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Adopting healthy habits: What do we know about the science of behavior change?
Longevity Behavioral & Social Research
For many people, living a long, healthy life can be attributed to adopting and maintaining healthy behaviors. NIA-funded researchers are looking at mechanisms that can help make behavioral interventions more successful for everyone.
On this page:
Understanding behavioral interventions
Studying mechanisms of behavior change, self-regulation: modifying or controlling your own behavior, stress reactivity and the role of coping in behavior change, social support: improving health behavior through social connections, tips to help sustain behavior change, what’s next in research.
Adopting and maintaining healthy behaviors increases the chances of living a long, healthy life, and engaging in unhealthy behaviors can have the opposite effect. Seven out of 10 deaths in the United States are the result of chronic diseases, which for many people can be prevented by eating well, staying physically active, avoiding tobacco use and excessive drinking, and getting regular health screenings. But simply knowing these facts isn’t enough to motivate most people to adopt long-lasting behavior change. Why is that?
If you’ve ever tried to start a new exercise routine or eat healthier, you may have found it was more challenging to keep up with than you anticipated. According to Donald Edmondson, Ph.D. , principal investigator of the Resource and Coordinating Center for the NIH Science of Behavior Change (SOBC) program, “Keeping behavior changes long enough to experience the benefits is incredibly hard.”
Behavior change requires letting go of old habits and adopting new ones, which is not always easy. However, what makes behavior change challenging for one person likely won’t be the same for someone else. Whether or not a person can maintain behavior change over time relies on different factors, too. For example, a person’s environment, workplace, and home life can make behavior change more or less likely to be successful.
Over the years, scientists have identified tactics for adopting healthier behaviors, such as wearing a watch to track your steps or keeping healthier foods in the home. However, these interventions don’t seem to work for everyone. Even when an approach is effective, the underlying mechanisms — why and how it works — often aren’t clear. Understanding these mechanisms could be the key to achieving effective and long-term behavior change for many people.
A behavioral intervention is an intentional change in the way you do something, such as eating healthier foods or exercising regularly, that is designed to make you healthier. In general, behavioral interventions use different ways of thinking, feeling, acting, or relating with others to stimulate a change in a person’s behavior to promote their health and well-being. For example, a behavioral intervention could be aimed at modifying something about a person’s living environment or diet, with the goal of improving their health.
It seems straightforward to assume that if someone wears a pedometer and adds 30 minutes of exercise to their day, they’re likely to notice changes in their body and overall health. The problem, however, is that even if this intervention is effective, we don’t fully understand how or why it worked for this individual. Did they set goals for daily step counts and enjoy the challenge of improving over time? Did the pedometer show them how sedentary they are normally, causing them to feel embarrassed?
If we don’t understand how an intervention worked, then we will not know if it will work for another person. And if several possible interventions are options, we will not know which one will work best for a specific individual. Learning more about the many underlying influences on behavior change can help researchers and health care professionals develop and provide more effective interventions.
Researchers involved in the SOBC Research Network — including scientists from NIA — are dedicated to discovering what underlies successful behavior change. The ultimate goal is to develop effective interventions that work consistently. Janine Simmons, Ph.D. , chief of the Individual Behavioral Processes Branch in the NIA Division of Behavioral and Social Research, works closely with the SOBC program.
“Through the SOBC initiative, we are moving behavioral intervention research forward via an experimental medicine approach designed to identify the key mechanisms underlying changes in behavior,” Simmons said. “Investigators can use this approach to design experiments that answer questions about how and why a given intervention might, or might not, elicit positive health behavior change.”
How does the experimental medicine method work? Researchers first identify an underlying mechanism that may drive a certain behavior. They then develop tools to measure that mechanism and test potential interventions to change it. In the example of the pedometer, the mechanism driving behavior change might be “awareness of steps.” The researchers would first measure awareness, and then test an intervention like wearing a pedometer daily.
If the person’s behavior changes (in this case, they increase their physical activity), the researchers would need to determine whether the change resulted from the mechanism (increased awareness of steps). Then, they can be confident that the mechanism is an effective target for behavior change interventions.
Additionally, knowing which interventions worked in one area could allow for them to be adapted and applied to many other areas.
“The SOBC program is about connecting basic scientists and scientists from different subfields of behavioral psychological work. It’s important to be able to leverage years of work in a basic behavioral lab to help intervention scientists to rapidly build successful behavioral change interventions — or report failures back to the basic lab for further research,” said Edmondson.
To date, SOBC researchers have identified three broad domains that show promise as potentially powerful mechanisms of behavior change: self-regulation, stress reactivity and coping, and social support.
Self-regulation has been studied widely for years. It refers to the extent to which people are able to monitor and control their own behaviors, thoughts, and feelings to achieve their goals.
One example of a self-regulation mechanism is called “delay discounting.” Every day, individuals must make trade-offs between short-term and long-term benefits. For example, do I want to relax and watch TV or go for a run to help improve my future cardiovascular health? Delay discounting, also known as “temporal discounting,” is a way to quantify how much an individual weighs smaller, short-term rewards (relaxing watching TV) versus larger, long-term rewards (cardiovascular fitness is a major factor in how long we live and the quality of our lives). A person with a high “discounting rate” places lower value on rewards that occur in the future, and a correspondingly higher value on rewards they will experience right away, because they “discount” the future rewards more steeply. Discounting the future can make a lot of sense when quick action is needed; however, there may be a downside when it comes to choosing and maintaining healthy behaviors over time.
Researchers are exploring the concept of delay discounting as a mechanism for improving health behavior. Research shows that the extent to which individuals discount the value of delayed rewards may be associated with important health- and disease-related outcomes — essentially, the more highly people value immediate, less healthy rewards, the more unhealthy or problematic decisions they make. If scientists could design interventions to help people recognize and better appreciate the value of long-term rewards, they could help us make better, healthier decisions in the moment.
A recent review considered 98 studies that tested different behavioral interventions to help reduce delay discounting. The review found that several interventions led to improved decision-making. Among the most promising avenues to reduce delay discounting are acceptance- and mindfulness-based trainings. These approaches focus on experiencing and accepting the present moment, even when it’s uncomfortable. However, the authors of the review noted that the success of many behavioral interventions appears to be short-lived. And their effectiveness is often dependent on the context in which they’re delivered — in other words, they won’t work for everyone or in every situation.
A related intervention that may improve delay discounting is simply asking people to vividly imagine or simulate experiences that might happen in their future, like playing with their grandchildren or the day of their retirement. This approach is known as episodic future thinking.
“What we’ve found is that this type of thinking shifts how much [a person] values future things relative to the present state, so it’s sort of like opening the cognitive window to the future, where long-term benefits will be extremely valuable,” said Edmondson.
How might episodic future thinking affect a person’s ability to maintain behavior change? If an intervention strengthens specific cognitive and neural mechanisms in the brain that support a more balanced valuing of the future and the present, then it may improve decision-making and self-regulation skills. An example of an intervention using episodic future thinking would be sending a person a text twice a day asking them to think about their ideal future for a few minutes. This intervention might lead them to make better short-term decisions in support of making that ideal future a reality.
There’s no question that everyone experiences stress, but how people cope with stressors can have a major impact on their health. An individual’s mental, emotional, and physical health can be affected both by external stressors, such as job loss or the death of a loved one, and by the subjective experience of stress — the internal feeling that one does not have the capacity to cope with life’s stressors. Uncontrolled stress can also lead to negative health outcomes, including high blood pressure and cardiovascular disease.
