Section 7. Supporting and Maintaining Behavior Change

Learn how supporting behavior change can take many forms, all aimed at making it easier for people to take action.

 

Many smokers looking for an easy way to quit have tried the patch, an adhesive pad that allows them to absorb nicotine through the skin. In theory, the nicotine in the patch initially acts as a substitute for cigarettes, to help them stop smoking. As their craving for cigarettes themselves diminishes, they use patches with diminishing amounts of nicotine until, eventually, they don't need either cigarettes or the patch: they've quit!

It sounds easy, and that's why many people try it. Unfortunately, relatively few of them successfully stop smoking, unless they're part of a structured program that includes education and group and individual support. It's hard to take that first step to stop smoking; it's a great deal harder to stick to it without support.

Just about everyone either knows or is a person who's concerned about his weight. The cycle of dieting, losing weight, starting to eat "normally," regaining what was lost, and dieting again has become totally familiar, the subject of sitcom jokes and conversation among friends. Perhaps a majority of Americans have been on diets at some point in their lives, and many or most have lost weight. But most gain the weight back within a year, and the U.S. remains the home of the most overweight population of any developed country in the world.

As these examples make clear, behavior change isn't just a matter of decision. All those smokers really do want to quit permanently, and all those dieters really do want to lose weight and keep it off. In most cases, however, they need help. If you want to make sure that your social marketing campaign is effective, you not only have to convince people to take action, but you have to support them as they do, and then you have to help them maintain the change once they've made it.

Note: This section, like the others in this chapter, assumes that you have done your market research. Listening to what your target audience has to say and responding to it is a cornerstone of social marketing. In this circumstance, it will tell you what makes it difficult for your target audience to take action or maintain behavior change

What do we mean by supporting and maintaining behavior changes?

Supporting behavior change, in simplest terms, involves helping to create or provide the environment, circumstances, equipment, information, and the logistical and psychological assistance that make it possible for people to take action to change their behavior. As we'll discuss later in this section, that support can take many forms, but they're all aimed at making it easier for people to take action.

Maintaining behavior change, on the other hand, goes on after the initial action has been taken. Often, that action is only the first step. Going on a diet, for instance, doesn't mean the dieter has accomplished the change he wants. That has only happened when he has reached his ideal weight and can stay at that point indefinitely. In order for that to happen, he may have to change a number of behaviors permanently: eating habits, exercise patterns, alcohol consumption, perhaps even where and with whom he eats lunch, or where he takes vacations.

Your social marketing campaign can't be successful unless it can help people maintain their changes over time. That may require some of the same kinds of support that action does, as well as helping people learn new skills and acquire other attributes that contribute to their ability to sustain the changes they've made.

What types of behavior changes need to be supported and maintained?

There are essentially four types of behavior change, each requiring a different approach to support and maintenance. Recognizing which type you're hoping to encourage will help you choose a strategy to make that change more probable.

One-time changes. The change may be permanent, but it requires only a single action to accomplish it. With one-time changes, you may have to provide support, but once the action has been taken, maintenance isn't an issue (although follow -up psychological support may be). Some one-time changes:

• Getting a vasectomy
• Donating a kidney
• Making an emergency donation for disaster relief
• Registering to vote

Repeated, but finite changes. This type of change requires more than one action, but has a definite end point, when the actions can cease. In this circumstance, support for the change itself is important, but help with maintaining the change until the goal is reached is even more so. Because the goal is defined and limited, it is relatively easy to find out what people need to keep moving, and to try to provide it. Examples of this kind of change include:

• Getting a child the appropriate immunizations
• Undergoing cancer treatment
• Earning a certificate in a job training program

Permanent lifestyle changes. These changes need to be sustained forever if they're to be effective. Here, obviously, support for both action and maintenance are crucial. The action may be hard to take just because it looks so daunting; changing a whole lifestyle is not the same as sending one check or signing a voter registration card. By the same token, once the action has been taken, the idea of having to keep at it forever - especially at a time when it still seems unfamiliar and difficult - can be overwhelming. Your campaign should be providing as much help as possible to keep people focused. Permanent lifestyle changes might entail:

