Lifestyle is central to a person's disease risk and overall health. Numerous health conditions are caused or exacerbated by unhealthy behaviors such as smoking, physical inactivity, excessive alcohol consumption, and poor dietary habits. Estimates suggest that unhealthy behaviors were directly responsible for more than 23 million deaths and 36.5% of disability-adjusted life-years in 2017 alone.
Day-to-day behaviors have profound implications for both short- and long-term health outcomes and quality of life. Positive or health-enhancing behaviors promote well-being, reduce disease risk, and improve quality of life. Health-enhancing behaviors include avoiding harmful substances (e.g., alcohol and tobacco), maintaining adequate physical activity levels, good nutrition, sufficient sleep, and stress management.
On the other hand, negative or health-compromising behaviors refer to those which increase the risk of developing disease, reduce well-being, and worsen the quality of life. Health-compromising behaviors include physical inactivity, substance abuse, and chronic excess calorie intake.
While the importance of maintaining healthy behaviors has been extensively documented in the medical literature, habits and behaviors remain unchanged at the population level. Studies have shown a decrease in the number of adults adhering to healthy behaviors in the United States. Between 1988 and 2006, the percentage of US adults adhering to 5 key health behaviors (not smoking, avoiding excessive alcohol consumption, eating five or more fruits/vegetables per day, exercising more than 12 times per month, and maintaining a healthy body weight) decreased from 15% to 8%. Furthermore, it is estimated that adhering to a healthy lifestyle could prolong life expectancy by 14.0 years for female adults and 12.2 years for male adults in the US.
Over the last decades, organizations, public health agencies, and healthcare professionals have started to highlight the importance of maintaining healthy habits. There have been many awareness and health promotion campaigns at the population level. However, the efficacy of these campaigns on behavioral outcomes remains controversial. It is estimated that mass media health communication campaigns in the United States promoting behavior change have an average positive effect size of 5%.
Understanding the factors influencing behavior is crucial to developing effective interventions and improving adherence to a healthy lifestyle. Human behavior is a complex phenomenon that involves changes or actions related to external circumstances. When discussing health behaviors, multiple factors have the potential to facilitate health-compromising behaviors or interfere with health-enhancing behaviors.
The Intention-Behavior Gap
A person's intention is the motivation to perform a behavior or attain a goal. In other words, an intention is an instruction that a person gives themselves to perform or omit a specific action, such as "I will exercise for 30 minutes" or "I will stop smoking."
Even though the behavior is considered to be voluntary, it is not always aligned with a person's intentions. Health-compromising behaviors are hard to stop, and health-promoting behaviors are challenging to adopt, so intention alone is not necessarily a predictor of behavior change. The intention-behavior gap refers to the discrepancy between what a person intends to do and what the person does. The odds of a person being able to act according to their intentions can be influenced by internal (eg, beliefs, skills, knowledge) and external factors (e.g., time, money, social support).
Understanding the intention-behavior gap can help healthcare professionals understand the difficulties that patients encounter when seeking behavior modification and allow for implementing strategies that address such problems and improve adherence to a healthier lifestyle.
Interventions targeting health behaviors should be tailored to the patient's place on the intention-behavior spectrum, promoting intention formation when patients don't feel ready to change or don't recognize the need for modifying behavior (increasing motivation), facilitating initiation when intentions have been formed (making a plan), reinforcing behavior when action has been taken (staying on course), and providing support when lapses occur (getting back on track).
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