Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories

ABSTRACT Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Methods: Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. Findings: One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. Discussion: There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance.


Self-regulation Yes Health-related behaviour
No 10 26 Health behaviour goal model (Gebhardt, 1997) A model is an attempt to describe and predict the process of behaviour change  (Bem, 1967(Bem, , 1972 A theory of self-attitudes Maintenance motives (identity)

No
No 0 54 Self-regulation theory (Kanfer & Gaelick-Buys, 1991) A theory of the initial stages of behaviour change, focusing on the detection of maladaptive behaviour and the early sources of motivation for change  (Greaves, Reddy, & Sheppard, 2010) A process model for supporting a lifestyle behaviour change

Self-regulation Habit
Yes Health-related behaviour No 1 92 Self-schema theory (Markus, 1977) A theory of 'self-schema' -the beliefs and ideas people have about themselves  (Sniehotta et al., 2005) A theory of the mental simulation of overcoming anticipated barriers to action. Instructions: Thank you very much for agreeing to take part in this theme validation exercise.

Self-regulation
This task should take about 15 minutes. Please read the theme definitions carefully.

Short theme definitions:
A. Maintenance motivesreasons why people engage in behaviour.
B. Resourcespsychological and physical assets that someone can draw on in order to engage in behaviour.
C. Self-regulationability to actively control behaviour; ability to override or inhibit behaviours, urges, emotions or desires that would otherwise hinder goal-directed behaviour.
D. Habits -behavioural patterns, based on context-behaviour associations which are learned through context-dependent repetition. They are elicited automatically when associated contexts are encountered.
E. Environment and social influences-the setting or conditions in which a particular activity is carried on; these may include social settings, social support and social change.
Please allocate each extracted theory statement to the theme it fits in (in your opinion). You can allocate one statement to more than one theme.
Statements examples: 1. 'The social reinforcements obtained from smoking are probably the most important influence on whether or not an experimenting adolescent will become a regular smoker.
Peer pressure still may play a role as this stage, although its effects probably are mediated through social reinforcement.' 2. 'We consider various mechanisms that could underlie the habitual control of action, and we conclude that direct cuing and motivated contexts best account for the characteristic features of habit responding-in particular, for the rigid repetition of action that can be initiated without intention and that runs to completion with minimal conscious control' 3. 'The term self-schema refers to the beliefs and ideas people have about themselves.
These beliefs are used to guide and organize information processing, especially when the information is significant to the self. 16. 'The family is a system in that a change in one part of the system is followed by compensatory change in other parts of the system.' 17. 'A habit seems to be accompanied by an enduring cognitive orientation, which we refer to as "habitual mind-set" that makes an individual less attentive to new information and courses of action, and thus contributes to the maintenance of habitual behaviour.' 18. 'People with high goals produce more because they are dissatisfied with less. The bar for their satisfaction is set at a high level. This is why they are motivated to do more than those with easy goals.' 19. 'Studies in psychophysiology and cognitive psychology provide evidence that activities which are habitually performed become "routine" in such a way that higher levels of cognitive processing is, for most of the time, unnecessary. Such activities are, therefore, carried out with minimum awareness, coming to the forefront of consciousness only occasionally.' 20. 'In later stages of the process, as the individual incorporates these cognitive changes and acquires behaviour change skills and behavioural intention to change, peer influence processes become increasingly important in reinforcing behavioural changes.' Please answer the following questions: