Facilitating

Source: Online Behavior Guidelines | Lifestyle in Healthcare Coalition

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The Facilitating strategy focuses on Doing: organizing the environment and support to make behavior change easier. This chapter covers four techniques.

1. Mobilizing social support

Social support from family, friends or peers can significantly strengthen behavior change.

Types of social support

Type	Description	Example
Emotional support	Listening, encouraging	”You can do it, I believe in you”
Instrumental support	Practical help	Exercising together, cooking healthy
Informational support	Sharing advice, tips	Exchanging experiences
Social accountability	Holding each other accountable	Buddy system

Step-by-step plan

1. Let the patient think about needed support:

   • What support do you need?
   • From whom would you like to get it?
   • What would help the most?

2. Inventory the social network:

   • Who are relevant people (partner, family, friends, colleagues)?
   • Who can provide practical support?
   • Who can provide emotional support?

3. Make agreements concrete:

   • Ask specifically for help
   • Agree on how and when
   • Discuss how to deal with difficult moments

Forms of social support online

Form	Example
Online community	Forum, Facebook group
Buddy system	App to follow goals together
Group challenge	Achieving a shared goal
Peer coaching	Peers helping each other

Tip

Social support works both ways - giving support to others also strengthens your own motivation.

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2. Reminders

Reminders help patients not to forget the desired behavior and to perform it at the right time.

Types of reminders

Type	Description	Example
Time-based	Fixed time	Daily alarm at 12:00
Location-based	At specific place	Note by the door
Action-based	After another action	”After brushing teeth…”
Social	By others	Partner reminds you

Step-by-step plan

1. Determine the purpose of the reminder:

   • What should the patient be reminded of?
   • When should the action take place?

2. Choose the appropriate reminder technique:

   • Digital: app notifications, calendar alerts
   • Physical: post-its, objects in visible place
   • Social: agreements with others

3. Test and adjust:

   • Does the reminder work at the right moment?
   • Is it annoying or helpful?
   • Should the frequency be adjusted?

Tips for effective reminders

• Timing is crucial - not too early, not too late
• Vary to prevent habituation
• Make the reminder specific (“Take your medicine now” instead of “Medicines”)
• Phase out reminders when the behavior becomes a habit

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3. Self-monitoring

With self-monitoring, the patient tracks how the new behavior is going themselves.

Note

What you measure, improves. Just tracking behavior often leads to improvement.

What to monitor?

Aspect	Example
Behavior	Number of steps, portions of vegetables
Outcome	Weight, blood pressure
Context	When, where, with whom
Feeling	Mood, energy

Step-by-step plan

1. Help the patient determine what to measure:

   • What is the target behavior?
   • How can you measure it?
   • How often to measure?

2. Choose a method:

   • Apps (step counter, food diary)
   • Paper logbook
   • Wearables (smartwatch, activity tracker)

3. Give feedback on the results:

   • Compare with the goal
   • Show progress over time
   • Celebrate successes

Methodological requirements

• Make recording as easy as possible
• Give direct feedback on measurements
• Visualize progress (graphs, streaks)
• Focus on trends, not daily fluctuations

Examples

• Step apps with daily/weekly goals
• Food diary apps
• Sleep trackers
• Weight curve tracking

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4. Creating a supportive environment

By adjusting the physical or social environment, healthy behavior becomes easier and unhealthy behavior becomes harder.

Two strategies

Strategy	Description	Example
Make healthy easier	Lower barriers	Put fruit in visible place
Make unhealthy harder	Raise barriers	Put candy out of sight

Step-by-step plan

1. Identify helping and hindering factors:

   • Which physical factors help or hinder?
   • Which social situations are difficult?
   • What materials do you need?

2. Advise adjustments to the physical environment:

   • Home: lay out workout clothes, healthy snacks at the front of the fridge
   • Work: standing desk, water bottle on desk
   • On the go: bike instead of car, stairs instead of elevator

3. Advise adjustments to the social environment:

   • Tell others about your goal
   • Avoid tempting situations (temporarily)
   • Seek out people with similar goals

Concrete examples

For healthier eating:

• Use smaller plates
• Put vegetables at the front of the fridge
• Don’t bring unhealthy snacks into the house
• Lay out ingredients in advance

For more exercise:

• Lay out workout clothes for tomorrow
• Put your bike by the front door
• Schedule walking meetings
• Get a standing desk

For quitting smoking:

• Throw away ashtrays and lighters
• Avoid smoking spots and breaks
• Tell colleagues you’ve quit

Methodological requirements

• Make changes as small and concrete as possible
• Start with the easiest adjustments
• Involve others in the environment (partner, housemates)
• Evaluate regularly what works

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Scientific foundation

• Heaney, C.A., & Israel, B.A. (2008). Social networks and social support. Health behavior and health education: Theory, research, and practice, 4, 189-210.
• Fry, J.P., & Neff, R.A. (2009). Periodic prompts and reminders in health promotion and health behavior interventions. Health Education Research, 24(6), 1015-1027.
• Burke, L.E., et al. (2011). Self-monitoring in weight loss: a systematic review. Journal of the American Dietetic Association, 111(1), 92-102.
• Hollands, G.J., et al. (2017). Altering micro-environments to change population health behaviour. The Lancet, 390(10103), 1724-1735.

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This article is from: Online Behavior Guidelines (PDF)

Published by the Lifestyle in Healthcare Coalition, February 2025