Marcia Ory, Patricia Jordan
& Terry Bazarre talk with ScienceWatch.com and
answer a few questions about this month's Fast Moving Front
in the field of Agricultural Sciences.
Article: The Behavior Change Consortium: setting
the stage for a new century of health behavior-change
MG;Jordan, PJ;Bazzarre, T
Journal: HEALTH EDUC RES, 17 (5): 500-511 OCT 2002
Addresses: Texas A&M Univ Syst, Sch Rural Publ Hlth,
College Stn, TX 77840 USA.
Texas A&M Univ Syst, Sch Rural Publ Hlth, College Stn,
TX 77840 USA.
Behav Change Consortium, Honolulu, HI 96816 USA.
(addresses have been truncated)
Why do you think your paper is highly
This paper sets the stage for understanding the processes by which health
behavior change theories and approaches could be translated into successful
intervention strategies. It addresses the challenges and opportunities for
behavioral health interventions to modify three of the nation's most
important behavioral risk factors—tobacco use, unhealthy diet, and
Moreover, this paper was prescient in addressing issues that are now at the
heart of the National Institutes of Health (NIH)
Transdisciplinary partnerships that were developed by the Behavior Change
Consortium (BCC) grantees are clearly moving to the forefront of clinical
and translational research efforts and are key to the successful
application and dissemination of research from bench to bedside to
community practice. This paper clearly describes the advantages of
transdisciplinary research with substantive examples of its successful
Does it describe a new discovery, methodology, or
synthesis of knowledge?
This article summarizes the state of the behavioral sciences for these
three lifestyle risk factors which together account for the majority of
preventable chronic diseases and premature deaths each year, and
synthesizes the approaches of 15 different NIH-funded grants to favorably
modify these risk factors. It describes the leading health behavior change
theories, novel research and measurement methods, successful intervention
strategies, and common mediator variables that are represented in this
innovative set of multi-risk intervention studies.
A major contribution of this paper is its attention to the simultaneous
examination of multiple behaviors and multiple intervention approaches for
improving the health of Americans in different settings and circumstances.
The collaborative mechanism described in the paper led to both conceptual
and methodological advances in behavioral change research. The BCC provided
a forum for identifying key constructs and measures across different
intervention approaches, with particular focus on common moderators and
mediators at play across the various studies. It also served as the initial
testing ground for the development and application of the
RE-AIM model, a planning and evaluation tool for
assessing the public health impacts of programs and policies.
A fuller synthesis of the BCC studies and findings can be found in a
Summary Report prepared at the conclusion of the BCC
Would you summarize the significance of your paper
in layman's terms?
In October 1997, the NIH Office of Behavioral and Social Sciences Research
(OBSSR) announced a special Request for Applications (RFA) focusing on
"Innovative Approaches to Disease Prevention through Behavior Change." The
goal of this initiative was to stimulate investigation of innovative
strategies designed to achieve long-term healthy behavioral change by
focusing on behaviors such as tobacco use, sedentary lifestyle, and poor
This RFA solicited intervention studies aimed at either a comparison of
theoretical approaches to behavior change or an assessment of the utility
of specific behavior change theory in a multi-behavioral or multiple-theory
framework. This initiative was responsive to concepts and recommendations
from several reports calling for increased research on key health behaviors
and lifestyle factors affecting disease.
This article analyzes and summarizes the novel approaches taken by the BCC,
an alliance of 15 NIH-funded research teams focused on changing multiple
behavioral risk factors with a single intervention, and also on testing
multiple different theories for health behavior change intervention.
The BCC was created to go beyond "research as usual." Most past research
has examined ways to help people change one risk behavior at a
time—even though Americans often engage in a cluster of risky
behaviors. Similarly, researchers and practitioners often employ familiar
intervention strategies although different populations or settings may call
for tailored approaches. This paper challenged researchers and
practitioners to examine the advantages and disadvantages of different
intervention approaches for different health behaviors.
This challenge resulted in some important conclusions about behavior change
research that emerged over the course of the study. Many behavior change
interventions rely on similar behavior change principles such as goal
setting, increasing social support, or increasing confidence to make
changes. These strategies are effective for helping people quit smoking,
become more active, and change their dietary patterns. Despite differences
in population, settings, behaviors, or interventions, most of the studies
in the BCC resulted in positive changes—reinforcing the potency of
behavior change interventions for improving healthy lifestyles across the
By using common measures and methods across studies, the BCC was able to
take the power of a single study and turn it into a behavior change
movement. Many current themes in behavior change research were incubated
within the BCC—multiple behavior change, population tailoring,
intervention fidelity, sustainability, and e-health, to name a few.
How did you become involved in this research and
were there any particular problems encountered along the way?
Selected on the basis of the scientific peer review, the sponsoring
organizations awarded approximately $8 million annually from 1999-2002 to
fund the 15 research grants featured in this supplemental issue. The
grantees attended semi-annual meetings co-sponsored by the American Heart
Association (AHA), in order to report progress, discuss problems, and share
information related to the conduct of their grants.
A Behavior Change Consortium composed of NIH program staff, research
investigators from the 15 sites, and representatives from the AHA and the
Robert Wood Johnson Foundation, was established to explore opportunities
for collaboration across the 15 sites. The authors of this paper were key
members of the BCC, with a broad knowledge of health behavior research
which enabled them to set the BCC activities within the larger behavioral
change research field. The biggest problems which were overcome through
participation in the Consortium were transforming the traditional mindset
of "your" science and "my" science to "our" science.
Where do you see your research leading in the
The BCC has served as a model of collaborative research and funding across
NIH Institutes as well as across different settings, populations, and
intervention strategies. The National Academy of Sciences (NAS) has
identified a broad domain of questions at the interface of social,
behavioral, and biomedical sciences, whose resolution could lead to major
improvements in the health of the US population, all the while stressing
the importance of approaching these questions from an interdisciplinary
In describing their vision of future directions, the NAS has emphasized
research priorities that cut across institute boundaries at the NIH,
thereby underscoring the broad significance of behavioral and social
science research for multiple disease outcomes as well as for health
promotion. These are the ingredients for a program of behavioral and social
science research that will advance our ability to change behavior in ways
that will prevent disease over the long term. The investigators
participating in the BCC have already started us down this path.
As a follow-up to this seminal article in the Health Education Research
volume which focused on individual grantee site efforts, BCC investigators
authored a special issue of Annals of Behavioral Medicine in 2005,
which highlighted themes developed by the BCC multidisciplinary workgroups
around topics such as enhancing recruitment and retention, ensuring
treatment fidelity, and applying the RE-AIM framework.
Mentorship of junior investigators, many of whom are now principal
investigators on their own NIH grants, has further extended the work of the
BCC. The successes of the BCC led to the establishment of the
Health Maintenance Consortium, a second-generation
NIH multi-site collaborative which addresses the follow-up science
question of how behavior change gains can be maintained. The BCC
approach—bringing together academics, government, and private
philanthropy—can serve as a model for other national research
Do you foresee any social or political implications
for your research?
The social and political implications lie in the reduction of chronic
disease patterns across the lifespan. Triple helix research—research
collaborations between government, academia, and industry—is vital to
the promotion of global health and the elimination of health disparities.
The BCC helped change the nature of scientific inquiry by demonstrating
that collaborative, transdisciplinary research requires substantially
different mechanisms for interaction, rapid translation of research
findings to practice, and mentorship of junior investigators.
The Consortium efforts pointed the way toward the importance of tailoring
behavioral and social interventions to different populations and the need
for cultural sensitivity and competencies when working in diverse
populations and settings. Examining the context of behavior change research
emphasizes the importance of designing multilevel interventions which can
also address social and physical environmental influences on individual
level behavior change.
Understanding the elements of efficacious behavioral change interventions
and strategies for maintaining successes over time is the first step in
widely diffusing and sustaining effective interventions in real-world
settings which can have a major impact on population health.
Marcia G. Ory, Ph.D., M.P.H.
Regents Professor, Social and Behavioral Health
Director, Active for Life National Program Office
School of Rural Public Health
College Station, TX, USA
Patricia J. Jordan. Ph.D.
Senior Research Methodologist/Grantwriter
Pacific Telehealth & Technology Hui
Honolulu, HI, USA
Terry Bazzarre, Ph.D., M.S.
Senior Program Officer
Robert Wood Johnson Foundation
Princeton, NJ, USA
Keywords: behavior change consortium, tobacco use,
unhealthy diet, sedentary lifestyle, national institutes of the health
roadmap initiatives, preventable and chronic diseases, multi-risk