Moving from Initiation to Maintenance: Why Do People Sustain Behavior Change?

Even when efforts to motivate people to modify their behavior prove successful, the changes that are elicited more often than not prove transient (e.g., diet and exercise to produce weight loss [Jeffery et al., 2000], smoking cessation [Ockene et al., 2000], recovery from substance abuse [Marlatt and Gordon, 1985]). Although some health behaviors need only be done once, the overwhelming majority of behaviors that people are urged to adopt (such as those identified in Healthy People 2010) require sustained action and their benefits are contingent on maintenance. Why is it that people who are able to successfully initiate changes in their behavior are more often than not unable to sustain those changes over time? One possibility from dual process models of persuasion is that some behavioral changes are ephemeral because the underlying attitudes that support the changes are weak (e.g., based on little cognitive elaboration) and thus unlikely to persist (Petty and Wegener, 1998). In addition, there may be meaningful differences in the processes that underlie the decision to initiate and the decision to maintain a pattern of behavior.

Current models of health behavior, cited above, have focused on elucidating how people determine whether to adopt a given behavior and have assumed, either implicitly or explicitly, that the factors underlying the decision to maintain a pattern of behavior are no different from those that govern its initiation. For example, the health belief model (Rosenstock et al., 1988), theory of reasoned action (Ajzen and Fishbein, 1980), and theory of planned behavior (Ajzen, 1991) make no direct reference to issues regarding behavioral maintenance other than to define it as a course of action sustained over a specified period of time.6 By comparison, stage models have identified maintenance as a distinct stage in the behavior change process. However, the primary focus of these theoretical approaches has been to delineate the processes through which people become ready to initiate a change in their behavior (Prochaska et al., 1992; Weinstein, 1988). The distinction between people in the action and maintenance stages is predicated solely on the length of time the behavior has been adopted, and thus the set of cognitive and behavioral strategies predicted to facilitate initial

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To the extent that investigators have actively focused on time, it has been to determine how to increase the likelihood that people act on their intentions (Gollwitzer, 1999). Although instructing people to articulate how they will implement their behavioral intention has been shown to increase the likelihood that people will take action, these approaches do not address whether a change in behavior, once enacted, will be maintained.



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