Individuals vary in their levels of stress reactivity; that is, their mental, emotional, and physical reactions to stress. These differences may help to explain why stress affects some people’s health behaviors more than others, even when they encounter the same stressor, such as the death of a loved one. What if we could minimize stress reactivity and increase the ability to cope and adapt under stressful situations? Would that make a difference in health outcomes?
One mechanism being studied in this area is anxiety sensitivity. Anxiety sensitivity refers to fears of anxiety-related sensations (such as stomach pain or racing thoughts) based on catastrophic beliefs about what those sensations mean. For example, anxiety sensitivity might lead someone with a feeling of chest tightening to worry that they’re having a heart attack. As a result, the person may avoid certain activities, such as physical exercise, that might produce that feeling. Or they may overeat or use alcohol to cope with the anxiety. In these ways, anxiety sensitivity can negatively affect a person’s health and well-being.
In fact, anxiety sensitivity is linked to some of the top preventable causes of disease and death in the U.S., including tobacco use, poor diet, physical inactivity, and alcohol overuse. It has also been linked to poor medication adherence, which happens when people don’t take their medicines in the right way or at the right time. Understanding the scope of these effects has clear public health significance.
A recent meta-analysis found that anxiety sensitivity and associated health outcomes, such as depression, insomnia, alcohol use, and pain, can be improved with brief behavioral interventions, for example, cognitive behavioral therapy, that target anxiety sensitivity. Another study looked at anxiety sensitivity as a possible mechanism linking exercise and smoking cessation. Specifically, the researchers wanted to find out whether physical exercise could help people with high anxiety sensitivity quit smoking successfully. The study found that participants who did high-intensity exercise were more likely to quit smoking than those who did not exercise, and that their success was related to having lower anxiety sensitivity
“We’re seeing some of these interventions improve people’s fear of their bodily reactions to anxiety,” said Edmondson. He added that scientists at the Columbia Roybal Center for Fearless Behavior Change are testing interventions “to determine whether reducing anxiety sensitivity leads to healthy behavior change — better medication adherence and better physical activity, which is really exciting.”
It has been recognized for decades that social networks influence behavior, and researchers are still learning how relationships shape an individual’s health behaviors. We know that many of our norms, expectations, and preferences come to us from our community and the people we spend time with. However, knowing where and how to intervene in a social network to optimize behavior change is still a challenge for scientists. At the most basic level, one way to extend the reach of a given behavioral intervention may be to adapt the intervention to take advantage of interpersonal relationships and the influence of others in a social network.
One study looked at the effects of social support and examined whether a weight loss program delivered to one spouse had beneficial effects on the spouse who didn’t participate. The study found that the untreated spouses — despite not participating in the weight loss program directly — lost a significant amount of weight. Although future research using the experimental medicine approach is required to identify the precise mechanism, the researchers suggested that spouses who directly received the intervention may have modeled health-promoting behaviors, such as weighing themselves regularly, for their spouses, and that they were less likely to have high-fat foods in the home during the program versus before. The findings of this research suggest that behavioral interventions for weight loss can create a “ripple effect” that benefits others, and that behavioral modeling and reduced access to high-fat foods are two potential mechanisms of behavior change to test in studies of these effects.
Another study analyzed data from more than 4,000 Americans aged 60 and older to help understand the connection between social relationships and health-related behaviors. Researchers found that social factors were associated with the likelihood of several different health-related behaviors, including alcohol use, smoking, physical activity, and visiting the dentist. The study showed that older adults with strong social ties, such as being married, living with a partner, or having a group of close friends, were more likely to engage in health-promoting behaviors than people with fewer social ties. These social relationships may benefit health in older adults by helping them cope with stress, providing emotional support, and encouraging them to adopt healthier behaviors.
What does this mean? If you’re looking to eat healthier or become more physically active, it may be worth asking your spouse or friend to do it with you.
“Researchers are beginning to examine how interactions within a social network have direct beneficial effects on health behaviors, and when we can leverage social networks to promote positive health behavior change,” said Simmons. “For example, after one partner stops smoking or starts exercising, the other is more likely to follow suit. The same pattern holds true for friends, siblings, and even co-workers."
Whether you want to become more physically active, lose weight, or start another new healthy activity, these tips — based on behavior change research — may be able to help you create and maintain successful new habits:
Practice envisioning the future. As you make decisions in everyday life, be aware of how your behavior may be driven by wanting what feels good now versus what your future self will wish you had valued.
Manage stress. Stress can affect your ability to adopt healthy behaviors, such as physical activity or healthy eating. If you feel stressed or overwhelmed, you may be less likely to exercise, which in turn can increase your stress levels the next day — creating an unhelpful cycle. Healthy activity and diet can reduce stress, both in the short and long term, so paying attention to how good you feel right after exercise may also help reduce your delay discounting.
Beware of avoidance. If you have a chronic condition, you may become hyper-aware of your body and start worrying that every sensation in your chest or change in your breathing rate signals catastrophe. Those anxieties about bodily sensations can become problematic not because they signal a cardiovascular event, but because they may become an excuse to avoid exercise or to eat comfort food. If you are medically cleared to exercise, it’s important to recognize that the bodily sensations associated with being active may be amplified by fear, but most do not indicate any real health problem.
There is still a lot to learn about behavior change interventions and how they work. Scientists continue to explore these areas to help people better adopt and maintain healthy behaviors. Currently, NIH-funded researchers are investigating how an experimental medicine approach to behavior change could have an impact in two specific areas: reproductive health and willingness to receive a COVID-19 vaccine . Their innovative approach offers new opportunities to improve the health of individuals and communities.
It's important for everyone to understand the importance and benefits of adopting and maintaining healthy behaviors — including the researchers studying them, your health care providers, your family, and yourself.
Behavior change is fundamental to human health at any age. It is critically important for NIA to support research in this area because NIA’s mission encompasses the full adult lifespan, and many of the health choices we make earlier in life directly affect the likelihood of avoiding illnesses and maintaining wellness as we age.
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Home — Essay Samples — Life — Healthy Lifestyle — My Health Beliefs and Behavior
My Health Beliefs and Behavior
- Categories: Healthy Lifestyle Self Assessment
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Published: Mar 3, 2020
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Introduction, works cited:.
- Craveri, M. (2002). The culture of the Europeans. University of Chicago Press.
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- Gennari, D. J. (2019). The joy of writing about Italian-American food. In Pizza, Pasta, and Cannoli: Italian-American Food (pp. 3-22). Bloomsbury Publishing USA.
- Giuffrè, L. (2017). School education in Italy: An overview. Italian Journal of Sociology of Education, 9(2), 41-55.
- Ilardo, J. (2013). Culture and customs of Italy. ABC-CLIO.
- Leaman, O. (Ed.). (2010). The future of philosophy. Wiley-Blackwell.
- Lillich, M. (2019). How to eat like an Italian. National Geographic.
- Nava, M. (2017). L’Italia del made in Italy. Società e politica, (2), 117-124.
- Scuderi, A. (2018). Family ties and migration decisions: Italy in comparison with Europe. European Journal of Population, 34(4), 491-511.
- UNESCO. (2019). Festivals in Italy. Retrieved from https://ich.unesco.org/en/lists.
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Understanding and Predicting Health Behaviour Change: A Contemporary View Through the Lenses of Meta-Reviews
Karina w. davidson.
