Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions.
Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited.
However, training by itself has often not been enough to create lasting change, and it is suggested that the implementation of teamwork should combine multiple behavior change interventions (BCIs) such as staff training, physical changes to the work environment, and management support [ 11].
Most previous multiple health behavior interventions have been of longer duration (6-12 months) and greater intensity [ 29, 36, 69] than the intervention presented here.
Multiple risk behavior interventions in communities, primary care and school settings, have primarily focused on the prevention of cardiovascular and cancer disease risks [ 6- 9].
The possibility to change both behaviors is included, because several studies have shown that multiple health behavior interventions result in greater weight loss [ 53], have higher participation rates [ 54], and may be more cost-effective [ 53].
Previous diet interventions have been delivered as part of multiple health behavior interventions, using a range of delivery modes over a period of 6 to 12 months, and found modest improvements in fruit and vegetable consumption and lower fat intake [ 35, 36].
There were a number of strengths to this study including: validated and reliable outcome measures that have been used over the telephone; a theory-based multiple behavior change intervention; a high rate of intervention delivery; a potentially low-cost, high-reach intervention; and a high level of interest and satisfaction with the intervention.
Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format.
The ENRICH multiple health behavior intervention was effective for improving pedometer-assessed PA, weight, and subsequently body mass index, and vegetable consumption.
One multiple health behavior intervention targeted both breast and prostate cancer survivors, using a 10-month tailored print intervention, and reported significant improvements to exercise behavior, fruit, vegetables, and lower fat intake [ 29].
