title: Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review.
abstract: BACKGROUND
  With an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones.
  
  
  METHODS
  Searches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to healthy behaviours. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset. Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks.
  
  
  RESULTS
  From 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries. Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities.
  
  
  CONCLUSIONS
  The barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kelly
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Martin
authors.affiliation: University of Cambridge Medical Library, University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge CB2 0SP, United Kingdom.
authors.forename: Isla
authors.initials: I
authors.lastname: Kuhn
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Cowan
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Lafortune
mesh_terms: D016208:Databases, Factual; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008913:Minority Groups; D009043:Motor Activity; D011788:Quality of Life; D020377:Self Efficacy; D012737:Sex Factors; D012923:Social Class
references.citation: Implement Sci. 2010 Jul 19;5:56
references.pmid: 20642853
references.citation: Occup Med (Lond). 2005 Mar;55(2):136-8
references.pmid: 15757990
references.citation: Am J Med. 2007 Jul;120(7):598-603
references.pmid: 17602933
references.citation: Rehabil Nurs. 2009 Jan-Feb;34(1):17-23
references.pmid: 19160920
references.citation: BMC Cardiovasc Disord. 2012 Dec 08;12:120
references.pmid: 23216627
references.citation: Prev Med. 2004 Dec;39(6):1164-71
references.pmid: 15539051
references.citation: Ethn Dis. 2011 Summer;21(3):261-7
references.pmid: 21942156
references.citation: Public Health. 2012 Aug;126(8):635-45
references.pmid: 22809493
references.citation: Womens Health Issues. 2008 Jul-Aug;18(4):281-91
references.pmid: 18468920
references.citation: PLoS One. 2016 Feb 04;11(2):e0144405
references.pmid: 26845035
references.citation: Health Educ Res. 2011 Dec;26(6):1010-24
references.pmid: 21873458
references.citation: Int J Behav Nutr Phys Act. 2010 Feb 02;7:12
references.pmid: 20181070
references.citation: Health Care Women Int. 2002 Dec;23(8):894-904
references.pmid: 12487704
references.citation: Lancet. 2013 Mar 2;381(9868):752-62
references.pmid: 23395245
references.citation: PLoS Med. 2008 Jan 8;5(1):e12
references.pmid: 18184033
references.citation: Obes Rev. 2012 Apr;13(4):329-46
references.pmid: 22106948
references.citation: CMAJ. 2012 Dec 11;184(18):1985-92
references.pmid: 23091184
references.citation: J Epidemiol Community Health. 2012 Aug;66(8):737-44
references.pmid: 22493474
references.citation: J Mens Health. 2012 Jun 1;9(2):79-88
references.pmid: 23459337
references.citation: PLoS Med. 2011 Jun;8(6):e1000440
references.pmid: 21695075
references.citation: Nurs Prax N Z. 2005 Nov;21(3):24-37
references.pmid: 16764159
references.citation: Br J Nutr. 2011 Mar;105(5):776-86
references.pmid: 20946706
references.citation: J Neurol Neurosurg Psychiatry. 2005 Dec;76 Suppl 5:v2-7
references.pmid: 16291918
references.citation: Int J Behav Nutr Phys Act. 2012 Dec 20;9:150
references.pmid: 23256686
references.citation: BMC Public Health. 2012 Aug 31;12:723
references.pmid: 22938046
references.citation: Int J Epidemiol. 2002 Apr;31(2):285-93
references.pmid: 11980781
references.citation: Health Place. 2013 May;21:70-85
references.pmid: 23454663
references.citation: Qual Health Res. 2001 Jul;11(4):450-63
references.pmid: 11521604
references.citation: Am J Mens Health. 2012 Nov;6(6):453-61
references.pmid: 22516565
references.citation: J Midwifery Womens Health. 2013 Jul-Aug;58(4):440-50
references.pmid: 23931661
references.citation: J Health Serv Res Policy. 2005 Jan;10(1):45-53
references.pmid: 15667704
references.citation: Prev Chronic Dis. 2008 Jan;5(1):A06
references.pmid: 18081995
references.citation: Am J Health Promot. 2008 Sep-Oct;23(1):2-12