Feinstein Institutes for Medical Research, Northwell Health
University of Zurich
Research on health behaviour change examines how to help people engage in healthy behaviours to prevent the development or worsening of chronic disease and early mortality and to improve mental health and well-being. While some of that research has been successful, it is often unclear why or how certain behaviour change interventions have worked ( Michie & Abraham, 2004 ; Nielsen et al., 2018 ; Sumner et al., 2018 ). Understanding why successful behaviour change occurs is the key to creating healthy behaviour, reducing the burden of chronic disease worldwide, and promoting health. Without understanding why a behaviour change intervention succeeds, researchers will remain with an evidence base that is fragmented and uninformed. As a result, a great deal of research wastes opportunities to build forward momentum and thereby limits opportunities to harness and synthesise findings to systematically improve behaviour change interventions. Conversely, with an understanding of the causal mechanisms, researchers can build more efficient behaviour change interventions and so create an evidence base that reveals what works for which populations in what contexts and for which behaviours. Researchers have completed thousands of health behaviour change interventions on topics ranging from improving medication adherence behaviour, to decreasing risky sexual activity, to promoting physical activity. In turn, numerous meta-analyses have attempted to examine the effectiveness and to understand the results of such interventions. These meta-analyses have tended to focus on specific behaviours, types of behaviour change interventions, ways of delivering the behaviour change intervention, health outcomes, or populations. At this point, there are often so many meta-analyses focused on a given phenomenon that it is challenging for any individual to summarise the conclusions of these analyses accurately. We present here a special issue devoted to advancing the science of behaviour change in two main ways. First, this special issue presents information across several articles to aid researchers in locating information on both effectiveness and possible explanations for the (in-)effectiveness of behaviour change interventions combined across existing meta-analyses. Second, this special issue provides information on the most important implications for future research on advancing the science of health behaviour change interventions. The first goal will be achieved by a series of meta-reviews of meta-analyses on behaviour change interventions, and the second by three narrative reviews and a series of commentaries.
So, what is a meta-review ? It is essentially a systematic review of systematic reviews ( Blackwood, 2016 ). The intent is to synthesise meta-analyses and thus examine at the highest level only the summary of current evidence. These types of reviews provide evidence to make better decisions about what exists in the research landscape, and what is missing after a comprehensive and thorough search. Similar to published guidelines on quality and reporting standard put forward for meta-analyses, best practice guidelines for meta-reviews have also been proposed, which include pre-registration and standardised quality ratings for their constituent meta-analyses ( Shea et al., 2017 ). By presenting a series of meta-reviews on differing aspects of health behaviour change, this special issue provides a clear overall picture of the current state of the research on health behaviour change research and its quality. It also delivers a clear message about what should be done now to advance the science of behaviour change to improve health.
The meta-reviews presented here were undertaken by personnel supported by The Science of Behavior Change (SOBC) Research Network. To move the health behaviour change field forward, the SOBC Research Network (funded by the U.S. National Institutes of Health) seeks to improve the understanding of underlying mechanisms of human behaviour change by promoting and a basic mechanism of action research by use of an experimental medicine method ( Nielsen et al., 2018 ; Suls et al., 2020 ; Aklin et al., 2020 ). SOBC aims to bring together basic and applied scientists to support this mechanistic research across health-related behaviours to ultimately develop more effective behavioural interventions. Work during SOBC Stage 1 (2009–2014) identified three broad classes of intervention targets that are highly relevant to the mechanisms relating to behaviour change: self-regulation, stress reactivity/stress resilience, and interpersonal and social processes. Stage 1 work also determined the need for reliable and valid ways to measure whether these hypothesised mechanisms of actions were engaged or influenced through experimental manipulation or interventions, which became the focus of SOBC Stage 2 (2015-present). In this work, when a change in the mechanism results in an observed change in behaviour, the inference is that the identified mechanism is indeed a valid mechanism of action. SOBC’s goal is to use the results of this method to optimise behaviour change interventions across disciplines.
Thus, the central goal of SOBC is to identify key mechanisms underlying successful behaviour change interventions aimed to change health behaviour, such as by improving positive health behaviours (e.g., diet and exercise) or by reducing unhealthy behaviours (e.g., smoking). SOBC also seeks to answer the critical question: What works, for whom, and under what circumstances? The SOBC network reviewed, provided feedback, and endorsed a plan for SOBC-supported personnel to undertake a systematic review of the current literature using extant meta-analyses, with the goal of a meta-review being created to understand what meta-analyses have been published thus far examining self-regulation as a means to influence health behaviour. By compiling meta-analyses across a wide range of interventions, behaviour change targets, and distal health outcomes, the results of the parent comprehensive meta-review ( Hennessy, Johnson, Acabchuk, McCloskey, & Stewart-James, 2020 ), and the accompanying targeted meta-reviews ( Protogerou, McHugh, & Johnson, 2020 ; Suls et al., 2020 ; Wilson et al., 2020 ) presented in this special issue promise to inform future studies by identifying gaps in current knowledge and advancing our knowledge where science has already established findings on the mechanisms of self-regulation.
Three salient facts make the current evidence base ripe for meta-reviewing the effectiveness and the explanatory mechanisms of behaviour change interventions: First, new strategies for characterising the content of interventions have led to a more standardised approach to descriptions in a taxonomic form, which has done much to resolve the fragmented and inconsistent way in which interventions have been previously described (e.g., Abraham & Michie, 2008 ; Knittle et al., 2020 ; Kok et al., 2016 ; Michie et al., 2013 ), with ongoing advances in nomenclature, definition, and structure promising even more precision. Thus, synthesising the evidence in meta-reviews by using existing taxonomies for identifying mechanisms most prominently and most effectively applied in behaviour change interventions is now possible. This approach also allows a more comprehensive and precise means for identifying shortcomings, gaps, and open questions in this field. The latter then allows for stimulating further improvements in planning, implementing, and describing intervention content. A long-term benefit of such an approach may be increasingly precise replication efforts together with substantial improvements in the effectiveness of the interventions tested across health behaviour change intervention research ( Byrne, 2020 ).
Second, theories to understand health behaviour itself have also grown more complex, relative to the health behaviour theories proposed in the 1970s and 1980s. Contemporary models for example consider not only reflective, but also automatic processes involved in behaviour change ( Deutsch & Strack, in press ), or place behaviour change within several contexts, such as the romantic relationship ( Lewis et al., 2006 ; Pietromonaco & Collins, 2017 ; Scholz, Berli, Lüscher, & Knoll, in press ) or broader social networks ( Berkman, Glass, Brissette, & Seeman, 2000 ) with individuals connected to others through reciprocal exchanges that vary depending both on the needs (or goals) of the individual and the needs (and goals) of the network partners. Furthermore, recent models also take into account that all this occurs within an overarching environment that facilitates or hinders behaviour change (e.g., via the presence of health-promoting policies and settings, such as bans on smoking in restaurants or streets with designated walking or bike paths; (e.g., Ruiter, Crutzen, de Leeuw, & Kok, in press ; Schuz, 2017 ). As a consequence, contemporary theories do not only more precisely specify potential mechanisms for explaining health behaviour change, but also address the crucial question about what factors are likely to moderate the intervention’s effectiveness. Using these models as theoretical frameworks for synthesising evidence in a meta-review allows a more purposive approach to this task.
