title: A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk.
abstract: BACKGROUND
  Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles.
  
  
  METHODS
  We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes.
  
  
  RESULTS
  Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes.
  
  
  CONCLUSIONS
  Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.
authors.affiliation: Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK. j.y.murray@leeds.ac.uk
authors.forename: Jenni
authors.initials: J
authors.lastname: Murray
authors.forename: Grania
authors.initials: G
authors.lastname: Fenton
authors.forename: Stephanie
authors.initials: S
authors.lastname: Honey
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Bara
authors.forename: Kate Mary
authors.initials: KM
authors.lastname: Hill
authors.forename: Allan
authors.initials: A
authors.lastname: House
mesh_terms: D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D005069:Evaluation Studies as Topic; D015438:Health Behavior; D006801:Humans; D010809:Physical Fitness / Q000502:physiology; D012307:Risk Factors; D040242:Risk Reduction Behavior