Behavior Change: What Really Works?

Reviewed by Dr. Jonathan Bonnet, MD, MPH

Every January first, millions of Americans set intentions for the year ahead. These resolutions include a diverse range of desired behavior changes, like: “I want to learn a new language,” “I want to read more books,” or “I want to spend more time in nature.” But despite a genuine desire to make changes, data shows that very few of us are successful at maintaining these new behaviors in the long run. In fact, one study from 2015 suggests that only 9% of those who make resolutions are successful at keeping them. But what about behavior changes that support our health?

Behavior changes are common recommendations in the world of medicine. In fact, many providers focus on helping patients to incorporate healthy behaviors that can prevent, treat, and often reverse chronic disease. But how many patients are successful at incorporating these changes into their life in a meaningful and sustainable way?

In this article, we explain the psychology behind behavior changes, how they can support your health, and which strategies can help you to make sustainable changes that can have a long-lasting impact on your quality of life.

How can behavior changes support my health?

According to data presented to the National Research Council in 2013, modifiable behaviors contribute to an estimated 40% of deaths in the United States. Additional research suggests that the number of healthy lifestyle behaviors a person follows may decrease their risk of all-cause mortaility.

With that data in mind, it’s no surprise that many providers regularly encourage patients to make healthy and lasting behavior changes. Some of the most prevalent behaviors believed to have a negative impact on the quality and length of patients’ lives include:

  • Tobacco use

  • Poor sleep

  • Poor adherence to medication

  • Diet

  • Physical activity

What influences behavior change?

Anyone who’s made a new year’s resolution but failed to keep it up knows how difficult it can be to make a change in behavior. There are several psychological theories aimed at explaining the factors that can make these changes difficult to keep.

The theory of planned behavior/reasoned action was developed by social psychologists Martin Fishbein and Icek Azjen in 1967. They proposed that behavior is influenced by three central factors:

  1. Personal attitudes: Your knowledge, attitudes, and prejudices about a certain behavior will impact your decision to engage, limit, or stop that behavior.

  2. Subjective norms: How you believe other people, including friends, family, or coworkers, view a certain behavior. Importantly, this does not refer to what other people actually think about this behavior, but your perception of their attitudes around a certain behavior.

  3. Perceived behavioral control: The extent to which you actually believe you can control a behavior. This perception may be influenced by internal or external factors, such as your ability and determination to make a behavior change and the resources and support available to you to make that change.

What helps us make sustainable changes?

There are many strategies in use by healthcare providers to help patients make sustainable changes. According to an article published in Family Practice Management (FPM), a peer-reviewed practice enhancement journal published by the American Academy of Family Physicians (AAFP), there are three techniques that can help to make changes successful across a wide variety of behavior types:

  1. “SMART” goal setting: Whether or not you’re working with a provider to make healthy changes, goal setting is an important first step. The “SMART” acronym helps to make goal-setting as specific and achievable as possible. When following “SMART,” you ensure that your goals are: a) specific, b) measurable, c) attainable, d) relevant, and e) timely.

  2. Problem-solving obstacles and behaviors: In line with setting goals that are attainable, it’s equally important to acknowledge the obstacles and barriers that are likely to prevent you from achieving them. After recognizing potential obstacles, make a plan to overcome them. Working with a provider, therapist, or trusted friend can help you to brainstorm possible solutions. If a particular barrier cannot be overcome, work to adjust or change the goal.

  3. Self-monitoring: Self-accountability can be a significant motivational tool when it comes to working through behavior changes. Specifically, monitoring your progress with a diary, app, or other tracking tool can be useful. Physicians believe that self-monitoring and/or tracking your goals can increase your chance of success while also providing valuable data throughout the process. Keep in mind that this strategy is most successful when the data captured is evaluated in collaboration with a healthcare provider. This creates an opportunity for patients and providers to celebrate successes, brainstorm new solutions for existing challenges, and plan for next steps.

Which factors impact our ability to change behavior?

Even when following every recommendation laid out by your provider, there are factors that can make it difficult to stick to a new health-promoting behavior, including known and unknown psychological, social, and environmental obstacles.

When it comes to psychological obstacles, there are at least six factors that can negatively impact a person’s ability to make health-promoting behavior changes according to the Health Belief Model (HBM):

  1. Perceived susceptibility: Your perception of the risk acquiring an illness or disease will affect your success at implementing behavior changes. For example, if you believe your risk of developing heart disease is low, you may not be as motivated to incorporate regular physical activity into your routine. But, on the other hand, if you witnessed your parents suffer from heart disease and think of yourself as high risk, you may be more motivated to incorporate physical activity and other lifestyle behaviors into your routine more regularly to help prevent the disease.