Third, standards for conducting meta-analyses and meta-reviews have become increasingly rigorous, transparent, and, with this, more useful (e.g., Shea et al., 2017 ). The level of sophistication now available while exploring multiple meta-analyses creates the ability to address study-level nuances and a growing understanding of the assumptions involved in pooling the results of independent studies on a subject across summaries. Thus, the synthesis of available research results of behaviour change interventions pooled in meta-analyses can be evaluated while considering the quality of the meta-analyses. This allows a more sophisticated view on the existing research. It is also important for considering how to improve future meta-analyses and how to understand the validity of the results.
To concentrate on the most comprehensive and methodologically sophisticated meta-analyses, the parent meta-review focuses on relatively recent published meta-analyses of interventions seeking to change participants’ health behaviours, with the intent of engaging self-regulation. Results of this meta-review indicate that self-regulation is usually addressed in the form of intervention components that administer specific behaviour change techniques. Effectiveness is inconclusive and seems to be dependent on the target population and the behaviour. The following articles of this special issue address critical questions that could best be answered by targeted meta-reviews. Wilson and others examine self-regulation-related changes focused on improving medication adherence ( Wilson et al., 2020 ), while Suls et al. (2020) address the role of self-regulation for improving cardiovascular disease prevention behaviours. Taking a slightly different approach, Protogerou and colleagues examine health-behaviour related self-regulation interventions to reduce risky health behaviour ( Protogerou et al., 2020 ).
Aside from this series of meta-reviews, this special issue also includes narrative reviews complementing the topics covered by the meta-reviews. Alcántara et al. (2020) examine health behaviour self-regulation-related interventions through the lens of the social disparities of health, and so they test the way these factors potentially moderate the effectiveness of behaviour change interventions. Next, Miller et al. (2020) investigate how a developmental perspective is, or is not, considered in the science of behaviour change for self-regulation interventions and provide a strong case for the importance of doing so. As meta-review methodology has advanced so rapidly recently, this special issue also includes one article on how artificial intelligence can be combined with manual systematic searching to support reviewing the existing evidence more efficiently and to enhance the breadth and precision of the meta-analyses found to be eligible when reviewing literature ( Marshall, Johnson, Wang, Rajasekaran, & Wallace, 2020 ).
We conclude this special issue with a series of commentaries on the state of the behaviour change science, and the perspective of funders ( Aklin et al., 2020 ) that further complement the comprehensive overview provided by this special issue as a whole. The commentaries go beyond the implications for future research outlined in the meta-reviews and narrative reviews ( O’Carroll, 2020 ) by e.g. addressing highly topical themes, such as the strong need for improving methods and quality in the area of health behaviour change research ( Byrne, 2020 ), the role of interpersonal differences and environmental factors ( O’Connor, 2020 ), and the interplay between intrapersonal and interpersonal processes ( Rothman, Simpson, Huelsnitz, Jones, & Scholz, 2020 ) as well as the call for taking implementation science into account ( Luszczynska, 2020 ). Finally, the special issue concludes with the perspective of a longstanding editor in chief of Health Psychology Review as the landmark journal for systematic reviews and meta-analyses of the science of behaviour change ( Hagger, 2020 ).
We are convinced that this selection of outstanding articles serves the dual functions of (a) providing a comprehensive overview of the state of the science of behaviour change in terms of knowledge of the role of self-regulatory processes for successful behaviour change interventions and (b) serving as a catalyst for promoting further highest-quality behaviour change interventions addressing the most pressing questions in the science of behaviour change.
Role of Funding Sources and Disclosures: This study was supported by the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Institute on Aging (U24AG052175). Karina W. Davidson is a member of the United States Preventive Services Task Force (USPSTF). This article does not represent the views and policies of the USPSTF.
Karina W. Davidson, Feinstein Institutes for Medical Research, Northwell Health.
Urte Scholz, University of Zurich.
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Definition and background, examples in human biology and public health, example in clinical medicine, acknowledgements.
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Culture, behavior and health
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Margarita Hernandez, James K. Gibb, Culture, behavior and health, Evolution, Medicine, and Public Health , Volume 2020, Issue 1, 2020, Pages 12–13, https://doi.org/10.1093/emph/eoz036
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Cultural behaviors have important implications for human health. Culture, a socially transmitted system of shared knowledge, beliefs and/or practices that varies across groups, and individuals within those groups, has been a critical mode of adaptation throughout the history of our species [ 1 ]. Socioeconomic status, gender, religion and moral values all play into how individuals experience, conceptualize and react to their world, and therefore general understandings of cultural groups are insufficient for grasping a patient’s unique experience with health and illnesses [ 2 , 3 ]. Additionally, structural inequalities and political economy play a critical, and often overlooked, role in health and disease [ 4 ]. Understanding how behaviors are rooted in an individual’s unique cultural experience and as a response to social pressures can better equip medical professionals with the context, skills and empathy necessary for holistic care [ 2 ].
Healthcare providers can improve individual outcomes by thoroughly factoring in life experiences as part of understanding an individual’s health and treating their illnesses. The use of a ‘mini-ethnography’ can help healthcare providers understand how identity, interpretation of illness and the moral values of patients factor into building a trusting relationship that considers the patient’s life experiences into treatment plans [ 3 ]. Table 1 summarizes this approach.
Kleinman and Benson’s approach to conducting a ‘mini-ethnography’ with every patient in order to best incorporate a patient’s culture into treatment plans [ 3 ]
In rural Bolivia, children of mothers with higher indices of local ecological knowledge (LEK) had reduced inflammation, taller height, and less hookworm infections than children of mothers with lower indices of LEK [ 5 , 6 ].
The Acholi people of Uganda have several cultural models for understanding and responding to disease outbreaks that were employed during the 2000 Ebola outbreak [ 7 ]. Acholi cultural practices related to gemo , or an epidemic outbreak, limit the spread of infectious diseases that may have occurred through traditional funerary practices, such as the washing and touching of deceased bodies [ 7 ].
Both examples highlight a need for understanding Indigenous knowledge systems as they relate to health and in responding to disease.
Understanding how social pressures, such as racism and discrimination, manifest biologically is critical in understanding how cultural behavior relates to health. In a sample of diverse pregnant women in New Zealand, those that experienced ethnic discrimination had high cortisol levels and their infants higher cortisol reactivity, suggesting a transgenerational effect of discrimination [ 8 ].
Margarita Hernandez is supported by National Science Foundation Grant No. DGE1255832.
Conflict of interest: None declared.
Hruschka DJ , Hadley C. A glossary of culture in epidemiology . J Epidemiol Commun Health 2008 ; 62 : 947 – 51 .
Napier AD , Ancarno C , Butler B et al. Culture and health . Lancet 2014 ; 384 : 1607 – 39 .
Kleinman A , Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it . PLoS Med 2006 ; 3 : e294 - 1676 .
Stonington SD , Holmes SM , Hansen H et al. Case studies in social medicine - attending to structural forces in clinical practice . N Engl J Med 2018 ; 379 : 1958 – 61 .
McDade TW , Reyes-Garcia V , Blackinton P et al. Ethnobotanical knowledge is associated with indices of child health in the Bolivian Amazon . Proc Natl Acad Sci USA 2007 ; 104 : 6134 – 9 .
Tanner S , Chuquimia-Choque ME , Huanca T et al. The effects of local medicinal knowledge and hygiene on helminth infections in an Amazonian society . Soc Sci Med 2011 ; 72 : 701 – 9 .
