The process of behavioral change in individuals who are uninterested in health: a qualitative study based on professional health knowledge

Background: In Japan and elsewhere, there is major concern over individuals who are uninterested in health and reluctant to change their health behaviors. While previous studies have investigated cognitive and behavioral characteristics in this population, there is limited evidence on whether they recognize the significance of health, nor is it clear how to motivate necessary behavior changes. This study identified specific characteristics of positive psychological and behavioral change in individuals who were uninterested in health, then constructed a model for their behavior change process, as advised via professional health expertise in the Japanese context. Methods: This qualitative survey study was conducted among 86 health professionals (public health nurses, registered dieticians, and city/prefectural employees). These participants reported their demographic characteristics (gender, age, job, and length of service) and entered free descriptions concerning perceived cognitive and behavior changes in individuals who were uninterested in health. Finally, we thematically analyzed the contents on psychological/behavioral change and constructed a thematic map. Results: We obtained 409 relative descriptive codes and four main themes, including (1) Health awareness: Recognize the significance of health via personal experience and/or illness among family/friends; (2) Psychological readiness: Preparative psychological state toward health behavior; (3) Gateway behavior: Precursory behavior leading to health behavior; and (4) Health behavior: Traditional healthy lifestyle behavior, with 45 subthemes. We constructed the abovementioned thematic map according to the Transtheoretical Model. Herein, health awareness may catalyze changes in health behavior, while changes in both psychological readiness (e.g., new interest in health behaviors and attitude toward appearance) and gateway behaviors (e.g., new points of discussion and information gathering) may arise before changes in health behavior. Conclusions: This study clarified positive cognitive and behavior changes in individuals who were uninterested in health and elucidated their behavior change process. As behavior changes in such individuals tend to be rigid, they are often left behind by health care systems and programs. In this regard, we identified pertinent cognitive and behavioral characteristics during the behavior change process and constructed a relevant model. These findings should be useful in developing interventions that can motivate the desire for behavior change.