What do we mean by supporting and maintaining behavior change? What types of behavior changes may require support? What are barriers to taking action and changing behavior? How do you address barriers and support action? What are barriers to maintaining behavior change? How do you support behavior over time? Deciding to change a behavior is often only the beginning. People may understand the benefits of a behavior and genuinely want to act, yet still encounter practical, financial, social, health-related, or structural barriers that make action difficult. For example, a person who wants to stop smoking may benefit from evidence-based cessation medication, counseling, quitline support, digital tools, encouragement from others, or a combination of approaches. The difficulty of quitting does not mean that the person lacks motivation or self-discipline. Nicotine dependence, withdrawal, stress, social environments, routines, access to treatment, and other factors can all affect the process. Similarly, someone working toward nutrition, physical activity, or other health goals may need more than information or motivation. Time, cost, chronic health conditions, neighborhood conditions, food access, caregiving, work schedules, stress, disability access, and other factors can affect whether a behavior can be initiated and sustained. Effective social marketing therefore does more than encourage people to act. It also considers what capability, opportunity, services, resources, environments, relationships, and ongoing support are needed to make beneficial behavior realistic over time. What do we mean by supporting and maintaining behavior change? Supporting behavior change means helping create the conditions that make action possible. Support may involve information, skills, services, treatment, financial assistance, accessible environments, transportation, reminders, technology, social support, changes in organizational practice, or policy changes. Maintaining behavior change means supporting beneficial behavior after it has begun. Maintenance does not necessarily mean that a person must perform a behavior perfectly or continuously for the rest of life. Behaviors may change as people's health, responsibilities, environments, resources, relationships, and priorities change. Some people may experience lapses or recurrence and later re-engage. A useful strategy helps people continue, adapt, or resume beneficial behavior rather than treating anything short of uninterrupted performance as failure. Contemporary behavioral approaches often consider the interaction among: Capability: Does the person have the knowledge, skills, physical ability, and psychological capacity needed? Opportunity: Do the person's environment, resources, services, relationships, and circumstances make the behavior possible? Motivation: Does the person see value in the behavior, intend to act, and have habits or expectations that support it? Social marketing can use this kind of analysis alongside audience research, exchange, competition, social influence, service design, and other approaches. What types of behavior changes may require support? Behaviors differ in how frequently they must occur and how long support may be needed. The categories below can be useful for planning, although not every behavior fits neatly into one category. One-time actions Some goals require a single action. Examples might include: Registering for a service Installing a smoke or carbon-monoxide alarm Making a disaster-relief contribution Completing an advance directive People may need information, transportation, assistance completing forms, financial support, accessibility accommodations, or other help to take the initial action. Follow-up may also be appropriate even when the behavior itself does not need to be repeated. Repeated but time-limited actions Other goals require several actions over a defined period. Examples may include: Completing a workforce or educational certificate program Participating in a scheduled series of health or rehabilitation appointments Completing a multistep application or enrollment process Participating in a time-limited community project Support may need to continue throughout the entire process. A person who can attend the first session but cannot obtain transportation for later sessions has not been adequately supported simply because participation began successfully. Ongoing behaviors and practices Some beneficial behaviors are practiced repeatedly over long periods. Examples might include: Maintaining tobacco cessation Participating in regular physical activity appropriate to one's health and ability Following a sustainable nutrition plan Conserving energy or reducing household waste Participating regularly in civic or community activities Following an ongoing treatment or self-management plan developed with appropriate health professionals Long-term support may involve habits, social networks, services, environmental changes, treatment, reminders, feedback, and opportunities to adapt the behavior as circumstances change. Recurring or context-dependent behaviors Some behaviors are needed only when particular situations occur. Examples might include: Using a seat belt on each vehicle trip Arranging a sober driver or alternative transportation when alcohol will be used Using appropriate safer-sex and sexually transmitted infection prevention practices Following emergency or safety procedures when a relevant situation occurs These behaviors may require preparation, reminders, access to necessary resources, supportive norms, and an environment in which the safer choice is practical. What are barriers to taking action and changing behavior? Barriers vary substantially by behavior, audience, community, and environment. Formative research can help identify which barriers actually matter rather than assuming the answer. The behavior is inaccessible or infeasible under current conditions A person may want to act but lack a realistic opportunity. Barriers may include: Transportation and geography. Services may be too far away, public