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Review: lasting health behaviour changes began with critical self appraisal and small steps that led to an identity shift

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Q What are the key influences and processes that enable people to make lasting health behaviour changes (eg, in diet, exercise, smoking cessation, and substance abuse recovery)?


Studies were identified by searching CINAHL, Medline, Sociofile, and PsycLIT and by hand searching relevant journals (to 2000).


Articles or dissertations were selected if they were qualitative reports, addressed turning points or a process of change in health behaviour over time, and were grounded in or supported by observational or verbatim qualitative data. 2 reviewers independently coded study findings in categories of main concept, pre-change influences, turning point, and steps in the change process. Categories were refined through discussion as inductive coding and analysis unfolded.


14 studies (399 participants, 73% women; 6 studies on weight loss and cardiovascular risk reduction, 6 on …

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  • For correspondence: Dr M H Kearney, William F Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.

  • Source of funding: no external funding.