title: Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation.
abstract: BACKGROUND
  Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program.
  
  
  METHODS
  In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis.
  
  
  METHODS
  A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial.
  
  
  RESULTS
  Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress.
  
  
  CONCLUSIONS
  Initiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers.
  
  
  BACKGROUND
  Australia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au.
authors: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia.
authors: Samantha
authors: S
authors: Kozica
authors: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia.
authors: Catherine
authors: C
authors: Lombard
authors: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Victoria, Australia.
authors: Helena
authors: H
authors: Teede
authors: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia.
authors: Dragan
authors: D
authors: Ilic
authors: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia.
authors: Kerry
authors: K
authors: Murphy
authors: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia.
authors: Cheryce
authors: C
authors: Harrison
mesh_terms: D000328:Adult; D001315:Australia; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D012424:Rural Population; D015430:Weight Gain / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology