# Diet and Oral Health Coaching Methods and Models for the Independent Elderly
## 5 Methodology for Behavior Change during Coaching  
Although no single theory or conceptual model dominates health behavior research or practice of coaching [109], it is well recognized that interventions to modify health behaviors are enhanced through reliance on health behavior theory [72; 110; 111; 87; 112], including foundational behavior change theories such as social cognitive theory [113], the health belief model [113; 114], the theory of reasoned action and the theory of planned behavior [115], the integrated behavioral model [116], the precaution adoption process model [117], health locus of control theory [118], and the transtheoretical model of behavior change [119]. Due to overlap among these and other foundational theories, and because only a limited number of variables are relevant to consider when promoting health behavior change [120], [PERSON] proposed the integrative model [55] to unite a volume of theory from years of interdisciplinary work into a coherent model to support health behavior change practices [120]. Further to be discussed here, social cognitive theory is a unified conceptual framework, which taps into patients' beliefs in their capability to engage in a new behavior and their expectations of how engaging in that new behavior will influence their health (i.e., the outcome of interest) [121]. Beliefs about capabilities, beliefs about consequences, and social influence are important determinants of adopting and maintaining dietary behavior change. These beliefs and attitudes are then targeted by behavior modification techniques (i.e., the intervention), which then leads to changes in behavior and subsequent changes in health outcomes [76]. The Transtheoretical Model stages of change construct complements by describing the five stages individuals move through as they make behavioral changes [122; 123; 124; 125]. It has been effectively used to target and adapt behavioral interventions and to measure the magnitude of effective interventions. This theory has been used extensively across cancer survivor populations, within different cultural settings and applied to variety of behaviors (e.g., diet, physical activity, and weight management) [71; 74]. Approaches to behavior change broadly consist of individual- and group-level interventions, and a combination of approaches has been shown to be more effective than one approach or the other [74; 75]. Changing dietary behaviors in cancer patient populations adopts variations in behavior change models, with success being driven by a unique combination of behavior change techniques. Five general techniques frequently emerge as effective within published interventions: Goal setting, action planning, social support, instruction on how to perform behavior, and motivation. Self-monitoring of behavior and feedback on behavior are common in interventions, but these techniques were less effective [75]. Behavior change models attempt to explain why patients may change their behavior, with an emphasis on how these internal and external factors mediate the relationship of change to improve health outcomes (e.g., diet). However, most successful interventions for cancer patients include not only dietary change but also physical activity and behavior modification support in the form of materials to assist in change [126]. Lifestyle behavior modification interventions have previously focused on cancer survivors, but more recently a change has taken place to shift focus to supporting patients with dietary change during treatment. Therefore, targeting theory-based factors is improving dietary and physical activity lifestyle interventions in cancer patients, although additional development is necessary to inform better intervention programs for longer-term maintenance of weight change. Evidence exists on the benefits of such interventions to achieve and maintain healthy weights and to adhere to nutrition and physical activity recommendations for improving cancer prognosis and survival.