Developing Strategies for Maintaining Behavior Change

Durham Va Medical Center, Durham NC

Investigators

Abstract

One major modifiable risk factor for coronary heart disease is elevated serum low-density lipoprotein cholesterol (LDL-C). Reducing LDL-C requires initiation of new behaviors (e.g., making dietary changes, starting medication), whereas keeping LDL-C at an optimal level requires maintenance of those newly adopted behaviors. Several interventions targeting patients alone or patients and their support person have proven effective for initiating adherence behavior for diet, exercise, and medication. However, new behaviors typically falter after 6 months, resulting in weight regain, failure to exercise, and medication discontinuation. Therefore, effective behavioral maintenance strategies are needed. The behavior maintenance literature indicates that maintenance is a separate process from initiation, with different psychological processes (e.g., types of self- efficacy) and behavioral strategies required to achieve success. To be best prepared to maintain newly adopted behaviors over the long term, a brief transition period is needed in which patients are taught behavior maintenance strategies. During this period, the focus, if not the intensity, of an intervention will need to change. The goal of the proposed study is to develop the materials and assess the feasibility of an intervention that will help patients transition from initiation to maintenance. We will enroll 20 veterans who initiated health-promoting behaviors as participants in the intervention arm of an ongoing telephone-based, spousal support intervention for self-management of high LDL-C;as soon as they complete that trial, patients will begin the maintenance intervention, which will be delivered by the same nurse. This pilot study will provide preliminary data for a VA HSR&D IIR grant submission that will involve a trial comparing patient- and couple-focused strategies for initiating and maintaining recently adopted health-promoting behaviors.