Version May 2024
| Cognitive-behavioral strategies for promoting behavior change |
| Class I |
| Design interventions to target dietary and physical activity behaviors with specific, proximal goals. (Level of evidence: A) |
| Provide feedback on progress toward goals. (Level of evidence: A) |
| Provide strategies for self-monitoring. (Level of evidence: A) |
| Establish a plan for frequency and duration of follow-up contacts (eg, in-person, oral, written, electronic) in accordance with individual needs to assess and reinforce progress toward goal achievement. (Level of evidence: A) |
| Utilize motivational interviewing strategies, particularly when an individual is resistant or ambivalent about dietary and physical activity behavior change. (Level of evidence: A) |
| Provide for direct or peer-based long-term support and follow-up, such as referral to ongoing community-based programs, to offset the common occurrence of declining adherence that typically begins at four to six months in most behavior change programs. (Level of evidence: B) |
| Incorporate strategies to build self-efficacy into the intervention. (Level of evidence: A) |
| Use a combination of two of the above strategies (eg, goal-setting, feedback, self-monitoring, follow-up, motivational interviewing, self-efficacy) in an intervention. (Level of evidence: A) |
| Class II |
| Use incentives, modeling, and problem-solving strategies. (Level of evidence: B) |
| Intervention processes and/or delivery strategies |
| Class I |
| Use individual- or group-based strategies. (Level of evidence: A) |
| Use individual-oriented sessions to assess where the individual is in relation to behavior change, to jointly identify the goals for risk reduction or improved cardiovascular health, and to develop a personalized plan to achieve it. (Level of evidence: A) |
| Use group sessions with cognitive-behavioral strategies to teach skills to modify the diet and develop a physical activity program, to provide role modeling and positive observational learning, and to maximize the benefits of peer support and group problem-solving. (Level of evidence: A) |
| For appropriate target populations, use Internet- and computer-based programs to target dietary and physical activity change; adding a form of electronic-counseling improves outcomes. (Level of evidence: B) |
| Class IIa |
| Use individualized rather than non-individualized print- or media-only delivery strategies. (Level of evidence: A) |
| Addressing cultural and social context variables that influence behavioral change |
| Class IIa |
| Utilize church, community, work, or clinic settings for delivery of interventions. (Level of evidence: B) |
| Use a multiple-component delivery strategy that includes a group component rather than individual- or group-only approaches. (Level of evidence: A) |
| Use culturally adapted strategies, including use of peer or lay health advisors to increase trust; tailor health messages and counseling strategies to be sensitive to the cultural beliefs, values, language, literacy, and customs of the target population. (Level of evidence: A) |
| Use problem-solving to address barriers to physical activity and dietary change, such as transportation barriers, poor local safety, and lack of access to affordable healthier foods and physical activity. (Level of evidence: B) |
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