• Adjusting eating and exercise habits to maintain ideal weight and fitness
• Keeping abreast of political issues and casting an informed vote in every election
• Recycling, composting, conserving electricity, and other environmentally-conscious practices
• Quitting smoking

Situational changes. Changes that need to maintained over the long term, but only require action in certain situations. Although these actions don't need to be performed constantly, they really need to be treated as a combination of all three other types. They are new, one-time actions each time they come up; they must be repeated each time a member of the target audience is in the appropriate situation; and they have to be continued indefinitely if they are to have the desired effect. Thus, they require both continuing support for specific action and ongoing encouragement and facilitation for maintenance. Some examples:

• Appointing a designated driver
• Practicing safe sex
• Using car seat belts

What are barriers to taking action and changing behavior?

There are specific barriers to every kind of socially desirable behavior change; if there weren't, you wouldn't need social marketing at all. Most of those barriers fall into one of six types:

The change is impossible, as the situation stands. Some of the reasons for this may be:

• Geography. In rural areas, in places where there are physical barriers, in cities where some neighborhoods or areas are unsafe, it may simply be impossible for people to get to where they need to be in order to implement the desired change.
• Economics. The change may simply cost more money than most or all of the target population can afford or is willing to pay.
• The tools for change are unavailable. Sometimes, making the desired change means using a device (an asthma inhaler, for instance), gaining a skill, getting treatment, joining a support group, or doing something else that requires a product, program or service. If that product, program, or service doesn't exist, either literally (i.e. there's none in the area) or because it's not accessible to the target population, then change is unlikely.

A Boston English-as-a-Second-or-Other-Language (ESOL) program, the only one in the city designed specifically for Cantonese speakers, had a waiting list of three years. For the thousand or so people on that waiting list - and others who didn't bother to sign up because the list was so long - there might as well have been no program at all.

• Circumstances. Before they can make the desired change, people may first need child care, handicap accessibility, information, or some other foundation or form of support. If this isn't obtainable, change may not be obtainable, either.

The change is too complex. This may mean that it requires too many steps, and is therefore difficult to learn; that it is too detailed for the education level of the people expected to do it; or that it requires physical or other skills beyond the reach of many members of the target population.

A young American worked with a West African non-governmental organization (NGO) on a project to teach villagers to use e-mail and the Internet. The project was meant to link rural people to one another, and to make possible large-scale cooperation among them. The American started out to train a few carefully chosen young people, who would then become the trainers for their villages.

He found out quickly that, although the trainees were bright and willing, they started with no knowledge of what the Internet was, or what computers did. The project's organizers were so eager, however, that they ignored the American's suggestions to lengthen the training course in order to provide some background knowledge. As a result, the project fell far short of its goals, with only one of the trainees absorbing enough to pass on what he had learned. The process as it was designed was simply too complex for the experience of the trainees.

The change is too hard to expect people to be able to accomplish on their own. Some of the behavior changes that people are often asked to undertake - stopping substance use, or changing eating habits, or exercising regularly - require an amount of drive and self-discipline that many people may not have. Some people can do it on their own, but most need help in order to make the change and to learn how to call up the resolve that will make them successful over the long run.

The change takes too much time. "Time" here can mean a number of things.

• The change can take too much of a block of time. People may not be willing to commit to a neighborhood clean-up or fixing up dilapidated housing if they have to commit to several days or weekends in a row, whereas they may be more than willing to commit to one or two.
• The change can take too much time on a regular basis. Mentoring a youth may be seen as taking an overwhelming number of hours per week. People may not see how they can fit a regular exercise program into their schedules.
• The change can simply take too long overall. Losing a large amount of weight in a healthy way, for instance, can take many months, or even years. Many people may see that as impossibly difficult, and not worth attempting.

