Insight problem solving, wellness and behavior change

The challenge: Individuals often resist health-promoting advice
Only 50% of Americans follow dietary recommendations to control weight and prevent chronic disease, although they are well aware of guidelines and their rationale. Among older adults, 1 in 5 chooses an activity level that will benefit their health.

Why do people often resist prescriptive actions and authoritative guidelines?
Although many factors come into play, behavioral research indicates that people do not follow prescriptions when they do not believe they can change, or when they are unconvinced of benefit trade-offs (Chen SL, et al. 2012). In addition they may believe they lack time and energy to make lifestyle changes due to persistent stress (Roos E, et al. 2007).

Self-efficacy: Key to effective health education and health promotion
Self-efficacy, individuals' belief in their ability to complete a goal, influences whether a person will undertake a new goal and whether she or he has the resilience to overcome inevitable obstacles. Self-efficacy determines how long a new behavior change will persist (Bandura, A. 2004).

Self-efficacy - What works?
In his social cognitive theory Bandura (1972) cited four factors: Among the most important is mastery: success increases self-efficacy, while lack of expected success reduces it. Modeling refers to vicariously experiencing the success of others. Social persuasion is a third factor: encouragement increases self-confidence, while negative persuasion reduces it. Physical factors affect self-efficacy. For example, a positive mood enhances self-confidence. With low self-efficacy, stress symptoms can be taken as a sign of weakness. In other words, an individual's belief about physiological responses can alter self-efficacy, beyond the stressor itself. 

Holistic perspective of health and wellness includes personal insight and creativity
Fotolia 22049682 XSWe propose that cognitive flexibility and insight can help resolve apparently intractable health-related problems. Creative problem solving pivots around seeing a health issue in new ways, illustrated by clients' comments:

1) A new awareness of a symptom -- "Yes, I never realized it before but I overeat when I feel lonely!"

2) A new awareness of a trigger -- "Yes, my headache does occur when my dog is shedding"

3) Realizing a workable solution.

For example, when fibromyalgia pain flared up after dealing with a difficult relative at a wedding, "I remember now how much better I felt when I de-stressed with aqua-aerobics." Such a new awareness can catalyze and help perpetuate new behavior changes.

Patient education with insight learning strategies that encourage creative problem solving, including insight, can promote self-efficacy to meet health challenges. When the goal is to improve self-management and self-empowerment, insight learning can nurture both endeavors.

Educational guidelines to promote self-management and self-efficacy
In a traditional medical setting, patient education focuses on disease - a lot on treatment and some on prevention. But very little goes into patient empowerment.

Health educators and healthcare providers can take positive steps to promote self-management and self-efficacy among their clientele (Koenigsberg MR, et al. 2004) using the following guidelines. 

  1. Recognize the stage of change the client/patient presents. The behavior change model involves the pre-contemplation stage through maintenance.
  2. Individualize a treatment plan by targeting the patient's preferences and accommodating her/his rate of progress.
  3. Encourage healthful choices and overcome barriers to change as they occur. Learn how these health promotion guidelines lay the foundation of a lifestyle coaching practice.
  4. Encourage and incorporate self-monitoring goals that build on small, achievable steps.
  5. Commit to regular follow-up to sustain the health promoting behavior change.


  • Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psych Rev 1972;84:191-215.
  • Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004;31:143-164
  • Chen SL, Tsia Jc, Chou KR. Illness perceptions and adherence to therapeutic regimens among patients with hypertension: a structural modeling approach. Int J Nurs Stud 2010; Jul 31 Epub).
  • Koenigsberg MR, Bartlett D, Cramer JS. Facilitating treatment adherence with lifestyle changes in diabetes. Am FamPhys 2004;69(2):309-316. 
  • Lee LL, Arthur A, Avis M. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity. Int J Nurt Stud. 2008;45:16090-1699 Epub May 22, 2008.
  • Roos E, et al. Associations of work-family conflicts with food habits and physical activity. Public Health Nutr.2007:10(3):222-229.