transportation may be inadequate, routes may be unsafe, or travel may take too much time. Financial barriers. Fees, transportation, childcare, equipment, lost work time, insurance limitations, or other costs may make participation unaffordable. Service availability. The necessary treatment, program, equipment, professional, medication, class, or other resource may not be available. Waiting times. A technically available service may function as an unavailable service if waiting lists are extremely long. Disability access. Physical spaces, transportation, websites, communication, or program procedures may be inaccessible. Language access. Interpretation, translation, or appropriate multilingual services may be unavailable. Caregiving responsibilities. Childcare or dependent-care needs may prevent participation. Scheduling. Service hours may conflict with work, school, caregiving, religious observances, transportation schedules, or other responsibilities. Safety. People may face unsafe transportation routes, interpersonal violence, harassment, or other threats. These are not failures of individual motivation. They are conditions the intervention should attempt to change whenever possible. The behavior or process is unnecessarily complex Programs may require too many forms, appointments, steps, passwords, approvals, instructions, or unfamiliar skills. Complexity may come from poor service design rather than from the abilities of participants. Ask: Can steps be eliminated? Can information be written more clearly? Can several requirements be completed at one time? Can staff provide navigation or technical assistance? Can people practice unfamiliar skills before being expected to use them independently? Are language, literacy, disability, or technology needs being accommodated? People need additional capability or support Some behaviors require skills, treatment, practice, confidence, or continuing professional or peer support. Examples include: Managing nicotine dependence Learning a new job skill Learning to use unfamiliar technology Developing communication or conflict-resolution skills Managing a chronic health condition Building a new routine Avoid framing these situations as a simple lack of willpower or self-discipline. The behavior requires substantial time or competes with other responsibilities Time burdens may include: Long individual sessions Frequent recurring appointments Long travel time Extended training requirements Competing employment or caregiving demands A long delay before meaningful benefits appear Do not assume that people who decline a time-intensive activity lack commitment. The program may need to become more flexible. The behavior is not currently a priority People may understand an issue and still decide that another need is more urgent. A person worried about housing, food, employment, safety, caregiving, debt, or health may reasonably prioritize those needs over the behavior your organization is promoting. Formative research can help determine whether: The benefits are unclear The behavior appears irrelevant More urgent needs are competing for attention People disagree with the proposed goal The service or intervention itself needs to change The answer should not automatically be to persuade people that your priority is more important than theirs. Remembering or organizing repeated action is difficult People may intend to act but forget because of competing responsibilities, stress, complex schedules, cognitive load, unfamiliar routines, or other factors. Examples include: Missing appointments Forgetting medication Forgetting exercises recommended as part of rehabilitation Forgetting administrative deadlines Design systems that make remembering easier rather than assuming that forgetting reflects a lack of concern. How do you address barriers and support action? Improve access When transportation or geography is a barrier, consider: Providing or subsidizing transportation Offering services at additional community locations Using mobile services Providing home-based services when appropriate Using telehealth, video conferencing, online learning, messaging, or other remote options when appropriate and accessible Coordinating services so people need fewer separate trips Remote services are not automatically accessible. Consider broadband, devices, privacy, digital literacy, disability access, language access, and people's preferences. Reduce financial barriers Possible approaches include: Reducing or eliminating fees Providing sliding-scale options Providing transportation, childcare, dependent-care support, equipment, or necessary supplies Obtaining grants or other funding Sharing facilities, equipment, or services with partner organizations Using donated or refurbished resources when they are safe, appropriate, and reliable Be cautious about reducing the quality or completeness of a service simply to increase the number of participants. Consider whether a lower-cost model still provides meaningful benefit and meets appropriate standards. Expand unavailable services or resources If the necessary service does not exist or does not have enough capacity, consider: Expanding your own service Partnering with another organization Creating referral relationships Developing community-based or remote alternatives Training additional providers or facilitators Advocating for funding, policy changes, or additional public services Long waiting lists and service shortages may be evidence that systems need additional capacity rather than that people need stronger motivation. Make services and environments accessible Consider: Physical accessibility Accessible websites and digital tools Interpretation and translation Plain-language communication Childcare and dependent-care support Privacy Transportation Scheduling Cultural responsiveness Respectful treatment by staff Simplify complex tasks If a behavior requires several unfamiliar steps: Remove unnecessary requirements Break the process into manageable steps Provide foundational information first Demonstrate skills Allow practice Use plain language