The change is not important enough to the target population for them to want to engage in it. They either don't understand its importance, or they don't consider its benefits important enough to convince them to take action, or they don't see it as applying to them. Whatever the reason, they don't see it as a priority.

The target population forgets to perform the action that the change requires. When repeated action is necessary - taking pills at regular intervals, doing physical therapy exercises, keeping appointments, writing in a journal - it may be difficult for people to remember to take it each time.

At least one of these barriers probably exists, at least potentially, for any desired behavior change and for any target population. Addressing the barriers so that change can take place smoothly and easily should be part of any social marketing campaign.

How do you address barriers to action and support behavior change?

While every situation has its own peculiarities and specific barriers, there are some guidelines for dealing with each of the types of barriers described above.

If change is impossible in the present situation, try to do something about the issues that make it impossible.

Geography. Some possible solutions to the geography problem:

• Arrange, provide, or subsidize transportation.
• Change services, meetings, etc. to a more convenient location.
• Bring services to the target population, where possible.

Bookmobiles and mobile clinics were instituted to reach those who couldn't or wouldn't come to libraries or health centers, often in rural areas.

• Use technology - teleconferencing, e-mail, chat groups, telephone conference calls, Internet- or TV-based courses - to get around distance issues.

Economics. Subsidize, reduce, or eliminate costs:

• Get a grant
• Find a cheaper and/or more efficient way to approach the issue
• Scale down the scope of service, on the assumption that it's better to have a lot of people participating in a reduced service than no one participating in a more comprehensive one.
• Look for used or reconditioned equipment, solicit donations of products and equipment from corporations, or join a service that can help you get free or cheap products and equipment.

NAEIR (the National Association for the Exchange of Industrial Resources) collects donations of new equipment and products from corporations and makes them available almost free (you pay annual dues - in 2001, $575.00 - and shipping and handling) to non-profit entities

The tools of change are unavailable. You can either try to provide what's unavailable, or find an alternative source.

• Try to get donations of unavailable products or services.
• Start or collaborate with a program that can help people gain the skills they need to take the desired action.
• Find an alternative way to provide services.
• Conduct an advocacy campaign to make products or services available to the target population.

The Boston ESOL program with the long waiting list employed both of the last two methods listed. It developed a tutoring component using videotapes and tutors recruited from among the ranks of advanced students and recent graduates. People on the waiting list could use the videotapes to start their study of English, going at their own pace, and working with a tutor weekly or biweekly. At the same time, the program used the size of its waiting list to advocate with the Department of Education and the state legislature for increased funding. Within a year and a half, the waiting list had been reduced to fewer than 200, and the tutoring component had become so successful that it had been made a regular part of the program.

Circumstances. Change the circumstances to make change possible. For example:

• Provide or subsidize child care.
• Move to, or provide supplementary services at, a handicapped-accessible location.
• Provide the needed information on posters or fliers, on radio, in newspapers, on local-access cable TV, door-to-door - whatever's necessary to make sure that people have what they need in order to take the action you're marketing.

If the task is too complex, simplify it as much as possible. Some ways to accomplish that:

• Teach complex skills through step-by-step mastery: people learn each step in a complex process separately, completely mastering each step before they go on to the next.
• Look for ways to eliminate steps: some may be unnecessary or repetitive.
• Find simpler ways to accomplish the same thing.
• Scale back the extent of the change to make it more reachable.
• Start your process at a lower level, in order to provide the background that will make it possible for the target audience to understand and take the sought-after action.

In the box above about the West African NGO, if the training course had allowed the time for trainees to gain enough background knowledge, it is likely that many or most of them would have successfully learned enough to become trainers in their villages.

 If the change is too hard for people to make on their own, provide support to help them accomplish it. There are a number of ways you might go about this:

• Organize and run - or refer people to - support groups. Smoking cessation programs, for instance, usually operate in this way, as do AA and most other 12-step or similar programs. Group support helps people understand they're not alone in their difficulty with change, and gives them allies in their struggle. Group members help one another to hold on to their resolve.
• Provide mentoring, the one-on-one equivalent of group support. Mentors call regularly, help with strategies to keep to the new behavior, and provide the human contact and reinforcement that many people need in order to stay with change.
• Set up a phone hotline that people can call (or even an Internet chat room that they can visit) when they're having difficulty.
• Provide classes or programs that help people gain strategies and understand the change and its implications for them and those around them.
• Set up, or encourage members of the target population to set up, groups that simply engage in the new behavior together. A group of women who walk or work out together every day is not necessarily a support group, but its members do support one another in sticking to the exercise routine. In addition, and perhaps more important, exercising with friends makes it far more pleasant, and more likely to become a welcome part of everyone's day.

If the change takes too much time, try either to cut the time down or to change the perception of what constitutes "too much time." A few ways to accomplish these ends:

• If the block of time you had in mind is too long, try shortening it or making it more flexible. Instead of two whole weekends, start with a smaller neighborhood cleanup that occupies a single day, or give people the option of coming for whatever time they have. If you can organize it so that people have a good time and feel they've accomplished something, they'll probably be willing to come back and finish the job.
• If a regular time commitment seems overwhelming, make clear what the actual time commitment is (one afternoon of mentoring a week, 40 minutes of exercise a day), and help people compare it to other types of commitments to see if it's really too great. If it is, can it be reduced?
• If the span of time is the problem, break it down into smaller, more realistic chunks. Rather than focusing on losing 100 pounds, a dieter can start by trying to lose five or ten, then five or ten more, etc. That way, a goal that's reachable within a reasonable time period is always in view.
• Suggest ways to combine new behavior with other tasks or activities. People can get part of their exercise by walking up and down stairs instead of taking elevators at work, for instance, or engage in advocacy by handing out fliers and talking to potential supporters in the course of a daily walk.
• Try to minimize the time element of a behavior change by teaching (or practicing, depending on the situation) time management, more efficient planning, creative scheduling, etc.

 If the change isn't important to members of the target population, try to change their perceptions about it.

• Find reasons for change that they'll respond to. Smokers may not be willing to quit for their own health, for instance, but may be more receptive to arguments about the effects of secondhand smoke on their children.
• Make sure that members of the target group have all the available information about the benefits of the change, and the drawbacks to its alternatives. They may need more information to understand why the change is important.
• Point out specifically how the change in question will affect the target population, and why it's relevant to them.
• Try to get community opinion leaders and other influential people to spread the word.
• Look for creative ways to present your message - street theater, for example.

If people keep forgetting to take action, institutionalize reminders, so they're more apt to remember.

• Along with medication, give out compartmented pill boxes marked for each day of the week or month, and show people how to use them.
• Give people pre-printed adhesive notes to post around the house to remind them of what it is they need to do.
• Arrange for a support group phone tree. One person calls another to remind her; that second person then calls a third, who calls a fourth, and so on until everyone in the group has been called.
• Teach people how to organize things to make remembering more probable. If you put the healthy snacks right in the front of the refrigerator or cabinet, you're less likely to forget and reach for the junk food. Better yet, if you don't have any junk food in the house, you have to make a conscious decision to go out and get some.

What are barriers to maintaining behavior change?

So the folks who are the targets of your campaign have, perhaps, embarked on an exercise program. How do you know they'll keep it up over the long term, and not revert to their former, couch-potato selves?

The key to maintaining a new behavior is the level of satisfaction that members of the target population have with the change. Here's yet another area where market research is extremely important. You have to monitor people's satisfaction, and act if it starts to dip. Both your marketing strategy and reality can be adjusted here. In other words, if people start to become dissatisfied with the results of the behavior change they've made, you can either find new ways to persuade them to keep going, change the circumstances or environment to make sticking to the change easier and more compelling, or both.

The major barriers to behavior maintenance are the possible sources of the target population's dissatisfaction with the action they've taken. Satisfaction and dissatisfaction are largely based on expectations: if their positive expectations for behavior change are fulfilled, then people tend to be satisfied; if reality falls short of expectation, or if significant negative consequences crop up, then dissatisfaction usually follows.

The behavior change has unsatisfactory consequences. The results of the change they've made isn't dramatic or visible enough to the target group, or isn't what they've expected.

• The expectations for change are too high. A dieter may have hoped to lose ten pounds a week; an alcoholic may have thought that once she stopped drinking, all craving for alcohol would go away; an activist might have expected that one campaign would lead to instant social change. If expectations are too high, they won't be met, and people can feel that the changes they made were useless.
• The outcomes of change are hard to detect. Improved cardiovascular health isn't immediately visible, and may never be detectable without an angiogram, or at least a blood pressure measurement. Contributors to organizations may see no apparent changes as a result of their donations. If there is no apparent result from the actions that people are asked to take, they can easily feel those actions are unnecessary.
• The outcomes of change may be deferred for a long period. Smokers' lungs may take as much as a year to clear after they've quit. Pollution cleanup or other environmental recovery may take decades or generations to be completed. Continuing action may seem futile in the face of such distant goals.
• The desired outcome is the absence of something. The Y2K situation is a prime example. The action that so many corporations and government agencies took to prevent a computer crisis on Jan. 1, 2000, was seen as largely unnecessary, because there was no disruption at all. It may be, however, that without that action, the disasters that many scientists predicted all would have happened. The situation is similar for immunizations: many untreated children never get the diseases that immunizations are meant to prevent, so it's hard to see whether they have done any good or not in a specific case.

The behavior change has excessive negative consequences. Negative consequences can quickly quell enthusiasm for maintaining behavior change. There are really two kinds of negative consequences: expected and unexpected.

• The (expected) negative consequences were underestimated. The side effects of that blood pressure medication were far greater than the target population was prepared to accept. The cleanup of that polluted area cost more than anticipated, and resulted in a tax increase.
• There are unexpected negative consequences. A job trainee is overwhelmed by her spouse's anger and resentment at her gaining skills and independence. Regular exercise brings on muscle strains and joint problems.

Important people provide negative feedback. The behavior change causes friction in the community, or brings on the disapproval of family, friends and neighbors, or people who are socially or culturally significant to members of the target population (clergy, business leaders, elected officials, etc.) This can range from an ex-smokers' friends expressing disappointment that he never takes breaks with them anymore, to a conservative religious or cultural group casting out one of its members who has adopted a mainstream practice.

Control over the new behavior is less than expected. This may happen either because of the system involved or because of the members of the target population themselves.

• The system. The system in this case could be an intervention that's badly planned, and therefore doesn't provide adequate services to participants; a delivery system that makes it difficult to get a needed product (condoms, medication, etc.); services that are inaccessible (a clinic or program whose hours are inappropriate for the population it serves, for instance) or inhospitable; life circumstances that make maintaining action impossible (mandatory overtime at work, or inability to find child care); or an unsympathetic social system (opposition or lack of support from family members, or sabotage of the change by friends).
• The self. Maintaining the behavior is harder than anticipated, or is tied into other unresolved psychological or personal issues.

Alan Andreasen, in Marketing Social Change, mentions an important consideration. We know a fair amount about what keeps people from acting, but very little about what spurs them to act. If we could better understand what motivates people, we could be far more effective in encouraging behavior change.

How do you address barriers to maintaining behavior change?

We will discuss some ways of addressing each of the barriers above, but first, there are some general guidelines for maintaining behavior change that should be mentioned.

General guidelines for maintaining behavior change

• Try to anticipate and plan for potential problems and issues. Use your market research, brainstorming, the literature, and talking to other individuals and organizations who've conducted similar social marketing campaigns to foresee as many possibilities as you can. If you have some idea what factors might get in the way of people's sticking to their changes, you can adjust your campaign and organize reality to neutralize those factors before they become problems.
• Honesty is not just the best policy - it's the only policy you should consider. Make sure that people have all the information they need - potential side effects of medication, possible consequences of actions they might take, etc. - so they won't be surprised by anything that happens. Help them understand whether potential consequences are unchangeable, or whether there's a Plan B to deal with them. Work with them to plan what they and you might do if particular consequences do occur. If they feel that they have been treated honestly, and if they feel they can have some control over the situation, they're much more likely to work to maintain their behavior changes.

How to deal with different types of barriers to maintaining change

Note: Initial honesty can head off all the different types of barriers listed under "unsatisfactory consequences" and "unexpected negative consequences," because it will help the target population understand the reality of what to expect. It should be understood that honesty about what to expect is the first remedy for each of these barriers. It should also be understood, however, that no matter how honest and careful you are, many people will ignore or reinterpret or not understand the information, and you'll still have to deal with their dissatisfaction.

Unsatisfactory consequences.

• Expectations are too high. In addition to trying to be realistic initially about what is possible, you can help by monitoring and calling attention to actual progress - regular weight checks, a newsletter detailing evidence of the results of social activism, etc. It might also be helpful, if the information is available, to look at the "average" amount of time it takes to accomplish a particular change - ideal weight loss per month, the amount of time it typically takes to get a bill passed, etc.
• Outcomes are hard to detect. Where possible, make hidden benefits visible. Give or lend people blood pressure cuffs, and show them how to use them, for example. Explain to contributors exactly where their money is going, and what would happen, or not happen, without it. Where there are no results - the blood pressure medication isn't working - discuss alternatives. You may need a combination of medicines before the desired outcome is achieved, or there may be another way to approach the problem.
• Outcomes are deferred. There are a number of strategies in this case.
  
  • Where possible, create interim benchmarks to track progress over time. Smokers might take monthly lung-capacity tests, for instance, and see incremental improvement, even if they were still experiencing some breathing difficulty; or they might keep a running total of the money they save by not smoking.
  • Marketing can emphasize the long-term benefits of change to members of the target audience themselves and/or to society.
  • Marketing can also use "hang-in-there" messages to try to keep people focused on maintenance.
• The outcome is the absence of something. Here, your marketing should make clear the consequences of the presence of whatever the desired change is meant to prevent.

An example of this comes out of the September 2001, headlines. In the wake of the World Trade Center disaster, airport security will be increased, leading to longer lines, longer waits at terminals, and less time advantage to flying. The consequence of all this inconvenience, if it's successful, is that nothing will happen - no hijackings, no crashes, no news. It's only a matter of time until everyone starts to complain... but if the security is reduced, the chances of further terrorism will increase. It will be important to keep reminding people of what can happen if airport security becomes lax, or it will become lax again.

Excessive negative consequences.

For both underestimated and unexpected negative consequences, the best remedy is forewarning. If people have as much control as possible over the situation, they're more likely to keep trying to maintain their behavior.

• The negative consequences were underestimated.
  
  • Provide information about what's happening and what might happen. It's particularly important to let people know if other courses of action are available, and what they are. There might be an alternative blood pressure medication to one that's causing depression, for instance, or there might be other ways to address blood pressure. The cost of not completing that environmental cleanup, on the other hand, may be greater even than the unexpected cost of completing it.
  • Provide tools - skills, training, education - and support for dealing with specific negative consequences. Teaching relaxation techniques or meditation might help people deal with the worse-than-anticipated physical and mental stress of quitting smoking, for example.
• There are unexpected negative consequences. You can't foresee every possibility, but you can forewarn people that there might be unexpected negative consequences, so they won't come as a complete shock. As above, you can provide support and tools to help the target population deal with unexpected consequences. Once again, an alternative medication might be substituted, for instance; family counseling could be made available to help spouses adapt to the changes in roles that might come with literacy or job training.

