Health-related behaviour changes: dealing with obstacles

Barrier management

Starting a new behaviour may sound simple in your head. But all too often we come up against unexpected problems in our daily lives that make it impossible to achieve our goals. That is why barrier management is one of the most important behaviour-changing techniques. When you use this technique, you are analysing which situations or conditions are or could be obstacles. By thinking about this, you can anticipate the barriers and develop sensible strategies for bypassing them.

Internal and external barriers

Incipient barriers can be multifaceted and highly personal. Considered broadly, however, we can distinguish between two sorts of barrier:

Internal barriers are obstacles that are mostly found “in our heads” and are not necessarily recognised as inevitable by other people. Typical examples are comfort, lack of enthusiasm, tiredness, dejection, but also fear of injury, and the judgement or scrutiny of others. A lack of faith in your own abilities (thoughts such as “I can’t do that!”) can create an internal barrier.

External barriers include the circumstances and conditions that make an action more difficult. For example, these could be a large organisational burden, bad weather or high costs. But a heavy workload, a training partner cancelling or family responsibilities that already fill your everyday life would also count as external barriers.

When you ask people about the barriers they face, the most common answer is “no time!”. A lack of time for something that you intend to do can be an internal or an external barrier, depending on the explanation. For example, you might not have the time to cook yourself something healthy because you are too tired after a long, physically demanding day. Since you are tired, lying on the sofa and phoning for a takeaway pizza take priority. Conversely, someone might not have the time because they have a long commute to work, need to go shopping and want to spend time with the family in the evening. Thirty minutes of exercise and subsequent shower then become difficult to accommodate beside these tasks. As these two examples show, “other priorities” often lie behind the obstacle of “no time”. We all have 24 hours every day, but we have different demands for what we absolutely want to do in this time, or subjectively speaking really have to do.

“It is not only for what we do that we are held responsible, but also for what we do not do.”
- Molière -

What’s more, it may be that you encounter unexpected consequences for other needs when you start putting an intention into practice. You might notice that it’s easy to eat a healthy diet when it’s just you, but this becomes impossible when you meet friends, but you don’t want to forego your nights out. Someone else might have decided always to cycle to work, but notice that they miss the time they spent reading the newspaper and texting their friends in the tram! We repeatedly come up against competing needs like this. They also raise the question of priorities. Can I find a solution, or is this intention suddenly no longer worth striving for from this perspective? As you will read below, it is sometimes possible to bypass “no time” or “competing needs” by simplifying matters or making appropriate compromises. Nevertheless, prioritising and not letting yourself be distracted from the long-term goal by acute needs will always remain a challenge.

Developing effective strategies

Actually, almost all barriers can be described as “competing needs”. This makes it clear that you have to look carefully in order to understand your own obstacles and then develop strategies for bypassing them. Depending on the situation, the following questions may help you to understand yourself better:

Before beginning to change your behaviour, think about:

• What could get in your way?
• When is it likely to be easy, and when more difficult?
• Will I have to give something up so I can put this behaviour into practice? Do I want this? And what is really important to me?

Obstacles frequently only become noticeable when you attempt to put something fully into practice. Bear in mind that, depending on the situation, different obstacles could arise for the same goal, and that the obstacles may change again and again. That’s why you should monitor your experiences and analyse the situation retrospectively.

• What aspects of the situation make reaching your goal more difficult? Has something come up that I initially didn’t think of?
• Can I bypass this element somehow? What would have to happen for me to reach my goal despite this situation?
• Why do I sometimes find this easy and sometimes hard? How are the situations different?
• Will I possibly need to adapt my goal to make space for other priorities? Would I like this?