  2. Perceived severity: Your perception of the seriousness of an illness or disease will also affect your success at implementing behavior changes. For example, if you believe that influenza doesn’t pose a significant risk to you or your community's health, you may be less likely to get vaccinated. However, if you recognize that an influenza infection is associated with health risk and will prevent you from showing up to work, which may lead to financial stress, you may be more motivated to take preventive actions like vaccination.

  3. Perceived benefits: Your perception of the effectiveness of a particular behavior change at improving your health is another factor. For example, if your provider recommends improving your sleep hygiene as a means of decreasing your risk of anxiety and depression, but you don’t believe this change will demonstrably benefit your mental health, you will be less likely to make that behavior change.

  4. Perceived barriers: How you feel about the obstacles and barriers impeding your changes will also affect your success. For example, if you perceive a behavior change to be expensive or dangerous, the benefits of that behavior change may not outweigh the risks in your mind. Barriers can include a number of constraints, including those that involve discomfort, expense, effort, inconvenience, or even social consequences, such as breaking social norms like happy hours.

  5. Cue to action: What inspires the behavior change. A provider’s recommendation alone may not be compelling enough for you to commit to a particular change. A visual reminder may be helpful, like placing your toothbrush beside the sink as a reminder to brush every morning and evening before bed.

  6. Personal motivation: Motivation drives all behavior. External rewards like money or trophies can be effective in the short term, however, intrisic motivation (behavior driven by internal rewards) is more effective for sustained behavior change. Internal motivation can include things like wanting to see a child grow up, or being able to do a particular activity later in life. Understanding your “why” behind making a behavior change can provide indefinite support and motivation, as this represents a core value that resides solely within you. Some people may need more meaningful factors to motivate their behavior change, like wanting to see their child grow up. Regular reminders, such as support groups, accountability buddies, or app notifications can also help to keep you motivated in the long-term.

  7. Self-efficacy: Your confidence in your ability to make a behavior change. This also relates to the “attainable” criteria laid out by the SMART goal setting framework. As Henry Ford said, "Whether you think you can or you can't, you're right."

How long does it take to change a behavior?

One of the most common questions that surfaces when planning to make a behavior change is how long it will actually take for the new behavior to stick. The unpopular answer? It depends.

A study published in the European Journal of Social Psychology suggests that forming new habits can take anywhere between 18-254 days, with a median of 67 days. This is a huge range, suggesting that habit formation depends on many factors, including: the individual, their personal motivations, available resources, and the complexity of the habit being created. One important takeaway from that study was that missing one opportunity to perform a behavior did not significantly impact the habit formation process. The most beneficial factors in building new habits were consistency and repetition.

What can I do to successfully and sustainably change my behavior?

Whether we realize it or not, making sustainable behavior changes isn’t easy. But that doesn’t mean it’s impossible. Working with a healthcare provider, therapist, support of a community group, or friend is one way to ensure that you have ample support during the process. Following the guidelines laid out by the AAFP are also likely to improve your chances of success.

But there are other factors that may help you make sustainable and healthy behavior changes. According to a study published in the British Journal of General Practice (BJGP) in 2012, repeating your health-promoting behavior once daily in cue with your environment will increase your chances of implementing your behavior in the long run.

For example, if your self-chosen behavior change is to brush your teeth every morning, you can assign it to a daily cue, like after eating breakfast. This stimulus is sometimes referred to as the cue to action, but can also be called behavior stacking.

Additionally, research shows that the rate of automaticity (when an act or habit is formed or performed involuntarily or unconsciously) increases with simple actions, like drinking water, when compared with more elaborate routines.

There’s a lot to keep in mind when planning to make a behavior change. But you don’t have to do it alone. The experts at Forfend are here to help you find the right strategies for safely and sustainably improving your health and whole body wellness.


Empowering interventions to promote sustainable lifestyles: Testing the habit discontinuity hypothesis in a field experiment. (2015).

Encouraging Health Behavior Change: Eight Evidence-Based Strategies. (2018).

How are habits formed: Modelling habit formation in the real world. (2009).

Making health habitual: the psychology of ‘habit-formation’ and general practice. (2012).

The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. (2012).

The Health Belief Model. (2019).

The Theory of Planned Behavior. (2021).

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