Meeting Objectives

This workshop was the fourth in a series of meetings sponsored by the NIH OBSSR and NIH-wide Adherence Research Network which aims to develop a better understanding of health behavior maintenance to promote and sustain health outcomes. It was conducted in a virtual format on June 4, 2024, and it was open to the public.

The workshop explored strategies for maintaining health behaviors among individuals with chronic conditions from two perspectives: first, the personal, lived experience of maintaining and supporting health behaviors over time, and second, efforts to implement and sustain health behavior interventions in real world clinical and community settings.

The first session at the workshop showcased the lived experiences of three individuals with chronic conditions as they work to maintain healthy behaviors, as well as the personal and professional perspectives of three clinicians regarding their experiences supporting health behavior maintenance among patients and clients. These first-person narratives were followed by a discussion of commonalities and differences in promoting health behavior maintenance across multiple chronic conditions and contexts.

The second session featured exemplars of effective health behavior maintenance programs that have been implemented in real-world clinical and community settings. A panel of researchers discussed challenges and strategies for their successful and sustained implementation over time.

The workshop closed with a high-level overview of key concepts from prior workshops in this series and next steps in disseminating information from the Behavior Maintenance convenings.

Session 1: The Lived Experience of Health Behavior Maintenance from Patient and Clinician Perspectives

Different Lenses, Different Needs: Narratives from Lived Experience with Health Behaviors and Chronic Conditions

The following considerations were shared by panelists of persons with lived experience managing chronic conditions, including cystic fibrosis, obesity, and HIV. These statements represent their personal experiences related to health behavior maintenance.

• Social support and acceptance without stigma and judgement from friends, family, community members, and health care professionals was described as essential for the long-term practice of health behaviors. It was felt that social support can improve communication and understanding of personal challenges, as well as inform problem solving and strategies to maintain health behavior. Receipt of social support also fosters mental health and well-being, additional factors that sustain health behaviors.
• Panelists underscored the value of establishing consistent self-care routines. Making a personal commitment/accepting responsibility, nurturing self-acceptance and self-compassion were viewed as vital support for self-care routines and health behavior maintenance. These strategies can build resilience for addressing challenges to health behaviors when they arise.
• Maintaining health behaviors is a personal journey. The process is unique to each individual and strategies for health behavior maintenance can vary over time. “Falling off the wagon” is part of the process. Knowing oneself (self-awareness) and other factors impacting health behavior maintenance are important to continue the journey successfully.
• Health conditions can be stigmatizing. Seeking social support networks and community connectedness not only reduces stigma but empowers personal efficacy and provides opportunities to access resources and emotional support. Taking an active role in accessing resources and promoting collaborative relationships is key.

Compassion and Constraints: Narratives from Clinicians Providing Care in Diverse Contexts and to Diverse Populations

The following considerations were shared by clinician panelists, including a primary care physician, clinical social worker and behavioral health psychologist.

• It is important to understand that patients are whole persons who live within multiple and changing contexts. Unmet and competing needs are often the most significant factors affecting peoples’ ability to manage health conditions through maintenance of health behaviors. Meeting the person “where they are” and first addressing their safety and other basic needs is key. This approach provides a stronger foundation for better addressing their disease management and health behaviors.
• Clinicians are best supported in their efforts to help patients maintain health behaviors within comprehensive care systems and with a multi-disciplinary team including community resources.
• Clinicians need to be aware of their own biases and expectations. Clinicians need to build their skill set in behavior maintenance strategies and engage in case management.
• Long-term, trusting relationships foster behavior maintenance skills in patients through improved communication, education, and understanding of individual strengths and contextual barriers.

In a joint discussion between the clinician panelists and the persons with chronic health conditions, there was strong agreement that nurturing a trusting therapeutic alliance between clinicians and the people they serve is essential to promoting the long-term adoption and practice of health behaviors.

Session 2: Exemplars of Successful Behavior Maintenance Approaches in Community and Clinical Settings

• Adoption and tailoring of evidence-based interventions in real-world clinical and community settings can benefit from a community-based participatory research (CBPR) approach, including evaluating community needs, engagement and buy-in. A landscape analysis of site characteristics, including health literacy, literacy, desired services and outcomes should begin the process. Cultural appropriateness and attention to feasibility is essential for intervention sustainment. Sustainability should be considered throughout the process of adapting interventions. Feasibility considerations include convenience (ease of use), accessibility, and receptivity to curricula, and the capacity to sustain personnel and resources. To address fidelity to effective components of the evidence-based intervention, materials for training of personnel for intervention delivery should be developed simultaneously with the curricula.
• Anticipating the need for staff training and re-training to address personnel changes over time can be very valuable for the long-term sustainment of health promotion programs.
• To support the success of community-based interventions, it is important to capitalize on existing resources, networks, and community partner interest.
• To encourage continued engagement during active intervention and sustainment efforts, curricula should address known barriers to implementation so that life events leading to missed sessions or other challenges to continuation are not barriers.
• Community partnerships are essential to sustainment of community programming. Care system infrastructure serves the same function in clinical settings.

Overview of Meetings 1-4: Key Findings

• Behavior Maintenance is a dynamic process and consists of varying processes. There are multi-level factors influencing behavior maintenance both at the individual and structural level. There is a need for a dynamic model of the processes that influence health outcomes.
• Behavior maintenance measurement and benchmarks for success are variable across domains and illnesses. There is a need to develop criteria for benchmarks and outcomes.
• There is not yet clear identification of mechanisms of action specific to the processes of behavior maintenance. Mechanisms of action need to account for individual, systems and structural factors to explain the process and outcomes. Targets/outcomes should consider their clinical relevance.
• Sustainment depends on the needs of the community. We need to capitalize and optimize the integration of multi-level mechanisms of action in our behavior maintenance approaches.
• It is important to create an agenda of behavior maintenance questions needing answers to optimize future research and clinical application.
• It is important to engage our stakeholders in these efforts so that approaches are not siloed and artificially limited in lens or understanding of relevant processes.