confidence, and relatedness for each specific behavior.
Once a coach finds a behavior that a client is highly motivated for they may move into the planning phase of goal attainment.
This planning phase may utilize implementation intentions along with automatic text message reminders to help keep the client’s intentions fresh in their memory.
Finally, be sure to download the open-access manual for step by step instructions HERE.
Notes and References:
*Surveys can easily be made on google drive and shared with clients.
*I wanted to make an overall note on motivation without complicating things in the text. There are different forms of motivation including Intrinsic (Exercise because it is fun and interesting), Identified (Because working out is important and beneficial for my health and lifestyle, Introjected (would feel bad about myself if I didn’t do it), and External (afraid of falling too far out of shape). Scales can be found at http://selfdeterminationtheory.org. Intrinsic and identified regulation are going to be stronger forms of motivation.
1. Rhodes RE, Courneya KS. (2005). Threshold assessment of attitude, subjective norm, and perceived behavioral control for predicting exercise intention and behavior. Psychology of Sport and Exercise. 6, 349-361.
2. Prestwich, A., Perugini, M., Hurling, R. (2010). Can implementation intentions and text messages promote brisk walking? A randomized trial. Health Psychology. 29(1): 40-49.
About the Author:
Justin Kompf was the former head strength and conditioning coach at SUNY Cortland. At Cortland he also instructed courses in kinesiology from 2012 to 2017. He is currently a PhD Student at the University of Massachusetts at Boston where he is studying health and exercise sciences. You can follow Justin on facebook HERE.