LACK OF WILLPOWER OR LACK OF WHEREWITHAL - INTERNAL AND EXTERNAL BARRIERS TO CHANGING DIET AND EXERCISE IN A 3 YEAR FOLLOW-UP OF PARTICIPANTS IN A HEALTH CHECK

The aims of this paper were to assess whether anticipated barriers to change in diet and exercise which were cited before a health check int ervention were related to subsequent behaviour changes. In 1989 a heal th and lifestyle questionnaire was posted to 17,965 people aged 35-64 who were registered with five general practices in Bedfordshire. Takin g account of non-contacts, a response rate of 80.3% was achieved and 1 1,090 people described their exercise and dietary habits. Those expres sing an interest in changing each behaviour were asked to identify rea sons why change might be difficult. Two types of barriers-''internal'' and ''external''-were identified. A total of 2205 respondents were in vited to attend a health check in Year One and a recheck three years l ater and 1660 attended. In this subgroup improvement in exercise and d iet was examined in relation to the participants' baseline characteris tics, including the type of barriers selected. Internal barriers to ch ange (e.g. lack of willpower, too lazy, too busy) were chosen most fre quently. In a logistic regression including a range of baseline variab les those who selected only internal barriers were less likely to take more exercise (OR 0.59,95% CI 0.41, 0.86) than those who cited only e xternal (e.g. no transport, can't afford sports facilities) or mixed b arriers to changing. There was a similar but not statistically signifi cant trend for changing diet (OR 0.78, 95% CI 0.48, 1.28). Those who a re aware of external limitations may be better placed to circumvent th em. Further research is needed to explore this relationship between ty pe of barrier and behaviour change. (C) 1997 Elsevier Science Ltd. All rights reserved.