What Is Slowing Us Down? Six Challenges to Accelerating Advances in Health Behavior Change

Background Accelerating advances in health behavior change requires releasing the brake, as well as applying the throttle. This paper discusses six challenges or brakes that have slowed progress. Purpose/Methods/Results We engage with six issues that limit investigators' ability to delineate and test the strategy-target and target-behavior relations that underlie effective interventions according to the experimental medicine approach. We discuss the need for guidance on how to identify the relevant mechanism of action (target) in an intervention and whether a periodic table of health behavior constructs might aid investigators. Experimental and correlational analyses (prospective surveys and behavior change techniques) have been used to test the validity of targets, and we present evidence that there is little agreement among the findings from different research designs. Whereas target engagement is typically analyzed in terms of increasing scores on constructs that impel behavior change, we discuss the role of impeding targets and the benefits of adopting a broader construal of potential targets and approaches to engagement. There is presently a paucity of competitive tests regarding which strategies best engage targets and we discuss empirical criteria and conceptual developments that could enhance the evidence base. Finally, we highlight the need to take context or conditional intervention effects more seriously by leveraging the interplay between questions about why interventions work and questions about when and for whom they work. Conclusion Candid appraisal of the challenges facing research on health behavior change can generate new opportunities for theoretical development and offer direction and cumulative impetus for empirical work.