Health Behavior Maintenance

What is Health Behavior Maintenance?

Health behavior maintenance is the ability to sustain health-related behaviors over the long term to maintain positive health outcomes. It’s crucial for managing treatments like heart failure medications, antiretroviral therapy, and insulin, as well as for lifestyle changes that prevent and manage conditions like obesity, cancer, heart disease, and diabetes. However, maintaining these behaviors can be challenging, and health care disparities and social determinants of health impact adherence. The COVID-19 pandemic highlighted these challenges, as many people struggled to follow their existing medical routines, worsening health inequities. Behavior maintenance is a specific category of behavioral adherence. Behavior maintenance may occur at the individual, systems, and/or structural levels.

Adherence Science: Success and Challenges

What is Adherence Science?

Adherence science explores ways to help people, communities, and health care systems sustain health behaviors, over time. Success depends on support from friends, family, community resources, and health care systems that follow clinical guidelines. It's also critical to address social determinants of health — nonmedical factors that affect health outcomes. These include the conditions and contexts in which people are born, grow, work, live, and age.

Challenges in Long-Term Adherence

While the field has made strides in promoting short-term adoption of recommended health behaviors, sustaining long-term healthy behaviors remains difficult. Clinical trials that initially show success often see a decline in effectiveness once interventions end. Additionally, short-term interventions are rarely tested for their impact on long-term behavior maintenance. Practical challenges and a lack of incentives have slowed progress in developing effective long-term health behavior maintenance strategies, particularly for populations experiencing health disparities. New initiatives are needed to promote more rigorous testing and support multi-level approaches for sustained behavior change.

Adherence Research Network Scientific Interest Group

The Adherence Research Network Scientific Interest Group is a transdisciplinary consortium of National Institutes of Health (NIH) Institutes, Centers, and Offices. It provides leadership and support to advance adherence research supported by the NIH. The group evaluates the state of the science and disseminates research priorities through conferences, meetings, and publications. 

The group also sponsors funding opportunities to improve adherence to treatment and prevention regimens and the maintenance of health behaviors.

Leadership

  • Chairs: Michael Stirratt, Ph.D., National Institute of Mental Health; Maureen Monaghan Center, Ph.D., National Institute of Diabetes and Digestive and Kidney Disorders 
  • Senior Advisor: Deborah Young-Hyman, Ph.D., OBSSR

Behavior Maintenance Initiatives 

OBSSR and the Adherence Research Network partner on health behavior maintenance initiatives focused on addressing key scientific and practical issues, including:

  1. Updating the conceptualization of behavior maintenance as specific processes of health behavior change. 
  2. Identifying and better understanding the interactive and fluid mechanisms of action and pathways relevant to successful health behavior maintenance.
  3. Determining whether there are behavior maintenance mechanisms of action and processes that are essential for success across all health behaviors. 
  4. Identifying disease and prevention/treatment characteristics which make health behavior maintenance processes disease specific requiring specific mechanisms of action and pathways for implementation.
  5. Addressing how to implement and what resources are needed to translate successful evidence-based approaches into community and clinical settings for intended recipients.

Promoting the Science and Practice of Health Behavior Maintenance Workshop Series

Beginning in 2023, the OBSSR and the NIH Adherence Research Network hosted a series of workshops titled "An Action Agenda: Promoting the Science and Practice of Health Behavior Maintenance."

The goal of these workshops was to develop a deeper understanding of health behavior maintenance to better promote and sustain positive health outcomes. These workshops built on previous efforts by the OBSSR and the NIH Health Maintenance Consortium to identify the processes, components, and contextual factors that influence health behavior maintenance.

Workshop Leadership

  • Chairs: Alexander J. Rothman, Ph.D., University of Minnesota; Anne L. Peters, M.D., University of Southern California
  • NIH Leads: Maureen Monaghan Center, Ph.D., National Institute of Diabetes and Digestive and Kidney Disorders, Sydney O’Connor, Ph.D., OBSSR, Michael Stirratt, Ph.D., National Institute of Mental Health; Deborah Young-Hyman, Ph.D., OBSSR

Workshop Recordings and Resources

Use the links below to access the workshop recordings, agenda, speaker biographies, and summaries (when available).

  1. Meeting 1: Advancing Consensus on the Conceptualization of Behavior Maintenance (internal meeting)
  2. Meeting 2: Measurement and Monitoring of Behavior Maintenance
  3. Meeting 3: Interventions for Behavior Maintenance
  4. Meeting 4: Behavior Maintenance Approaches in Clinical and Community Settings
  5. Meeting 5: Integrating Evidence for Behavior Maintenance Processes (spring 2025)

Additional Resources

  • Funding Opportunity: Improving Adherence to Treatment and Prevention Regimens and Maintenance of Health Behaviors to Promote Health (NOT-OD-24-146).
  • Portfolio Review: Analysis of funded and unfunded grants and applications addressing long-term adherence submitted under prior funding opportunities (NOT-OD-21-100 and NOT-OD-22-140)
  • Scoping Review: A review of existing literature on behavior maintenance to identify key concepts, types of evidence, and research gaps (currently in process).
  • Special Topic Issue: Planned for 2025.