Motivating the unmotivated: how can health behavior be changed in those unwilling to change?

Motivating the unmotivated: how can health behavior be changed in those unwilling to change? Many individuals do not engage in health-promoting behaviors that would confer important health benefits despite research that has shown that engaging in a suite of four health behaviors (physical activity, eating a healthy diet, not smoking, drinking alcohol in moderation) leads to a 11–14 year delay in all-cause mortality (Khaw et al., 2008; Ford et al., 2011). Motivating people disinclined to engage in health behavior presents a significant challenge to public health practitioners. Although there have been advances in interventions to increase individuals' motivation to engage in health-related behaviors, gaps in knowledge exist. In particular, effective strategies to promote behavior change in individuals with little or no motivation to change are relatively scarce. Most social psychological theories applied to health behavior change tend to assume a degree of motivation for change and have focused on attempts to promote action by converting motivation into action. focus on harnessing motivation and promoting action in those already likely to be motivated to change. As a consequence, such approaches are heavily dependent on individuals having some motivation to change even though they are not actually engaging in the behavior. These individuals are best characterized as " inclined abstainers " (Orbell and Sheeran, 1998) or " unsuccessful intenders " (Rhodes and de Bruijn, 2013). The approaches, however, do not focus on individuals with low or no motivation to change which account for a substantive proportion of the population. For example, less than 10% of smokers report wanting to quit (Wewers et al., 2003) and 60% of smokers do not make a quit attempt during any given year (Centers for Disease Control and Prevention, 2007). Similarly, up to 30% of individuals express no intention to exercise (Ronda et al., 2001; Rhodes and de Bruijn, 2013). It is clear, therefore, that a large number of individuals are not motivated to engage in health-promoting behaviors and tend to be those most at risk. In this article, we briefly review theoretical perspectives focusing on individuals who are not motivated to engage in health-promoting behaviors. We contend that although theories identify low motivation as a state, they do not provide complete explanations of, and underlying reasons for, the absence of motivation, nor do they suggest comprehensive strategies that may engage these hard-to-reach individuals. We offer some theory-derived suggestions on how to engage unmotivated individuals to increase …