A Lexicon for Measuring Maintenance of Behavior Change

Abstract

Objectives To establish a workgroup within the NIH-funded Health Maintenance Consortium (HMC) to examine how “maintenance” of behavior change was conceptualized and measured across and within behaviors. Methods Multiple meetings were held by the workgroup to reach consensus definitions of maintenance and maintenance-related constructs across diet/nutrition, tobacco, substance abuse, and physical activity. Once consensus was reached, a survey assessed how maintenance was operationalized across 16 HMC intervention studies. Results Seventy-five percent of 16 studies assessed are using a criterion to assess maintenance and are tracking maintenance as a continuous measure. Eighty-one percent are assessing facilitators and barriers, and conceptualizing maintenance as both an intermediate and primary outcome measure. All 16 studies are assessing maintenance at the individual level with fewer at the organizational (N=3), environmental (N=3), and policy levels (N=1). Conclusions This survey found similarities and differences in measurement across behaviors that have important implications for advancing the quality of transbehavioral research.

Effectiveness of physical activity interventions in achieving behaviour change maintenance in young and middle aged adults: A systematic review and meta-analysis

“…The selected time intervals reflect the tendency of PA studies to measure effectiveness at six month time intervals (i.e. 6 months, 12 months and 24 months) (Seymour et al, 2010). Meta-analyses were conducted using Review Manager (The Cochrane Collaboration, 2014).…”

“…most studies measured PA at six month intervals with few using shorter, more continuous intervals or modelling maintenance trajectories (Seymour et al, 2010)). Included studies did not explicitly measure maintenance in terms of behaviour sustained at a target level and our operational definition of 'maintenance' reflected this.…”

Understanding and influencing the maintenance of physical activity and dietary behaviour change in breast cancer survivors

“…Maintenance of physical activity behaviour change has most commonly been defined as continuing to engage in regular physical activity for at least six months after the end of an intervention (Crain et al, 2010;Pekmezi et al, 2011;Van Stralen et al, 2010). Dietary interventions reporting maintenance of behaviour change similarly report on six month post-intervention outcomes, although a number of physical activity and dietary studies report 'maintenance' after only two or three months post-intervention Seymour et al, 2010). A six month post-intervention timeframe is consistent with the more established evidence base for defining 'short-term' weight loss maintenance (Abildso et al, 2014;Carels et al, 2014;Elfhag et al, 2005), while researchers evaluating 'long-term' weight loss maintenance apply a more conservative maintenance timeframe of 12 months postintervention Clifton et al, 2014;Dombrowski et al, 2014;.…”

“…Some studies assess maintenance relative to an individual's baseline levels, while others report maintenance based on a known behavioural guideline or pre-determined criterion being achieved at both end-of-intervention and maintenance assessments (e.g., less than 5% change postintervention; Dombrowski et al, 2014;Seymour et al, 2010). Inconsistencies remain in the amount of change required to define successful maintenance of behaviour change.…”

“…The HMC defined maintenance of behaviour change as the continuation of behaviour after the end of an intervention that meets a threshold believed to be necessary to improve health . This definition draws on the current evidence base across multiple behaviours and is intended to be applicable to a range of behaviours (i.e., physical activity, diet/nutrition, smoking cessation, and substance abuse; Seymour et al, 2010).…”