By self-monitoring, you are already looking for strategies for bypassing obstacles and making compromises in your next step, or finding alternative plans for competing needs. This can include 1. Finding a way to make space for the competing needs alongside your target behaviour. For example, I could decide that I will do sport in my lunchbreak twice a week and have time for lunch with my colleagues on the other three days. And maybe 2. The needs can also be combined with compromises. Ideally, you could combine social interaction with exercise, for example. Or include your family in new food habits. 3. Many people find it helpful to plan exactly for “What will I do if... happens?” For example, this way I can decide in advance that I will go for a walk in the rain if it is too wet and cold to run. In this case, it’s worth considering how bad the weather needs to be exactly before you can implement Plan B. Otherwise you risk making it easier for yourself with an excuse.
Frequently behaviour change is a long-term goal, while other needs are urgent now. For this reason, we are open to such “excuses” right now, but this mean we may lose sight of the long-term goal. In the end, you can 4. Consciously bring about simplifying situations or explicitly bypass anything that makes it more difficult. For example, if I undertake to read more instead of watching Netflix, but my other half still puts the TV on, it might help me if I prepare another place as my special “reading spot”. Conversely, I might notice that I find it much easier to go to the gym directly after work, as then I don’t even think about sitting down again, so I don’t struggle to get back up. To make this easier, I could take my gym kit to work with me in the morning.

Some application tips

When preparing strategies, it is crucial to know that there is no panacea. Everyone must find out for themselves what works best for them. We all know our own obstacles best. Even though it would be nice if someone could defeat your inner couch potato from the outside, there is only one person who can change your behaviour – you. Nevertheless, it can help if you learn what works for someone else. This means that the examples below should be understood as ideas to help you develop your own possible strategies.

• When time is short, you can make a definite entry in your diary. You should give this the same importance as, for example, an appointment with a physiotherapist. If the appointment really has to be postponed, another one must be agreed and fixed directly.
• Have starting aids ready: getting back on your feet after work to go for a run can be difficult. Many people find it helpful to have their running kit ready, or to get changed before sitting down briefly and having a drink.
• When you’re really hungry, you often don’t have the patience to cook. In this case, it may help to have a healthy snack to quell the worst of the hunger pangs.
• Discovering what you enjoy: many people notice that an initial idea was maybe not ideal and that they haven’t learned to love, say, Nordic walking. In such a case, it’s worth changing plans and trying out different things to find what suits you best.
• If you’re tired or exhausted, physical activity is very hard to do. But so that this doesn’t become an excuse for doing something else, or nothing at all, many people find it helpful if they still invest that time in themselves and pursue a less demanding activity. In such a case, you could go for a walk instead of jogging. Or, instead of strength training, you do some gentle exercises.
• Defining rules and exceptions: For example, you could: stipulate that, if you feel like a beer during the week, you drink an alcohol-free beer. But you could also make one exception per week, if a special occasion arises.
• Involving friends: arranging to, e.g., go outside with someone can be a great boost to your motivation.
• Asking for and accepting help: many people find it difficult to admit that they can’t do everything and need support for certain things. Maybe you will need to withdraw from another obligation so you can make time for yourself and your health-related behaviours.

Keeping at it

Even when a behaviour has purportedly become a habit, other unexpected obstacles may still arise. Maybe an upcoming exam, a house-move or a death will turn the world upside down. If this happens, it is important to remember that “relapses” are normal in all behaviours. Old, broken habits become “dormant” and may at some point re-emerge as the path of least resistance. Imagine it as the bed of a stream. A small dam and the creation of a new, small bed, and the stream has been successfully diverted. If the new bed is used repeatedly, it will get bigger and deeper, and the old course of the stream will be almost forgotten. But, if an obstacle appears in the new bed, the water will find its way back to the old one. In this case, remember: the very first time, there were obstacles you needed to bypass. They are certainly different obstacles this time, and they require new strategies. But you’ve done it once, so you can do it again!

Sources:
Fischer, X., Donath, L., Zwygart, K., Gerber, M., Faude, O., & Zahner, L. (2019). Coaching and prompting for remote physical activity promotion: Study protocol of a three-arm randomized controlled Trial (Movingcall). Int. J. Environ. Res. Public Health, 16(3), 331.
Gerber, M., Oberer, N., & Pühse, U. (2014). Beweg dich gesund! Ein praktischer Ratgeber für ein körperlich aktives Leben. Aachen: Meyer & Meyer Verlag.
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., . . . Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81-95.