Hewlett BS , Hewlett BL. Ebola, Culture and Politics: The Anthropology of an Emerging Disease. Boston, MA : Cengage Learning , 2008 .
Thayer ZM , Kuzawa CW. Ethnic discrimination predicts poor self-rated health and cortisol in pregnancy: insights from New Zealand . Soc Sci Med 2015 ; 128 : 36 – 42
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Studying Health Psychology and Illness
Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
- Current Issues
- Biosocial Model
- In Practice
Health psychology is a specialty area that focuses on how biology, psychology, behavior, and social factors influence health and illness. Other terms such as medical psychology and behavioral medicine are sometimes used interchangeably with the term health psychology.
Health and illness are influenced by a wide variety of factors. While contagious and hereditary illnesses are common, many behavioral and psychological factors can impact overall physical well-being and various medical conditions.
An Overview of Health Psychology
Health psychology is a field of psychology focused on promoting health as well as the prevention and treatment of disease and illness. Health psychologists also focus on understanding how people react to, cope with, and recover from illness. Some health psychologists work to improve the health care system and the government's approach to health care policy.
Division 38 of the American Psychological Association is devoted to health psychology. According to the division, their focus is on a better understanding of health and illness, studying the psychological factors that impact health, and contributing to the health care system and health policy.
The field of health psychology emerged in the 1970s to address the rapidly changing field of healthcare. Today, life expectancy in the U.S. is around 80 years, and the leading causes of mortality are chronic diseases often linked to lifestyle. Health psychology helps address these changes in health.
By looking at the patterns of behavior that underlie disease and death, health psychologists hope to help people live better, and healthier, lives.
How Is Health Psychology Unique?
Because health psychology emphasizes how behavior influences health, it is well-positioned to help people change the behaviors that contribute to health and well-being. Examples of health psychology in action would be researchers conducting applied research on how to prevent unhealthy behaviors such as smoking or to find new ways to encourage healthy actions such as exercising.
For example, while most people realize that eating a diet high in sugar is not good for their health, many people continue to engage in such behaviors regardless of the possible short-term and long-term consequences. Health psychologists look at the psychological factors that influence these health choices and explore ways to motivate people to make better health choices.
Importance of Health Psychology
The U.S. Centers for Disease Control's National Center for Health Statistics compiles data regarding death in the nation and its causes. Congruent with data trends throughout this century, nearly half of all deaths in the United States can be linked to behaviors or other risk factors that are mostly preventable.
In the CDC's 2012 report, the rate of death had declined for all leading causes except suicide. Life expectancy was also at an all-time high (78.8 years), yet about 83 Americans die from heart disease and stroke every hour. And more than a quarter of those deaths are preventable.
Cancer deaths were second, followed by chronic lower respiratory diseases—primarily chronic obstructive pulmonary diseases (COPD) such as emphysema and chronic bronchitis. COPD was followed by drug poisonings, including overdoses , then fatal falls among an increasingly elder population.
Current Issues in Health Psychology
Health psychologists work with individuals, groups, and communities to decrease risk factors, improve overall health, and reduce illness. They conduct research and provide services in areas including:
- Stress reduction
- Weight management
- Smoking cessation
- Improving daily nutrition
- Reducing risky sexual behaviors
- Hospice care and grief counseling
- Preventing illness
- Understanding the effects of illness
- Improving recovery
- Teaching coping skills
The Biosocial Model in Health Psychology
Today, the main approach used in health psychology is known as the biosocial model. According to this view, illness and health are the results of a combination of biological, psychological, and social factors.
- Biological factors include inherited personality traits and genetic conditions.
- Psychological factors involve lifestyle, personality characteristics, and stress levels.
- Social factors include such things as social support systems , family relationships, and cultural beliefs.
Health Psychology in Practice
Health psychology is a rapidly growing field. As increasing numbers of people seek to take control of their own health, more and more people are seeking health-related information and resources. Health psychologists are focused on educating people about their own health and well-being, so they are perfectly suited to fill this rising demand.
Many health psychologists work specifically in the area of prevention, focusing on helping people stop health problems before they start.
This may include helping people maintain a healthy weight, avoid unhealthy or risky behaviors , and maintain a positive outlook that can combat stress, depression, and anxiety.
Another way that health psychologists can help is by educating and training other health professionals. By incorporating knowledge from health psychology, physicians, nurses, nutritionists, and other health practitioners can better incorporate psychological approaches into how they treat patients.
Branches of Health Psychology
Individuals who are interested in a health psychology career can choose to work in a specific branch of this field. Four main branches of health psychology are:
- Clinical health psychology : This health psychology branch involves working with individuals, helping them make lifestyle changes for better health.
- Community health psychology : Health psychology workers can also work with entire communities, such as studying diseases that are common in certain communities and the causes behind them.
- Occupational health psychology : This branch of health psychology focuses on how a person's job can affect their health, in addition to finding ways to promote employee health within work environments.
- Public health psychology : Another option for health psychology professionals is to work in a position that studies and/or is able to influence policies and programs designed to promote the health of the public as a whole.
A Word From Verywell
If you are struggling to make healthy changes in your life , dealing with the onset of illness, or facing some other type of health problem, seeing a health psychologist is one way to help start you off on the right foot. By consulting with one of these professionals, you can gain access to support and resources designed to help you cope with your illness and achieve your health goals.
American Psychological Association. Society for Health Psychology .
Centers for Disease Control and Prevention. Mortality in the United States, 2017 .
DeStasio KL, Clithero JA, Berkman ET. Neuroeconomics, health psychology, and the interdisciplinary study of preventative health behavior . Soc Personal Psychol Compass . 2019;13(10):e12500. doi:10.1111/spc3.12500
Centers for Disease Control and Prevention. CDC National Health Report Highlights .
Mason PH, Roy A, Spillane J, Singh P. Social, historical and cultural dimensions of tuberculosis . J Biosoc Sci . 2016;48(2):206–232. doi:10.1017/S0021932015000115
Baum A, Revenson TA, Singer JE. Handbook of Health Psychology. Second Edition . Psychology Press; 2012.
Brannon L, Updegraff JA, Feist J. Health Psychology: An Introduction to Behavior and Health . Cengage Learning; 2014.
By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."
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Using these brief interventions, you can help your patients make healthy behavior changes.
STEPHANIE A. HOOKER, PHD, MPH, ANJOLI PUNJABI, PHARMD, MPH, KACEY JUSTESEN, MD, LUCAS BOYLE, MD, AND MICHELLE D. SHERMAN, PHD, ABPP
Fam Pract Manag. 2018;25(2):31-36
Author disclosures: no relevant financial affiliations disclosed.
Effectively encouraging patients to change their health behavior is a critical skill for primary care physicians. Modifiable health behaviors contribute to an estimated 40 percent of deaths in the United States. 1 Tobacco use, poor diet, physical inactivity, poor sleep, poor adherence to medication, and similar behaviors are prevalent and can diminish the quality and length of patients' lives. Research has found an inverse relationship between the risk of all-cause mortality and the number of healthy lifestyle behaviors a patient follows. 2
Family physicians regularly encounter patients who engage in unhealthy behaviors; evidence-based interventions may help patients succeed in making lasting changes. This article will describe brief, evidence-based techniques that family physicians can use to help patients make selected health behavior changes. (See “ Brief evidence-based interventions for health behavior change .”)
Modifiable health behaviors, such as poor diet or smoking, are significant contributors to poor outcomes.
Family physicians can use brief, evidence-based techniques to encourage patients to change their unhealthy behaviors.
Working with patients to develop health goals, eliminate barriers, and track their own behavior can be beneficial.
Interventions that target specific behaviors, such as prescribing physical activity for patients who don't get enough exercise or providing patient education for better medication adherence, can help patients to improve their health.
Although many interventions target specific behaviors, three techniques can be useful across a variety of behavioral change endeavors.
“SMART” goal setting . Goal setting is a key intervention for patients looking to make behavioral changes. 3 Helping patients visualize what they need to do to reach their goals may make it more likely that they will succeed. The acronym SMART can be used to guide patients through the goal-setting process:
Specific. Encourage patients to get as specific as possible about their goals. If patients want to be more active or lose weight, how active do they want to be and how much weight do they want to lose?
Measurable. Ensure that the goal is measurable. For how many minutes will they exercise and how many times a week?
Attainable. Make sure patients can reasonably reach their goals. If patients commit to going to the gym daily, how realistic is this goal given their schedule? What would be a more attainable goal?
Relevant. Ensure that the goal is relevant to the patient. Why does the person want to make this change? How will this change improve his or her life?
Timely. Help patients define a specific timeline for the goal. When do they want to reach their goal? When will you follow-up with them? Proximal, rather than distal, goals are preferred. Helping patients set a goal to lose five pounds in the next month may feel less overwhelming than a goal of losing 50 pounds in the next year.
Problem-solving barriers . Physicians may eagerly talk with patients about making changes — only to become disillusioned when patients do not follow through. Both physicians and patients may grow frustrated and less motivated to work on the problem. One way to prevent this common phenomenon and set patients up for success is to brainstorm possible obstacles to behavior change during visits.
After offering a suggestion or co-creating a plan, physicians can ask simple, respectful questions such as, “What might get in the way of your [insert behavior change]?” or “What might make it hard to [insert specific step]?” Physicians may anticipate some common barriers raised by patients but be surprised by others. Once the barriers are defined, the physician and patient can develop potential solutions, or if a particular barrier cannot be overcome, reevaluate or change the goal. This approach can improve clinical outcomes for numerous medical conditions and for patients of various income levels. 4
For example, a patient wanting to lose weight may commit to regular short walks around the block. Upon further discussion, the patient shares that the cold Minnesota winters and the violence in her neighborhood make walking in her area difficult. The physician and patient may consider other options such as walking around a local mall or walking with a family member instead. Anticipating every barrier may be impossible, and the problem-solving process may unfold over several sessions; however, exploring potential challenges during the initial goal setting can be helpful.
Self-monitoring . Another effective strategy for facilitating a variety of behavioral changes involves self-monitoring, defined as regularly tracking some specific element of behavior (e.g., minutes of exercise, number of cigarettes smoked) or a more distal outcome (e.g., weight). Having patients keep diaries of their behavior over a short period rather than asking them to remember it at a visit can provide more accurate and valuable data, as well as provide a baseline from which to track change.
When patients agree to self-monitor their behavior, physicians can increase the chance of success by discussing the specifics of the plan. For example, at what time of day will the patient log his or her behavior? How will the patient remember to observe and record the behavior? What will the patient write on the log? Logging the behavior soon after it occurs will provide the most accurate data. Although patients may be tempted to omit unhealthy behaviors or exaggerate healthy ones, physicians should encourage patients to be completely honest to maximize their records' usefulness. For self-monitoring to be most effective, physicians should ask patients to bring their tracking forms to follow-up visits, review them together, celebrate successes, discuss challenges, and co-create plans for next steps. (Several diary forms are available in the Patient Handouts section of the FPM Toolbox .)
A variety of digital tracking tools exist, including online programs, smart-phone apps, and smart-watch functions. Physicians can help patients select which method is most convenient for daily use. Most online programs can present data in charts or graphs, allowing patients and physicians to easily track change over time. SuperTracker , a free online program created by the U.S. Department of Agriculture, helps patients track nutrition and physical activity plans, set goals, and work with a group leader or coach. Apps like Lose It! or MyFitnessPal can also help.
The process of consistently tracking one's behavior is sometimes an intervention itself, with patients often sharing that it created self-reflection and resulted in some changes. Research shows self-monitoring is effective across several health behaviors, especially using food intake monitoring to produce weight loss. 5
The following evidence-based approaches can be useful in encouraging patients to adopt specific health behaviors.
Physical activity prescriptions . Many Americans do not engage in the recommended amounts of physical activity, which can affect their physical and psychological health. Physicians, however, rarely discuss physical activity with their patients. 6 Clinicians ought to act as guides and work with patients to develop personalized physical activity prescriptions, which have the potential to increase patients' activity levels. 7 These prescriptions should list creative options for exercise based on the patient's experiences, strengths, values, and goals and be adapted to a patient's condition and treatment goals over time. For example, a physician working with a patient who has asthma could prescribe tai chi to help the patient with breathing control as well as balance and anxiety.
In creating these prescriptions, physicians should help the patient recognize the personal benefits of physical activity; identify barriers to physical activity and how to overcome them; set small, achievable goals; and give patients the confidence to attempt their chosen activity. Physicians should also put the prescriptions in writing, give patients logs to track their activity, and ask them to bring those logs to follow-up appointments for further discussion and coaching. 8 More information about exercise prescriptions and sample forms are available online.
Healthy eating goals . Persuading patients to change their diets is daunting enough without unrealistic expectations and the constant bombardment of fad diets, cleanses, fasts, and other food trends that often leave both patients and physicians uncertain about which food options are actually healthy. Moreover, physicians in training receive little instruction on what constitutes sound eating advice and ideal nutrition. 9 This confusion can prevent physicians from broaching the topic with patients. Even if they identify healthy options, common setbacks can leave both patients and physicians less motivated to readdress the issue. However, physicians can help patients set realistic healthy eating goals using two simple methods:
Small steps. Studies have shown that one way to combat the inertia of unhealthy eating is to help patients commit to small, actionable, and measurable steps. 10 First, ask the patient what small change he or she would like to make — for example, decrease the number of desserts per week by one, eat one more fruit or vegetable serving per day, or swap one fast food meal per week with a homemade sandwich or salad. 11 Agree on these small changes to empower patients to take control of their diets.
The Plate Method. This model of meal design encourages patients to visualize their plates split into the following components: 50 percent fruits and non-starchy vegetables, 25 percent protein, and 25 percent grains or starchy foods. 12 Discuss healthy options that would fit in each of the categories, or combine this method with the small steps described above. By providing a standard approach that patients can adapt to many forms of cuisine, the model helps physicians empower their patients to assess their food options and adopt healthy eating behaviors.
Brief behavioral therapy for insomnia . Many adults struggle with insufficient or unrestful sleep, and approximately 18.8 percent of adults in the United States meet the criteria for an insomnia disorder. 13 The first-line treatment for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I), which involves changing patients' behaviors and thoughts related to their sleep and is delivered by a trained mental health professional. A physician in a clinic visit can easily administer shorter versions of CBT-I, such as Brief Behavioral Therapy for Insomnia (BBT-I). 14 BBT-I is a structured therapy that includes restricting the amount of time spent in bed but not asleep and maintaining a regular sleep schedule from night to night. Here's how it works:
Sleep diary. Have patients maintain a sleep diary for two weeks before starting the treatment. Patients should track when they got in bed, how long it took to fall asleep, how frequently they woke up and for how long, what time they woke up for the day, and what time they got out of bed. Many different sleep diaries exist, but the American Academy of Sleep Medicine's version is especially user-friendly.
