Lessons from the Oslo Study Diet and Anti-smoking Trial: a qualitative study of long-term behaviour change.

The aim of this study was to identify factors associated with sustainable behaviour change among persons at increased risk for future cardiovascular disease. A qualitative approach based on focus group interviews was used. Twenty-five men aged 62-71 years who participated in the Oslo Study Diet and Anti-smoking Trial were interviewed in four focus groups. The study identified five categories of factors linked to the process of lifestyle changes: the doctor-patient relationship, significant others, motivators, barriers, and empowerment. A strong personal attachment to the principal investigator of the Oslo Study was revealed. The relationship was described as friendly and supportive. The family based approach and the impact of spouses, in particular, was emphasized by the participants. Somatic symptoms and fear often acted as motivators to behavioural change. Individual feedback was also identified as an important motivator. Psychological resistance to external pressure, concerns regarding behaviour change, and benefits from current (unhealthy) behaviour were identified as barriers. Participants reported a process of empowerment and personal control as an important element of sustainable change. The importance of the unique relationship with a certain provider has implications for future healthcare planning. This factor may also limit the external validity of studies of human behaviour.