Interdisciplinary Perspectives on Maintenance of Health Behavior Change

Modifying health behaviors can be difficult, especially for older adults who are challenged by multiple chronic conditions, reduced functional and/or cognitive capacity, and limited social support. Although much attention has been given to the theories, skills, and resources behind initiating and achieving behavior change, less work has focused on maintenance of health behaviors over time. This presentation will showcase pilot research inspired by RCCN’s first workshop, Achieving and Sustaining Behavior Change. Specifically, this pilot brings together an interdisciplinary team of behavioral scientists and health services researchers working at the intersection of intervention science and implementation science to better understand the construct of maintenance and discuss emerging methods for intervention development and evaluation. The presentation will utilize physical activity as an example behavior to demonstrate the value of interdisciplinary research, including recommendations on how some of the six NIA research centers can make unique contributions to understanding health behavior maintenance.

Multi-Level Resources to Support Health Behavior Maintenance

Although behavior change is largely thought to occur on the individual level, maintenance of health behaviors also depends upon factors at the community and population levels. As discussed in earlier presentations, health behaviors can be influenced by social support, environmental context, and population-level policies. For example, maintaining a physical activity regimen is made easier when an older adult has access to a safe environment, support of family and friends, and/or ongoing access to a program that is continuously offered, or sustained, at a local community center. This presentation will focus on the importance of discussing sustainability when considering long-term maintenance of health behaviors. Specifically, this presentation will use examples from the evidence-based Fit & Strong! program, now being offered in 32 states, to explore sustainability of programs at the participant and community level and will provide an overview of barriers and facilitators faced by community organizations.

Defining the Construct of Health Behavior Maintenance

Prior research on health behavior maintenance has proposed several key constructs that distinguish this concept from initiation. Initiation is thought to depend upon action self-efficacy, goal setting, and outcome expectations. Maintenance, on the other hand, depends upon self-regulation, relapse prevention, recovery self-efficacy, and satisfaction with original outcome expectations. Although much prior research has focused on cognitive components of maintenance, there has been little attention to how higher-order cognitive processing and decision-making may be challenging for some older adults. This presentation will discuss a proposed conceptual model of health behavior maintenance, specifically as this construct applies to older adults. Special consideration will be given to how both normative and non-normative age-related changes (e.g., physical, cognitive, psychosocial) impact maintenance and how such changes might influence older adults’ goals and outcome expectations. Finally, individual-level maintenance will be discussed within a larger context of program sustainability at community and population levels.

How intensive longitudinal data can stimulate advances in health behavior maintenance theories and interventions

Interventions that promote long-term maintenance of behaviors such as exercise, healthy eating, and avoidance of tobacco and excessive alcohol are critical to reduce noncommunicable disease burden. Theories of health behavior maintenance tend to address reactive (i.e., automatic) or reflective (i.e., deliberative) decision-making processes, but rarely both. Progress in this area has been stalled by theories that say little about when, why, where, and how reactive and reflective systems interact to promote or derail a positive health behavior change. In this commentary, we discuss factors influencing the timing and circumstances under which an individual may shift between the two systems such as (a) limited availability of psychological assets, (b) interruption in exposure to established contextual cues, and (c) lack of intrinsic or appetitive motives. To understand the putative factors that regulate the interface between these systems, research methods are needed that are able to capture properties such as (a) fluctuation over short periods of time, (b) change as a function of time, (c) context dependency, (d) implicit and physiological channels, and (e) idiographic phenomenology. These properties are difficult to assess with static, cross-sectional, laboratory-based, or retrospective research methods. We contend that intensive longitudinal data (ILD) collection and analytic strategies such as smartphone and sensor-based real-time activity and location monitoring, ecological momentary assessment (EMA), machine learning, and systems modeling are well-positioned to capture and interpret within-person shifts between reactive and reflective systems underlying behavior maintenance. We conclude with examples of how ILD can accelerate the development of theories and interventions to sustain health behavior over the long term.

Identifying Key Elements to Inform the Development of an HIV Health Behavior Maintenance Intervention

Purpose: To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors. Design: Focused, in-depth individual and group interviews. Setting: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC. Participants: A total of 42 individuals who had participated in The Positive Life Workshop—an HIV self-management intervention adapted and implemented by the NYC DOHMH. Method: Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data. Results: Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others. Conclusion: Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

Perilaku pemeliharaan kebersihan gigi tiruan lepasan pada masyarakat Desa Kema II Kecamatan Kema

The main purpose of using denture is to restore the aesthetic function, speech function, and masticatory function which are disturbed due to tooth loss. Unclean oral condition can cause the oral cavity become susceptible to caries and periodontal disease. Poor behavior to maintain dental and oral hygiene of removable denture users plays an important role in the occurrence of these two diseases. Removable denture that is kept unclean is harmful to the hard tissue as well as the soft tissue of the oral cavity. This study aimed to determine the behavior of removable denture maintenance among Kema II villagers in Kema. This was a descriptive study with a cross sectional design. There were 62 respondents as samples. The results of the behavior score of denture hygiene maintenance were as follows: score of knowledge was 552; score of attitude was 581; and score of action was 572. Conclusion: The behavior to maintain the removable denture hygiene of Kema II villagers which included knowledge, attitude, and action was classified as poor category.Keywords: behavior, maintenance of hygiene dentures, removable dentureAbstrak: Tujuan utama penggunaan gigi tiruan yaitu untuk memulihkan fungsi estetik, fungsi bicara, serta fungsi pengunyahan yang terganggu akibat kehilangan gigi. Kondisi rongga mulut yang kurang terjaga kebersihannya dapat menyebabkan rongga mulut rentan terhadap karies dan penyakit periodontal. Perilaku pemeliharaan kebersihan gigi dan mulut yang kurang baik dari pengguna gigi tiruan lepasan berperan penting pada terjadinya kedua penyakit tersebut. Gigi tiruan lepasan yang kurang terjaga kebersihannya bukan saja menimbulkan gangguan pada jaringan keras gigi namun juga pada jaringan lunak mulut. Penelitian ini bertujuan untuk mengetahui perilaku pemeliharaan kebersihan gigi tiruan lepasan pada masyarakat Desa Kema II Kecamatan Kema. Jenis penelitian ialah deskriptif dengan desain potong lintang. Sampel berjumlah 62 responden. Hasil penelitian menunjukkan skor pengukuran perilaku pemeliharaan kebersihan gigi tiruan yang terdiri dari skor pengetahuan sebesar 552; skor sikap sebesar 581; dan skor tindakan sebesar 572. Simpulan: Perilaku pemeliharaan kebersihan gigi tiruan lepasan masyarakat Desa Kema II Kecamatan Kema yang meliputi pengetahuan, sikap dan tindakan kesemuanya tergolong kurang baik.Kata kunci: perilaku, pemeliharaan kebersihan gigi tiruan, gigi tiruan lepasan