Education. In the next clinic appointment, briefly explain how the body regulates sleep. This includes the sleep drive (how the pressure to sleep is based on how long the person has been awake) and circadian rhythms (the 24-hour biological clock that regulates the sleep-wake cycle).
Set a wake-up time. Have patients pick a wake-up time that will work for them every day. Encourage them to set an alarm for that time and get up at that time every day, no matter how the previous night went.
Limit “total time in bed.” Review the patient's sleep diary and calculate the average number of hours per night the patient slept in the past two weeks. Add 30 minutes to that average and explain that the patient should be in bed only for that amount of time per night until your next appointment.
Set a target bedtime. Subtract the total time in bed from the chosen wake-up time, and encourage patients to go to bed at that “target” time only if they are sleepy and definitely not any earlier.
For example, if a patient brings in a sleep diary with an average of six hours of sleep per night for the past two weeks, her recommended total time in bed will be 6.5 hours. If she picks a wake-up time of 7 a.m., her target bedtime would be 12:30 a.m. It usually takes up to three weeks of regular sleep scheduling and sleep restriction for patients to start seeing improvements in their sleep. As patients' sleep routines become more solid (i.e., they are falling asleep quickly and sleeping more than 90 percent of the time they are in bed), slowly increase the total time in bed to possibly increase time asleep. Physicians should encourage patients to increase time in bed in increments of 15 to 30 minutes per week until the ideal amount of sleep is reached. This amount is different for each patient, but patients generally have reached their ideal amount of sleep when they are sleeping more than 85 percent of the time in bed and feel rested during the day.
Patient education to prevent medication nonadherence . Medication adherence can be challenging for many patients. In fact, approximately 20 percent to 30 percent of prescriptions are never picked up from the pharmacy, and 50 percent of medications for chronic diseases are not taken as prescribed. 15 Nonadherence is associated with poor therapeutic outcomes, further progression of disease, and decreased quality of life. To help patients improve medication adherence, physicians must determine the reason for nonadherence. The most common reasons are forgetfulness, fear of side effects, high drug costs, and a perceived lack of efficacy. To help patients change these beliefs, physicians can take several steps:
Educate patients on four key aspects of drug therapy — the reason for taking it (indication), what they should expect (efficacy), side effects and interactions (safety), and how it structurally and financially fits into their lifestyle (convenience). 16
Help patients make taking their medication a routine of their daily life. For example, if a patient needs to use a controller inhaler twice daily, recommend using the inhaler before brushing his or her teeth each morning and night. Ask patients to describe their day, including morning routines, work hours, and other responsibilities to find optimal opportunities to integrate this new behavior.
Ask patients, “Who can help you manage your medications?” Social networks, including family members or close friends, can help patients set up pillboxes or provide medication reminders.
The five Rs to quitting smoking . Despite the well-known consequences of smoking and nationwide efforts to reduce smoking rates, approximately 15 percent of U.S. adults still smoke cigarettes. 17 As with all kinds of behavioral change, patients present in different stages of readiness to quit smoking. Motivational interviewing techniques can be useful to explore a patient's ambivalence in a way that respects his or her autonomy and bolsters self-efficacy. Discussing the five Rs is a helpful approach for exploring ambivalence with patients: 18
Relevance. Explore why quitting smoking is personally relevant to the patient.
Risks. Advise the patient on negative consequences of continuing to smoke.
Rewards. Ask the patient to identify the benefits of quitting smoking.
Roadblocks. Help the patient determine obstacles he or she may face when quitting. Common barriers include weight gain, stress, fear of withdrawal, fear of failure, and having other smokers such as coworkers or family in close proximity.
Repeat. Incorporate these aspects into each clinical contact with the patient.
Many patients opt to cut back on the amount of tobacco they use before their quit date. However, research shows that cutting back on the number of cigarettes is no more effective than quitting abruptly, and setting a quit date is associated with greater long-term success. 19
Once the patient sets a quit date, repeated physician contact to reinforce smoking cessation messages is key. Physicians, care coordinators, or clinical staff should consider calling or seeing the patient within one to three days of the quit date to encourage continued efforts to quit, as this time period has the highest risk for relapse. Evidence shows that contacting the patient four or more times increases the success rate in staying abstinent. 18 Quitting for good may take multiple a empts, but continued encouragement and efforts such as setting new quit dates or offering other pharmacologic and behavioral therapies can be helpful.
Family physicians are uniquely positioned to provide encouragement and evidence-based advice to patients to change unhealthy behaviors. The proven techniques described in this article are brief enough to attempt during clinic visits. They can be used to encourage physical activity, healthy eating, better sleep, medication adherence, and smoking cessation, and they can help patients adjust their lifestyle, improve their quality of life, and, ultimately, lower their risk of early mortality.
Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all-cause mortality: a systematic review and meta-analysis. Prev Med . 2012;55(3):163-170.
Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns . 2009;76(2):174-180.
Lilly CL, Bryant LL, Leary JM, et al.; Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in three underserved populations: Colorado, North Carolina, West Virginia, 2009. Prev Chronic Dis . 2014;11:E32.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans (7th Ed). Washington, D.C: U.S. Government Printing Office; 2010.
Sreedhara M, Silfee VJ, Rosal MC, Waring ME, Lemon SC. Does provider advice to increase physical activity differ by activity level among U.S. adults with cardiovascular disease risk factors? Fam Pract . 2018;35(4):420-425.
Pinto BM, Lynn H, Marcus BH, DePue J, Goldstein MG. Physician-based activity counseling: intervention effects on mediators of motivational readiness for physical activity. Ann Behav Med . 2001;23(1):2-10.
Hechanova RL, Wegler JL, Forest CP. Exercise: a vitally important prescription. JAAPA . 2017;30(4):17-22.
Guo H, Pavek M, Loth K. Management of childhood obesity and overweight in primary care visits: gaps between recommended care and typical practice. Curr Nutr Rep . 2017;6(4):307-314.
Perkins-Porras L, Cappuccio FP, Rink E, Hilton S, McKay C, Steptoe A. Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change?. Prev Med . 2005;40(3):314-320.
Kahan S, Manson JE. Nutrition counseling in clinical practice: how clinicians can do better. JAMA . 2017;318(12):1101-1102.
Choose My Plate. U.S. Department of Agriculture website. https://www.choosemyplate.gov/ . Updated January 31, 2018. Accessed February 1, 2018.
Ford ES, Cunningham TJ, Giles WH, Croff JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med . 2015;16(3):372-378.
Edinger JD, Sampson WS. A primary care “friendly” cognitive behavioral insomnia therapy. Sleep . 2003;26(2):177-182.
Viswanathan M, Golin CE, Jones CD, et al.; Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med . 2012;157(11):785-795.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management services . 3rd ed. New York: McGraw-Hill; 2012.
Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults — United States, 2005–2015. MMWR Morb Mortal Wkly Rep . 2016;65(44):1205-1211.
Patients not ready to make a quit attempt now (the “5 Rs”). Agency for Healthcare Research and Quality website. http://bit.ly/2jVvpoY . Updated December 2012. Accessed February 2, 2018.
Larzelere MM, Williams DE. Promoting smoking cessation. Am Fam Physician . 2012;85(6):591-598.