and visual instructions Provide navigation or coaching Make help available when people encounter problems Complexity should not be treated as evidence that participants lack intelligence or education. Often the process itself needs redesign. Provide appropriate support Different behaviors require different kinds of support. Options may include: Individual counseling Group counseling Peer-support or mutual-help groups Mentoring or coaching Evidence-based medication or clinical treatment when appropriate Telephone quitlines or helplines Text messaging Secure online or app-based support Classes and skills training Community health workers or navigators Family or social support when the participant wants it For tobacco cessation, for example, evidence-based medications and behavioral counseling can each help adults quit smoking, and using them together generally provides the strongest support. Avoid assuming that a particular mutual-help program, counseling model, medication, or support group is right for everyone. Reduce time burden Consider: Shorter sessions Flexible scheduling Evening or weekend options Remote participation Drop-in options Combining appointments or services Breaking long-term goals into manageable milestones Clarifying the actual time commitment can be helpful when people have inaccurate expectations, but do not dismiss a time burden that participants identify as real. Understand why the behavior is not a priority If people are not interested in the behavior, ask why before developing a stronger promotional campaign. You may learn that: The proposed benefit is not meaningful The behavior does not address the problem people care about More immediate needs take priority People distrust the organization The service is inconvenient or inaccessible People understand the proposal and simply disagree with it Provide accurate information and explain relevance when needed, but respect informed disagreement and autonomy. Use reminders thoughtfully Reminders may include: Calendar reminders Text or app notifications Automated phone calls Pill organizers or medication-management tools Appointment reminders Visual cues Habit-linked routines Peer or family reminders when the participant wants them Ask permission before using reminders that could disclose sensitive information. Consider privacy, frequency, accessibility, and whether people can easily opt out. What are barriers to maintaining behavior change? Initiating a behavior does not guarantee that the same behavior will remain feasible, useful, or desirable over time. Maintenance can be affected by changing health, stress, work, finances, caregiving, services, relationships, environments, motivation, habits, and unexpected consequences. Expectations and outcomes do not match People may stop a behavior when: Expected benefits do not appear as quickly as anticipated Benefits are difficult to observe Benefits are primarily long-term The behavior is intended to prevent an outcome, so success is difficult to see directly The original expectations were unrealistic Set realistic expectations from the beginning and identify meaningful ways to monitor progress when possible. Negative consequences are greater than expected The behavior or intervention may produce burdens or side effects that were underestimated or not anticipated. Examples might include: Medication side effects Physical discomfort Increased costs Work or scheduling problems Stress Conflict within relationships Stigma When health care is involved, changes to medication or treatment should be discussed with an appropriate health professional rather than managed through a social marketing campaign alone. Social environments do not support the behavior Friends, family members, coworkers, peers, community norms, workplaces, and institutions may make maintenance easier or harder. Social support can help, but do not assume participants should involve family or community members when doing so would compromise privacy, autonomy, or safety. Services or systems stop supporting the behavior Maintenance may become difficult because: Services end Insurance coverage changes Transportation disappears Work schedules change Childcare becomes unavailable Program hours change Supplies become unavailable Digital tools become inaccessible Staff relationships change Maintenance strategies should therefore address the reliability of the surrounding system, not merely personal motivation. The behavior becomes more difficult Stress, illness, injury, changing responsibilities, cravings, changes in mental health, fatigue, or other circumstances can affect capability and motivation. Build flexibility into the plan so that people can adjust rather than viewing any disruption as failure. Lapses or recurrence occur Some behaviors involve periods in which a person returns temporarily or repeatedly to a previous behavior. This can occur in tobacco cessation, substance-use recovery, physical activity, nutrition, medication routines, and many other areas. A lapse does not necessarily erase previous progress. Help people identify what changed, what they learned, what additional support is needed, and how they want to proceed. For smoking cessation, for example, people may make more than one quit attempt. Current guidance encourages people who have tried before to continue trying and to use effective treatments and support. How do you support behavior over time? Anticipate potential barriers Use formative research, previous program experience, evidence, and conversations with participants and community partners to anticipate what might interfere with maintenance. Consider: Changes in motivation Changes in access Financial barriers Stress Changes in health Social influences Service interruptions Expected and unexpected side effects Changes in work or caregiving Be transparent about benefits, burdens, and uncertainty People should receive accurate information about: Likely benefits Possible risks or side effects How long meaningful results may take What support is available What options exist if the first strategy does not work What remains uncertain Avoid overstating likely results simply to motivate participation. Set realistic expectations Unrealistically high expectations can make normal progress feel like failure. Establish goals and benchmarks appropriate to the behavior, the evidence, and the individual's circumstances. Health-related goals should be individualized with appropriate clinical guidance when needed rather than relying on universal targets. Make progress visible when appropriate Feedback can help people understand whether their efforts are producing benefits. Examples may include: Tracking personally meaningful health or activity measures Tracking financial savings Recognizing completed milestones Sharing community-level environmental improvements Reporting what donations or volunteer efforts accomplished Avoid excessive monitoring or measures that increase anxiety, stigma, or unhealthy behavior. Use measures appropriate to the individual and the goal. Provide continuing support Continuing support may include: Counseling Clinical treatment Follow-up appointments Peer support Coaching Mentoring Quitlines or helplines Text or app-based support Community health workers Skill-building opportunities Family or social support when wanted Support should match the behavior and the person's needs rather than assuming one model works for everyone. Maintain supportive systems and environments If the environment that enabled the behavior disappears, maintenance becomes harder. Organizations should consider whether they can sustain: Affordable services Transportation Childcare Accessible facilities Appropriate hours Language access Clinical or professional support Safe environments Equipment or supplies Follow-up communication Plan for setbacks and changing circumstances Ask in advance: What might make the behavior difficult later? What early signs would indicate that additional support is needed? What alternatives are available? Who can the participant contact? How can the plan be adapted? Avoid all-or-nothing thinking. If a person cannot maintain the original plan, an adapted form of the behavior may still provide meaningful benefit. Respond to negative consequences Do not simply encourage people to tolerate consequences that are serious, harmful, or unacceptable. Instead: Investigate what is happening Provide accurate information Modify the intervention when possible Offer alternative services or strategies Refer to appropriate professionals Address organizational or environmental causes For medication or other clinical issues, encourage participants to consult an appropriate health professional. Engage supportive relationships when participants want them Family members, peers, clinicians, community health workers, coaches, and other people may help sustain behavior. Ask participants which relationships are helpful rather than assuming who should be involved. In situations involving controlling, unsafe, or abusive relationships, prioritize safety and appropriate survivor-centered support rather than attempting to gain the other person's approval of the behavior change. Use incentives carefully Financial or nonfinancial incentives can support participation or particular behaviors in some settings. Consider: Whether the incentive is evidence-informed Whether it is proportionate Whether it creates inappropriate pressure Whether benefits continue after the incentive ends Whether the incentive is distributed equitably Do not assume that behavior supported by an external incentive is automatically less meaningful or less likely to last. Evaluate what happens in the specific program and whether other supports and enabling conditions remain in place. Continue formative research and evaluation Maintenance should be evaluated rather than assumed. Ask: Are people continuing the behavior? What makes continuation easier? What makes it harder? Have circumstances changed? Are services and supports still accessible? Are some groups experiencing greater barriers? Are unexpected harms or burdens occurring? What adaptations would participants find useful? Use what you learn to improve the intervention rather than simply intensifying messages telling people to continue. In Summary Beneficial behavior change often involves two related challenges: making action possible in the first place and creating conditions that help people sustain, adapt, or resume the behavior over time. Barriers to action may involve transportation, cost, service availability, disability access, language access, caregiving, safety, complexity, time, skills, health needs, competing priorities, memory, or other circumstances. These barriers should not be reduced to a lack of motivation or self-discipline. Organizations can respond by improving services and environments, reducing financial and logistical burdens, simplifying processes, building capability, providing evidence-based treatment or support where appropriate, and making beneficial actions easier to integrate into people's lives. Maintenance also depends on realistic expectations, meaningful benefits, continued access, supportive environments, changing circumstances, social relationships, and the ability to respond to lapses or setbacks. A return to a previous behavior does not necessarily erase progress or mean that an intervention has failed. Social marketing should therefore support people rather than simply persuade them. Listen to participants, identify what actually makes behavior possible, provide honest information, strengthen capability and opportunity, address structural barriers, and continue adapting the strategy as people's circumstances and community conditions change. Resources Online Resources An outline of what appears to be a well-thought-out social marketing campaign, Eat Smart, aimed at Food Stamp recipients with children under 18, originally conceived by the Maine Nutrition Network. Print Resources Alan, R. (1995). Marketing Social Change. San Francisco: Jossey-Bass Publishers. Kotler, P., & Alan, R. (1987). Strategic Marketing for Nonprofit Organizations. Englewood Cliffs, NJ: Prentice-Hall.
