Behavior Change Models for Chronic Disease Management

Behavior change models aim to help individuals adjust behaviors to promote and improve health. Rural communities may use a combination of strategies for behavior change to overcome barriers to chronic disease management. For example, a rural program promoting smoking cessation for COPD management might combine a theory-based approach to leverage rural strengths, such as strong social ties between rural providers and patients, with technology like telehealth to overcome barriers to accessing care.

The Rural Health Promotion and Disease Prevention Toolkit describes theories and models for health promotion and disease prevention. The Rural Social Determinants of Health Toolkit discusses how environmental factors create challenges for individual behavior change.

Example Rural Chronic Disease Management Programs Using Behavior Change Models

• The Med-South Lifestyle Program (MSLP) is a behavior change model that encourages adoption of a Mediterranean diet alongside increased physical activity, smoking cessation, and medication adherence activities to manage chronic diseases per the American Diabetes Association's guidelines.
• The American Lung Association's Better Breathers Club connects people with various lung diseases to resources, peer-support networks, and education about managing lung disease. In-person activities are led by trained facilitators. The program is offered nationwide, including options for virtual meetings geared towards rural or mobility-impaired patients. Better Breathers Clubs can be hosted in rural areas by community organizations, such as done by Memorial Hospital in rural Illinois. Breathe California of the Bay Area, Golden Gate, and Central Coast is also implementing a Better Breathers Club for rural patients with COPD in the Bay Area.
• Health Coaches for Hypertension Control is an 8-week program providing hypertension management training led by community volunteers trained as health coaches to patients older than 60 years being implemented in several rural areas.
• Fit & Strong!® is an 8-week in-person and online behavior change program designed to increase mobility and prevent falls for older adults with osteoarthritis. The program is currently being implemented in a number of rural communities.  
• LIVESTRONG at the YMCA is 12-week program that supports cancer survivors as they transition between treatment and a “new normal.” In each 75-minute session, a wellness coach trained in post rehab exercise and supportive cancer care tailors the program to the participant's needs. The program provides a supportive environment and cultivates a sense of community among survivors to support recovery. LIVESTRONG at the YMCA is currently being implemented in rural Maryland.
• The Arthritis Foundation offers Walk With Ease, a six-week behavior change program aimed at improving physical mobility and self-management of arthritis through walking, health education, stretching and strengthening exercises, and motivational strategies. The program includes a guidebook and walking plan and is offered both in-person and virtually. A number of rural communities are implementing Walk with Ease programs, including University of New Hampshire Extension and Oregon State University Extension.

Implementation Considerations

One important resource designed to achieve lasting and impactful behavior change is the Personal Success Tool from the Center for Disease Control and Prevention's National Diabetes Prevention Program (DPP), which helps providers and patients identify and follow through on health goals that fit the patient's lifestyle. The tool includes multiple modules that programs can share with participants to help track progress on different goals, such as managing stress, eating well, and staying motivated.

A common challenge to patient behavior change is a disconnect in communication between the patient and the provider. When using behavior change for chronic disease management, it is important for the patient and provider to work side by side to tailor the approach to fit the patient's needs. This approach is often called health coaching, where coaches use techniques such as motivational interviewing and positive psychology. Programs using health coaching and other behavior change approaches may benefit from implementing staff training to build motivational interviewing skills.

Furthermore, programs may consider opportunities to host peer support groups to provide people living with chronic conditions the opportunity to learn from others within their community. Peer support groups can offer social support for program participants to increase the likelihood of sustained behavior change and can.

Program Clearinghouse Examples

• Delta Health Alliance
• Mainline Health Systems, Inc.

Resources to Learn More

Integrating Behaviour Change Counselling into Chronic Disease Management: A Square Peg in a Round Hole? A System-Level Exploration in Primary Health Care
Document
Evaluates the competencies of a behavior change counseling training program for healthcare providers in primary care who assist patients in their management of chronic disease. Addresses provider readiness for behavior change training, understanding the importance of this training, and perceived competence after training was completed.
Author(s): Vallis, M., Lee-Baggley, D., Sampalli, T., et al.
Citation: Public Health, 175, 43-53
Date: 10/2019

Peer Support for People with Chronic Conditions in Rural Areas: A Scoping Review
Document
Reviews the literature on community-based peer support systems for adults with chronic conditions who live in rural settings. Discusses the importance of telecommunications with face-to-face meetings, social supports and skill development, ongoing training of peer leaders, and program implementation and sustainability.
Authors: Lauckner, H.M., & Hutchinson, S.L.
Citation: Rural and Remote Health, 16 (1)
Date: 3/2016

Perceived Benefits of Peer Support Groups for Stroke Survivors and Caregivers in Rural North Carolina
Document
Discusses the experiences of stroke survivors and caregivers who participated in four peer support groups in rural North Carolina to determine their impact in stroke recovery. Results revealed peer support groups are an important resource for rural stroke survivors and caregivers to share experiences, foster a sense of community, and empathize with others to help with recovery.
Author(s): Christensen, E.R., Golden, S.L., & Gesell, S.B.
Citation: North Carolina Medical Journal, 80(3), 143-148
Date: 2019