Activation Versus Change as a Principle Underlying Intervention Strategies to Promote Health Behaviors

Abstract

Background and purpose: Interventions are effective in promoting health behavior change to the extent that (a) intervention strategies modify targets (i.e., mechanisms of action), and (b) modifying targets leads to changes in behavior. To complement taxonomies that characterize the variety of strategies used in behavioral interventions, we outline a new principle that specifies how strategies modify targets and thereby promote behavior change. We distinguish two dimensions of targets-value (positive vs. negative) and accessibility (activation level)-and show that intervention strategies operate either by altering the value of what people think, feel, or want (target change) or by heightening the accessibility of behavior-related thoughts, feelings, and goals (target activation).

Methods and results: We review strategies designed to promote target activation and find that nudges, cue-reminders, goal priming, the question-behavior effect, and if-then planning are each effective in generating health behavior change, and that their effectiveness accrues from heightened accessibility of relevant targets. We also identify several other strategies that may operate, at least in part, via target activation (e.g., self-monitoring, message framing, anticipated regret inductions, and habits).

Conclusions: The Activation Vs. Change Principle (AVCP) offers a theoretically grounded and parsimonious means of distinguishing among intervention strategies. By focusing on how strategies modify targets, the AVCP can aid interventionists in deciding which intervention strategies to deploy and how to combine different strategies in behavioral trials. We outline a research agenda that could serve to further enhance the design and delivery of interventions to promote target activation.

Keywords: Health behavior change; Interventions; Strategies; Taxonomy; Techniques; Theory.

Fig. 1.

Intervention strategies can modify two dimensions of targets: value or accessibility.

Fig. 2.

Intervention strategies modify the value or accessibility of targets via change or activation strategies. Note. Change strategies are from Duckworth et al. (2019) [right-angled rectangle], The Behavior Change Wheel (Michie et al., 2011) [oval] and the Behavior Change Technique Taxonomy (v1) (Michie et al., 2013) [rounded rectangle]. Activation strategies [solid and dotted hexagons] come from Duckworth et al. (2019), Michie et al. (2011, 2013), the TIPPME taxonomy (Hollands et al., 2017), and reviews of specific strategies (Finitsis et al., 2014; Gollwitzer & Sheeran, 2006; Harkin et al., 2016; Papies, 2016; Wilding et al., 2016).