By Dominika Kwasnicka, SWPS University, Poland and University of Melbourne, Australia

The ultimate goal of health promotion programmes is to promote long-lasting change and health care professionals can play a role and help patients to improve their health outcomes and maintaining behaviour change. We know that health behaviour change is difficult to initiate and it can be even more challenging to maintain in the long term. One big question in health psychology is why maintenance is so difficult. 

To answer this question our group looked into theories that explain how people change and subsequently maintain positive health changes such as quitting smoking and becoming more active. We identified 100 theories that explain how people change their behaviour and maintain those changes. The good news for people who promote health is that 100 theories can be summarised to five key themes that need to be addressed in order to achieve this long-lasting change.

1. Maintained motivation is important when we start a new health behaviour, such as joining the gym, starting jogging, eating healthily or avoiding fast food or excessive alcohol consumption. Not surprisingly, our motivation is also crucial for establishing long-lasting behaviour change. Motivation fluctuates over time and in order to maintain new health behaviours, we need to come up with effective strategies to maintain new health behaviour even when motivation drops. It can be done for instance with planning what you can do when you face potential barriers. For example, by setting a plan that “when there is pouring rain outside, I will then exercise at home instead of going to the gym or for a jog”.

2.  Self-regulation involves keeping an eye on what you do. Monitoring your behaviour is important for identifying whether your current behaviour needs to change and so that you can actively change it, if change is needed. For example, in order to know if your level of physical activity is an issue, you need to be aware of how active you are every day. You can use a mobile phone app to see how many steps you do each day or you can note down how many minutes you are active every day, noting the intensity of the activity. The World Health Organisation guidelines say that we need approximately 30 minutes of moderate intensity physical activity each day, and if you realise that you are far off these guidelines, then you need to plan how to change it, in order to maintain regular activity, i.e. by specifying when, where and how you will make those changes.

3.  Resources including psychological and physical, are important for health behaviour change maintenance. For example, it is difficult to stay healthy (exercise, eat well) when you feel sluggish, when you are stressed, low on energy or if you hardly slept the night before. Plentiful psychological resources are needed to maintain health behaviours, that means feeling full of energy, rested, and not stressed. Physical resources are important too; we need to build an infrastructure around us to live healthily. For example, we cannot eat well if we do not have easy access to healthy foods and we cannot take medicines, if we simply cannot access them. Psychological and physical resources ensure that we can maintain healthy lifestyles.

4.  Habits – everyone is talking about habits and ordinary people understand them slightly differently than psychologists. For a health psychologist, habit associations develop when in response to a specific situation, someone consistently does something that achieves desirable outcomes. Bad habits such as smoking or eating late at night are difficult to change, as they can become our default options that come naturally and without thinking. In order to maintain health behaviour change, we need to break bad habits and shape good ones and psychology gives us some great actionable solutions on how to do that. New positive habits usually take time to form and old ones take time to fade out. A popular behaviour change technique to develop habit is to monitor the cues (what causes the particular behaviour) and to respond with the same behaviour to the same cues in the same context. 

5.  Finally, our environment, place where we are and people who surround us, needs to be supportive for us to maintain positive health behaviours. When we change our behaviour, we often need to change our environment or restructure it. People around us are an important part of our environment. Family, friends and people who we spend time with have an impact on how healthy we are. They can help us improve by providing encouragement or being our role models, yet they can also have a negative impact by nagging us to smoke cigarettes and drink alcoholic drinks with them. We do not recommend that you stop spending time with your friends who are inactive, drink alcohol, smoke and eat unhealthy food. We do encourage you to share your health plans and make an active decision to not be pressured by others. For example, saying no to that third cake serving.

How do you inspire your patients not only to change what they do but also to maintain new health behaviours long term? 

Practical recommendations:

1. Stay motivated – easier said than done. Ask your patient why they want to change and maintain new health behaviour, mention previous success or other people who struggled but succeeded.
2. Monitor – encourage your patients to self-regulate and keep an eye on what they do, e.g., monitoring and regulating sleep, activity, diet, substance use.
3. Everyone needs resources – ensure that your patients have what they need to succeed in terms of psychological and physical resources, e.g., by getting enough sleep and stocking up on healthy food supplies. 
4. Work on habits – having good habits is the single best predictor of long-lasting health behaviour change. In order to develop good habits, your patient can form an ‘if-then’ plan linking cues with actions, e.g., when I see my walking shoes by the door, I will go for a walk.
5. Environment needs to be supportive – your patient needs to be embedded in a supportive environment with access to resources and people who provide support. It is good to check with the patient if the place where he/she lives and works is supportive for their behaviour change, if it is not, how could it improve? Also your patient could reach out to family and friends for support in long-lasting behaviour change.