Important people provide negative feedback.

The ideal here is to use your market research to find out who the target audience's important people are, and to market the change to them as well. It's a lot easier to do this from the start of a campaign, rather than to use marketing to attempt to correct a wrong or negative impression after the fact. If you can get the support of people important to the target population from the beginning, you'll not only reduce the probability of this source of dissatisfaction, but you'll greatly increase the probability of your campaign's success.

Control over the new behavior is less than expected. The system and the self - the two sources of lack of behavior control - are strongly interconnected. If you can set up a system to support people's motivation, self-control, and abilities, they're apt to be able to maintain their behavior changes.

Support groups and mentoring, already discussed above, are among the best ways to help the target population develop the skills to maintain changes on their own. Alcoholics Anonymous, Weight Watchers, and other similar groups have their own styles, but they all essentially work because of peer support, skills training, structure, and immediate help, reinforcement, and feedback when they're needed.

Support and structure (and someone to call to help in resisting temptation) give people someone and something to lean on at the beginning, when change is often hardest. Skills training enhances personal resources and develops self-discipline. Together they address both the system and the self to create a solid foundation upon which long-term maintenance can be built.

Some programs use rewards other than the mere satisfaction of behavior maintenance and its benefits. This can sometimes be effective, but there's always a danger that the rewards themselves become the reason for maintaining behavior. If that's the case, the change is unlikely to last, because it's not internal. As soon as the rewards stop, there's no more reason to sustain the change.

In Summary

There are two steps to cementing behavior change: the first is to take the action that leads to or represents behavior change; the second is to maintain that action, or the change it brings about, over time. A social marketing campaign has to include strategies for helping people both make and maintain the desired change.

Changes usually fall into one of four categories:

• One-time changes
• Repeated, but finite changes
• Permanent lifestyle changes
• Situational changes

Each type of change requires a different type, or combination of types, of support.

Common barriers to initiating change include:

• Action is impossible because circumstances won't permit it.
• The necessary action is too complex.
• Action is too hard for people to undertake on their own.
• The action takes too much time.
• The action isn't important to the target population.
• The action keeps being forgotten.

You can remove those barriers by, in each case, doing something about the issue that creates the barrier:

• Address the issues that make action impossible (change the circumstances).
• Simplify the action, either by breaking it down into manageable pieces, or by providing the background necessary to understand it.
• Support people in taking difficult action.
• Use more efficient or more creative and flexible planning and scheduling to minimize the importance of the time element.
• Increase the target population's perception of the urgency of the action.
• Institutionalize reminders so that people can remember to act.

Barriers to maintaining change are largely based on dissatisfaction with its consequences.

• Consequences are unsatisfactory.
  
  • Unrealistic expectations aren't met.
  • Outcomes are hard to detect.
  • Outcomes are deferred.
  • The outcome is hard to see because it's the absence of something.
• Negative consequences are seen as excessive, because they were either underestimated or totally unexpected.
• Important people provide negative feedback about the change.
• Behavior control is less than expected because of either the system or people themselves.

Dealing with these barriers requires anticipation of potential problems and complete honesty with the target population from the beginning. In addition, there are some specific remedies for each of the barriers described:

• Unsatisfactory consequences:
  
  • Clarify realistic expectations.
  • Make the invisible visible, or adjust the behavior to obtain the desired results.
  • Break a long-term goal up into manageable pieces, with benchmarks.
  • Emphasize the consequences of dealing with the presence of what's being prevented.
• Help people control negative consequences with information, alternative plans, and skills.
• Market to important people as well as directly to the target population.
• Set up the system to provide support and help develop personal internal resources.

If you can, with the aid of market research, overcome these barriers, your campaign should achieve success.