Health Promotion Resolutions

Dyed-in-the-wool health promoters, on either side of a graduation are familiar with a theory called the Transtheoretical Model, sometimes also called stage theory.  There are just a few basic ideas needed to understand this theory.  People are at different points of readiness to change any particular health behavior: some are not interested in making a health-related change, some are in the process of changing, and some are trying not to relapse in their change.  The corollary is that health promoters must tailor their intervention efforts to the varying needs of people at different levels of readiness.  I want to relate this theory to New Year's resolutions.

It is customary for people to make pledges for self-improvement when they turn the calendar for the new year; often the intentions are health-related. Usually a price will be paid in doing something that takes discipline, changing time and schedule, and requires flexibility by significant others.  This tradition is still a good one:  Surely it is better to say "This year I want to quit smoking!" as opposed to "This year I want to put on 75 pounds!"  The problem of course is that most people have trouble carrying out their pledges.  Today we are one week into the new year and already the relapse curve is rising.  Why is it that doing good things for ourselves is so difficult?

We can think about this in terms of the Transtheoretical Model.  People who decide to make health-related changes are in a stage of readiness in which they are thinking about reasons to change and the benefits and barriers of doing so.  They are in that stage because of personal life events and broader social influences.  It is just by chance that their inclination to change coincided with the custom of New Year's resolutions.  Health  promotion agencies should be preparing people in November and December, so that when January rolls around they are in a frame of mind supportive of change.  This does happen, but the effort is not extensive enough to reach most people.

Continuing the theme of resolutions and theory, people more times than not will relapse.  It is not that the pledges were not genuine.  It was that they don't have the supports to move to the next levels of stage theory.  In order for people to act on their intentions, they need to have access to resources and must learn competencies and skills.  People are genuine when they say they want to lose 25 pounds in the new year.  What is lacking is a way for them to learn the necessary skills, such as how to grocery shop, plan meals, eat in restaurants, and obtain social support in ways that advance losing the weight.  Do they have access to safe places to exercise?  Without those things, their motivation isn't channeled into positive action. 

Another problem is that for many health-related changes, once the change is made and the goal is attained, communities don't provide resource and motivational ramparts to sustain the achievement long term.  We may say let people take care of their own stuff, and that is a legitimate point of view.  On the other hand, without communities taking a role in helping people, we can expect to see lots of health promotion relapse.  That is a choice society makes, but at the present time it is not an informed choice.

If you are a consumer trying to change, look for help in the surrounding community.  If you are a health promotion advocate, be the change you want to secure.