The complexity of lifestyle change, motivation, and health among participants in a Healthy Life Centre

Background: Physical inactivity and unhealthy diet are lifestyle behaviours known to increase risk for non-communicable diseases and mental health problems, but many people struggle to overcome this lifestyle. Norway has established Healthy Life Centres (HLCs) to promote physical and mental health by supporting lifestyle change, mainly towards physical activity, diet, and quitting tobacco. The scope of the present thesis is lifestyle change related to physical activity and diet, and motivation for changes over time. There are, up to this date, only a few studies on the Healthy Life Centre setting. Aims: This thesis aims to contribute to increased understanding of the process and results of lifestyle change among participants in an HLC. Methods: The studies included in the thesis used both quantitative and qualitative designs, a longitudinal observational study followed by individual interviews. The baseline data were used in a cross-sectional study to describe the sample and compare it to other representative samples on physical activity levels and psychological distress. The longitudinal observational study investigated levels and characteristics of adherence to the service, and changes in lifestyle, motivation, and mental and physical health. In the qualitative study factors that participants in an HLC perceived as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and a healthier diet was explored. Results: A total of 120 participants were included in the cross-sectional baseline study (Paper I), and 66 and 50 participants adhered for 6 and 12 months respectively in the longitudinal observational study (Paper II). Out of the 50 participants adhering for 12 months to the longitudinal observational study, 14 participants were recruited for participating in individual interviews after 12 months (Paper III). The results revealed that the participants attending the HLC for the purpose of lifestyle change reported strikingly high levels of psychological distress (Paper I). The adherence rate at 12 months was 42%, and it was difficult to conclude concerning characteristics predicting adherence due to low statistical power. The adherers perceived the HLC to be supportive of basic psychological needs, and there were significant changes, of varying effect size, after 12 months: improvements in diet, improvements in motivation, and improvements in indicators of physical and mental health. Rather high baseline levels of moderate to vigorous PA levels were upheld. More surprising, sedentary behaviour did not decrease, and very low baseline levels of LPA did not increase (Paper II). The factors found as important for initiation and maintenance of lifestyle changes were: that the motivational basis for change was self-determined; the necessity of skills to cope with stress and challenges for emotional balance; and the necessity of specific skills to self-regulate in pursuit of goals (Paper III). Conclusion: The findings from the three studies reveal the complexity of lifestyle changes. The HLC was found to be supportive for the adherers in the process of lifestyle change, resulting in some indications of progress towards better health for the participants that adhered. Though the low adherence rates may indicate that a large proportion did not benefit from the services. Despite the service emphasising support of autonomy, competence, and relatedness, claimed by self-determination theory to be essential for motivation, many did not adhere throughout the year. Coping skills for stress and challenges and self-regulation skills was found necessary for initiation and maintenance of lifestyle changes, additional to autonomous motivation. This may reflect the obstacles of lifestyle change, especially under emotional distress. Future research should address the tendency for many to drop out. HLCs and similar services should address coping skills for emotional regulation. To address emotional distress and help the participants to cope better with frustrations and negative emotional experiences during their efforts for lifestyle changes could be one way to enhance adherence and the results of interventions to aid lifestyle change. In this way, the service can enhance participants’ competence in coping with stress and challenges in ways that are not maladaptive to health. By doing so, the HLC service can contribute to strengthening the individual’s capacity to govern their process regarding lifestyle, and to be self-determined rather than easily side-tracked, which will hopefully result in fewer giving up