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Table of Contents
Factors that influence an individual's personal health behaviors.
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People adopt different health behaviors depending on how, where and when they grew up. In this essay we will discuss factors that influence an individual's personal health behaviors. We will look at hypothetical health behaviors; those that promote and those that diminish health. We will wind up on health and unhealthy eating and on factors that promote healthy generating choices.
The health status of an individual and the subsequent health behaviors are influenced by a convergence of individual factors. The Arizona Department of Education lists; family, culture, peers, media, technology as the factors affecting health behaviors.
The family through our parental education plays a big role in the development of dietary choices that we make. The children will most likely take after their parental dietary choices such that if parents have never learned to choose healthy foods, then naturally their children will take after them. Parental eating habits are handed down to their children which are then handed down to their grandchildren, this is because children admire and copy their parents. Lack of parental guidance is another factor such that today's parent has no time to make nutritious food for their kids at home.
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Another fact is that today's parent leaves their children to choose over what they want and as children, they do not know what a nutritious meal is and as a result will pick over Macdonald's over a healthy packed food. These children are likely to develop improper eating habits because they are just allowed to access food supply at will. Children are also not taught what the proper proportion is, especially in the US people tend to eat more than what they need and again children copy this improper eating habits. They need to be taught on the right portion sizes based on what their body requires (McGregor W. 2010).
Studies do suggest that different cultures have different eating habits and these habits influences a person's health. Example is the health of Mexican American, it is suggested that their health is better than expected due to their low socio-economic status as compared to that of other Americans. Strategies aimed to achieve and maintain good health vary along the cultural groups, for example the US dominant culture endorses a low fat, high fiber diet, regular exercises and earlier immunizations so as to promote and protect health. To that culture that links their beliefs to etiology, they can place their greater value on prayers and meditation. These cultures can emphasize disease prevention to be done through paying homage to ancestral spirits rather through hospitals. (McGregor W. 2010).
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Our ethnicity also affects our eating habits. Some people select certain foods because they feel they have a duty to eat these kinds of foods simply because they have been eating them. It is important though for people to realize that what we take affects directly the health we experience and regardless of their heritage, nutrient packed, low-fat foods are good for all of us.
Although available and saves a lot of time, the availability of prepared, processed and microwave, bleached , sugar filled and sodium laden foods which otherwise accumulate toxics should be avoided. These kinds of foods are mainly liked because they are convenient but there is evidence that long time exposure to this kind of foods reduces human health levels.
Too often, families settle in front of television, video games and computers surfing and do not pay attention to the manners in which they eat. Instead of structuring mealtime and enjoying the food, they hastily gobble down foods with no thought. This denies them the ability to sit down, relax and enjoy foods together.
In most adolescents, because the educational role of the parents decreases, young people will tend to orient themselves towards peer groups thus meaning that they will orient towards their subcultures. Some of the risk behaviors like smoking, drug use becomes part of the social interaction within these peer groups. Usually group pressure will cause their maintenance which will impair health.
Other societal influences of eating habits are:
- Time constraints. Time affects everybody and thus everything has to be planned. Although everybody has busy schedules, there is enough time to prepare for nutritious food if planned well. In order to contribute to good eating habits, each person needs to have a good plan for his/her time such that s/he watches less TV or surfs less on the internet.
- Holiday celebrations. During holiday celebrations, most activities are centered on food. It has become like a norm that during such times like Christmas and thanksgiving, people tend to eat large quantities of food without caring about the nutrient or observing healthy eating habits.
- A form of entertainment. Eating is a popular form of entertainment that almost every social event is based in part by eating. This include weddings, family re-unions, and church gatherings have a central theme; that of eating. People tend to care less on the food nutrition during these times and will eat unhealthy. (McGregor W. 2010).
Health behaviors are those characteristics exhibited by individuals to protect, promote or maintain their health status reflecting a person's health beliefs. This may include proper diet, appropriate exercises or a certain lifestyle.
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Example of health behaviors are:
- Smoking- it is estimated that more than 400,000 Americans each year are killed by smoking and its effects.
- Overworking in the office
- Not getting enough sleep- makes any problem more worse. People need enough undisturbed sleep daily.
- Excessive Alcohol use- may lead to healthy problems like cancer. It als damages brain and body cells.
- Eating too quickly- not having enough time to sit down and have a proper meal. This may lead to excess gases, acid reflux and a bloated stomach.
- Skipping breakfast- due to tight schedules in the morning. But skipping breakfast leads to the body slowing down to conserve energy and this will affect one's metabolism. Most people will compensate by over-eating during lunch time and will more likely lead to obesity.
- Drug abuse- like medicine under or overdose and can lead to hurting the body.
- Drinking coffee. May result to overdependence on caffeine.
- Drinking soft drinks- these carbonated drinks erode tooth enamel and may promote kidney stones.
- Eating too much meat.
- Snacking enough fruits
- Drinking enough water daily. (Saul A. 1999).
There are a host of reasons why people stick to unhealthy behaviors, like a smoker won't quit smoking or an obese person cannot shed some excess fat. Scientists have come up with reasons why humans stick to bad habits. They are; need for social acceptance- an individual will want to continue smoking or drinking simply because he wants to keep company of his peers or to be accepted as one of their own, inability to understand the nature of risk associated- if a person has no adequate knowledge of the food or drug s/he is using, s/he will continue using it despite its adverse effects. Another factor is genetic predisposition to addiction-some people are not able to control their acts and this may be partially planted in them genetically thus hey will continue engaging in un/healthy behaviors with little control of what they engaging in. (Bryner J. 2008).
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While many people want to have a healthy lifestyle, the initiation and maintenance of such kind of a behavior results from an interaction of social, psychological, environmental and biological factors. There are some reasons why people engage from in unhealthy behaviors. This can be explained by starting and maintaining a behavioral change. They may include the fact that some people think that they have the psychological resources to undertake the desired behavior and the individual's belief to use self regulatory strategies. (Healthy behavior).
In the UK for example, the number of smokers has halved in the last 30 years because of its impact on health. It has been reported that smoking causes 1 in 4 cancer deaths in the UK and thus positive response by people to quit smoking. Obesity levels have quadrupled in the last 25 years. It is estimated that obesity reduces life expectancy between 3 and 13 years.
Factors that could influence one to make more health-generating choices
Factors that could influence an individual make more health-generating choices include advice from the hospital. A certain unhealthy habit like smoking or excessive drinking leads to cancer related complications and upon visiting one is told to quit altogether such behavior. Messages like smoking cigarettes kills thousands every year, smoking cigarettes causes lung cancer, and other healthy problems, smoking cigarettes shortens your life span will lead to the only other choice for smokers; quitting. Right counseling of these types of individuals and the fact that their live can end anytime will lead them to quit drug use. (Healthy behavior).
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Obesity is a disease caused by unhealthy eating of fatty foods. Obese people feel very uncomfortable with their bodies and most of them will do anything to get rid of the excessive fats. These people have to make and stick to more health-generating choice. (Healthy behavio).
A person's health is influenced by several factors that we have dealt with above. Technology, peer pressure, the family, culture and time all dictate the health of an individual in different ways. Due to these factors, people develop different health behaviors; some which promote and others that diminish good health. Some people stick to these bad habits despite the fact that they know or are ignorant of the consequences. But some factors like advice from the doctor dictate that one follows a health way of living.
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