March 21, 2025
Thom Carroll/For PhillyVoice
People start their journeys toward healthy lifestyles at different points — and understanding that is key to applying tailored strategies to help them achieve their goals, new research shows.
Starting and sticking with a healthy lifestyle is tough. It's a complex proposition with multiple dimensions.
There are the challenges associated with behavior change and the difficulty of altering our daily habits, routines and rituals. Keeping true to new practices requires willpower and a level of self-control. On the plus side, if you find the passion for healthy behavior and leverage your internal psychological assets, you may develop the behavior quality of high achievers that one psychologist calls grit.
Exhausted already? Overwhelmed? A new study from Sweden offers some context for those aspiring to adopt healthy practices. The research suggests that each of us starts our journey at a different point — with some not even interested in the journey — and that a deeper understanding of that point is key to applying tailored strategies that extend beyond the one-size-fits-all approach that can lead to frustration and failure.
In the study, published in the International Journal of Qualitative Studies on Health and Well-Being, Swedish researchers describe how individual, interpersonal and environmental factors influence our health behaviors and how this understanding enables lifestyle strategies to be tailored to an individual's ecological needs.
In short, the circumstances of our lives can be viewed as our personal ecosystems with social, emotional, physical and other factors influencing our perspectives on healthy behaviors. The scientists call this health identity. Understanding our health identity — where we start on our journey — is an important first step in crafting a plan for long term success.
The research is based on in-depth interviews with 17 middle-aged adults who were enrolled in a community-based, cardiovascular disease prevention program in Northern Sweden designed to motivate healthy habits. It focuses on the "central role" that behavior plays in influencing health, and the complexity of the underlying factors.
The connection to activities that directly impact health — like the link between smoking and lung cancer — is clear. But a person's social activities and engagement with others, and factors like social media, create more complicated interpretation.
The researchers cite the persistence of people to smoke or eat junk food despite knowing these habits are unhealthy as evidence that information alone does not influence behavior or transform into action. Though there are numerous models anchored in individual psychological interventions and group-based interventions proposing cognitive, community and even worksite approaches to behavior change, the researchers suggest the complexity of the challenge requires consideration of individual and social strategies, perhaps in tandem.
The social-ecological model examined in the study is very much woven into a contemporary concept in health known as social determinants of health. As referenced in the study, the World Health Organization defines social determinants of health as "the conditions in which people are born, grow, live, work and age, including the health system."
The study describes these factors as "the causes of the causes" or the "root causes" behind our behavior. The impact of these social factors on health aligns strongly with the notion of complexity embedded in the multi-level, social ecological models advocated in the study. The alignment lends further support for approaching any behavior-influencing interventions on a more comprehensive basis with individual and social tactics. Unfortunately, as the study notes, research on social ecological health promotion interventions is scarce.
The interviews conducted for the study produced three categories of health identity centered around obstructing and enabling factors for health behavior changes.
Researchers define the first category as people who make health the main priority of their lives. It is the most common identity in the study and, not surprising, contains few barriers to health behavior change. Respondents express a devotion to a healthy lifestyle, with a determination to reach their health goals. They view setbacks as normal and are inclined to remain positive and conquer any obstacles.
These people view exercise as a priority and an enjoyable part of their daily routines. They value their social networks and relations with family and friends – with family being the most important. Social support is seen as essential to their health, and they recognize that sometimes this takes the form of tough love that includes ultimatums for change. Having a "training buddy" is common and perceived as quality time away from family life.
The second identity type is people who let life stand in the way of their health. These people acknowledge a need for health behavior change, but cite a challenging life situation as the reason for their conclusion that there was no possibility that this would happen. They see few options for attending to healthy practices and place the well-being of others before themselves.
For them, physical activity is only possible if they can overcome their challenges. They lack time for investments in their own health, or for socializing with family and friends, due to stressful daily routines, caring for family members with health problems and the struggle to manage obstructions. They find socializing unappealing because they believe others can not understand their situations. But they find socializing online to be valuable and acceptable compensation because access is less demanding.
The third group of people reject the need for health behavior change, because health is not a major concern in their lives. Independent-minded, they express no concern for the opinions of others. They acknowledge that they do not practice good health behaviors, and may be overweight or physically inactive. But they have no motivation to change, because they feel fine. Further, they are skeptical about achieving meaningful results, in some cases having tried and failed. Socially, they express limited social needs and a preference to remain independent, whether at work or relaxing alone at home to relieve stress.
The researchers conclude that health identities can be a useful tool for understanding the unique characteristics within a person's health ecosystem. I agree. Among the men I've studied, each have their own stories, and while there are some common denominators, any effort to adopt healthy practices needs to confront their obstacles and build on the resources they have to enable healthy living.
With only 17 people participating in the study (13 women and four men), the findings should be viewed through the lens of preliminary research, but a contribution to the dialogue of behavior change, nonetheless. My purpose is to give those struggling to adopt a healthy lifestyle as much perspective as I can.
By reflecting on your health identity and inventorying the elements of your behavioral ecosystem, you'll be better positioned to tailor a strategy that produces a fulfilling and sustaining lifestyle. Think of these concepts as a couple of new tools in your healthy behavior toolkit and put them to work building the lifestyle you've always wanted.
Louis Bezich, senior vice president and chief administrative officer at Cooper University Health Care, is author of "Crack The Code: 10 Proven Secrets that Motivate Healthy Behavior and Inspire Fulfillment in Men Over 50." Read more from Louis on his website.
