title: 'You need a support. When you don't have that . . . chocolate looks real good'. Barriers to and facilitators of behavioural changes among participants of a Healthy Living Program.
abstract: BACKGROUND
  Health behavioural change is complex, especially for underserved patients who have higher rates of obesity and physical inactivity. Behavioural change interventions that show high efficacy in clinical trials may be difficult to disseminate and may not be effective in the office.
  
  
  OBJECTIVE
  We sought to identify factors that facilitate or hinder behavioural change among past participants of a healthy lifestyle intervention in an urban underserved health centre.
  
  
  METHODS
  Between March and October 2011, we conducted five focus group sessions with a total of 23 past participants. The focus group transcripts were analysed with a framework approach using the Social Ecological Model as a coding structure.
  
  
  RESULTS
  We found four interconnected levels of social contexts: individual, interpersonal, programmatic and community levels. Themes of social support and the importance of relationships for making and maintaining behavioural changes were found at all levels.
  
  
  CONCLUSIONS
  Social support and relatedness were key facilitators of healthy lifestyle changes and influenced individual motivation and perseverance. Harnessing the power of social support and motivation may be a way for future behavioural change interventions to bridge the gap between efficacy and effectiveness.
authors.affiliation: Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 777 South Clinton Avenue, Rochester, NY 14620, USA. holly_russell@urmc.rochester.edu
authors.forename: Holly Ann
authors.initials: HA
authors.lastname: Russell
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rufus
authors.forename: Colleen T
authors.initials: CT
authors.lastname: Fogarty
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D032763:Behavior Control / Q000379:methods / Q000523:psychology; D015444:Exercise / Q000523:psychology; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D040361:Healthy People Programs / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008019:Life Style; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009042:Motivation / Q000502:physiology; D009765:Obesity / Q000517:prevention & control / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012944:Social Support; D014481:United States
keywords: Exercise; health behaviour; medically underserved area; obesity; qualitative research; social support.