Some Next Steps in Changing Many Health Behaviors

Claudio Nigg, PhD and Ding Ding, PhD, Multiple Health Behavior Change SIG

Chronic diseases (e.g., cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) are responsible for 36 million deaths worldwide each year. Health behaviors play an important role in the prevention of many chronic diseases. Although each health-risk behavior (e.g., tobacco use, unhealthy eating, physical inactivity, etc.) contributes uniquely to morbidity and mortality, many risk behaviors co-occur within individuals (e.g., poor diet and lack of physical activity, drug and alcohol use) and may have synergistic effects on health. These typically clustering health-risk behaviors cause enormous disease burden and have a large impact on health care costs.

This burden can be minimized by quitting health-risk behaviors and taking up healthy behaviors; namely a lifestyle change or to engage in multiple health behavior change (MHBC). MHBC is a developing field and has received growing research interest in the last 20 years. Here, we highlight essential next steps to motivate readers to move this field forward.

First, improvement in assessing multiple health behaviors is fundamental to evaluation of MHBC. Some concepts that should be considered include: a) a standardized health behavior index where all the behaviors are measured and then standardized (e.g., a z-score) and combined; b) assigning weights to individual risk behaviors based on their independent contribution to mortality risk; or c) a single item addressing general health (which is thought to encompass all relevant issues for the person).

Second, MHBC is thought to occur through shared co-variation of underlying motivating mechanisms. For example, one’s self-efficacy for one behavior (e.g., physical activity) can influence one’s confidence to do another behavior (e.g. eat more fruits and vegetables), but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. For example, does self-efficacy for physical activity play a similar or different role in healthy eating?

Third, future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Some topics here include sequential (short interventions focusing on one behavior at a time offered to the person sequentially), simultaneous (where the person receives all behavior interventions at once) or integrated (where the intervention content is an overarching theme [health or some chronic disease] and the behaviors are integrated into the messages).

Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considerations integrated during development. Some concepts to consider include: 1) what is the capacity to conduct the intervention/program for the long-term; 2) what structure or system in the community will implement the intervention; 3) are there policies that should be implemented to support the structures/capacity that would help sustain the intervention; and 4) how should the environment be adapted/changed to support the MHBC intervention.

Focusing MHBC research in these areas will improve our understanding and maximize the impact on the health of populations.