references.pmid: 18785368
references.citation: Psychosoc Med. 2012;9:Doc07
references.pmid: 23133501
references.citation: J Health Care Poor Underserved. 2013 Aug;24(3):1042-52
references.pmid: 23974379
references.citation: Iran J Nurs Midwifery Res. 2012 Jul;17(5):390-8
references.pmid: 23853654
references.citation: Scand J Public Health. 2008 Jun;36(4):389-96
references.pmid: 18539693
references.citation: Syst Rev. 2015 Jan 14;4:4
references.pmid: 25589399
references.citation: J Gen Intern Med. 2002 May;17(5):387-97
references.pmid: 12047738
references.citation: Int J Behav Nutr Phys Act. 2012 Sep 19;9:116
references.pmid: 22992350
references.citation: Soc Sci Med. 2012 Aug;75(4):659-67
references.pmid: 22365936
references.citation: J Nutr Educ Behav. 2012 Jul-Aug;44(4):282-301
references.pmid: 22732708
references.citation: Med Care Res Rev. 2012 Oct;69(5):495-518
references.pmid: 22457269
references.citation: Health Care Women Int. 2008 Nov-Dec;29(10):997-1018
references.pmid: 18821211
references.citation: Health Educ Res. 2011 Aug;26(4):732-8
references.pmid: 21597100
references.citation: Health Place. 2012 Mar;18(2):349-57
references.pmid: 22154843
references.citation: Addiction. 2011 Dec;106(12):2110-21
references.pmid: 21752135
references.citation: Sports Med. 2012 May 1;42(5):433-47
references.pmid: 22512413
references.citation: Drug Alcohol Depend. 2008 Jun 1;95(3):269-78
references.pmid: 18339490
references.citation: Aging (Albany NY). 2011 Jan;3(1):63-76
references.pmid: 21258136
references.citation: Eur J Clin Nutr. 2000 Sep;54(9):706-14
references.pmid: 11002383
references.citation: Nicotine Tob Res. 2010 Oct;12(10):1050-4
references.pmid: 20819787
references.citation: Am J Epidemiol. 2012 Dec 15;176(12):1078-89
references.pmid: 23144364
references.citation: BMC Public Health. 2009 Apr 05;9:96
references.pmid: 19344526
references.citation: Implement Sci. 2011 Apr 23;6:42
references.pmid: 21513547
references.citation: Age Ageing. 2011 Sep;40(5):589-95
references.pmid: 21616956
references.citation: J Hum Nutr Diet. 2011 Feb;24(1):61-7
references.pmid: 21029215
references.citation: Med Sci Sports Exerc. 2002 Dec;34(12):1996-2001
references.pmid: 12471307
references.citation: J Womens Health Gend Based Med. 2002 Apr;11(3):239-53
references.pmid: 11988134
references.citation: Manag Care. 2002 Jun;11(6):42, 45-50
references.pmid: 12098874
references.citation: Issues Ment Health Nurs. 2008 Jun;29(6):619-38
references.pmid: 18569208
references.citation: J Telemed Telecare. 2012 Oct;18(7):419-22
references.pmid: 23104771
references.citation: Psychol Health. 2010 Jan;25(1):25-42
references.pmid: 20391205
references.citation: J Health Commun. 2013;18(9):1070-83
references.pmid: 23647448
references.citation: J Public Health (Oxf). 2004 Sep;26(3):250-8
references.pmid: 15454592
references.citation: Obes Rev. 2011 May;12(5):e460-71
references.pmid: 20149118
references.citation: Br J Nutr. 2006 Oct;96(4):620-35
references.pmid: 17010219
references.citation: Am J Public Health. 2007 Aug;97(8):1434-43
references.pmid: 17600254
references.citation: Obes Rev. 2010 Jun;11(6):413-29
references.pmid: 19889178
references.citation: Am J Prev Med. 2002 Aug;23(2 Suppl):26-35
references.pmid: 12133735
references.citation: Epidemiol Rev. 2009;31:7-20
references.pmid: 19589839
references.citation: Am J Prev Med. 2011 Apr;40(4):476-85
references.pmid: 21406284
references.citation: Am J Prev Med. 2004 Jun;26(5):419-25
references.pmid: 15165658
references.citation: Soc Sci Med. 2008 Nov;67(9):1343-55
references.pmid: 18691793
references.citation: J Cardiovasc Nurs. 2005 May-Jun;20(3):170-6
references.pmid: 15870587
references.citation: Obes Rev. 2011 May;12(5):e95-e106
references.pmid: 20604870
references.citation: J Clin Epidemiol. 2009 Oct;62(10):1013-20
references.pmid: 19230606
references.citation: Women Health. 2009 Mar-May;49(2-3):164-80
references.pmid: 19533508
references.citation: Qual Health Res. 2010 Jul;20(7):966-76
references.pmid: 20207956