NIH OBSSR Scoping Review Protocol on Long-Term Health Behavior Maintenance

This research project is a scoping review designed to examine the state of the science on long-term health behavior maintenance. While many interventions and programs focus on initiating behavior change, far fewer studies explore what enables individuals and communities to sustain healthy behaviors over time, for at least one year or more—when most intervention resources and supports are no longer available. This review addresses that gap by systematically mapping interventions, programs, and policies that support long-term behavior maintenance across multiple levels (individual, social, organizational, and systemic). Its aim is to provide a broad, structured understanding of the characteristics, strategies, and mechanisms that contribute to sustained health behavior change leading to improved health. The review will include both peer-reviewed and grey literature published between 2017 and 2024. Included studies must evaluate interventions, programs or policies that target long-term maintenance of health-related behaviors, which may be prevention and/or disease management-focused, such as physical activity, medication adherence, smoking cessation, substance abuse, or dietary change. These behaviors may involve either the ongoing adoption of healthy actions (commission) or the avoidance of harmful ones (omission). By focusing on outcomes measured at least one year after intervention initiation, the review will help identify which strategies are associated with sustained behavior change and which contexts support long-term success. A key addition of this review is the identification and synthesis of mechanisms of action (MoAs)— mediating processes and factors—that may explain why certain interventions facilitate sustainment of health behavior as distinct from initiation or adoption. This includes understanding whether intervention approaches specifically target behavior change techniques, test candidate mechanisms of action (psychological, biological, and their interactions) and/or use multi-level or systems approaches. In addition, the review will examine the extent to which successful interventions link behavior maintenance to health outcomes, such as disease prevention or progression, improve overall or disease related quality of life, and/or reduce morbidity. Expected outcomes of this project include a descriptive synthesis of intervention characteristics and successful health behavior maintenance strategies linked to evidence-based MoAs (if identified), and a summary of research gaps that warrant further investigation in future research and implementation approaches. By clarifying what is currently known and where evidence is lacking, this scoping review aims to guide future research questions and study design, provide evidence to inform public health policy, and support the development of more effective and sustainable health behavior interventions in community and clinical settings. Ultimately, the findings will contribute to a deeper scientific understanding of how to support individuals and populations in maintaining behaviors that promote long-term health and wellness. This project is supported by the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR)