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Many charities rely on donations to support their work addressing some of the world’s most pressing problems. We conducted a meta-review to determine what interventions work to increase charitable donations. We found 21 systematic reviews incorporating 1339 primary studies and over 2,139,938 participants. Our meta-meta-analysis estimated the average effect of an intervention on charitable donation size and incidence: r = 0.08 (95% CI [0.03, 0.12]). Due to limitations in the included systematic reviews, we are not certain this estimate reflects the true overall effect size. The most robust evidence found suggests charities could increase donations by (1) emphasising individual beneficiaries, (2) increasing the visibility of donations, (3) describing the impact of the donation, and (4) enacting or promoting tax-deductibility of the charity. We make recommendations for improving primary research and reviews about charitable donations, and how to apply the meta-review findings to increase charitable donations.
Individuals with severe mental illness face a significantly reduced life expectancy compared to the general population. Addressing key modifiable risk factors is essential to reduce these alarming rates of mortality in this population. Nutritional psychiatry has emerged as an important field of research, highlighting the important role of nutrition on mental health outcomes. However, individuals with severe mental illness often encounter barriers to healthy eating, including poor diet quality, medication-related side effects such as increased appetite and weight gain, food insecurity, and limited autonomy over food choices.
While nutrition interventions play a key role in improving health outcomes and should be a standard part of care, their implementation remains challenging. Digital technology presents a promising alternative support model, with the potential to address many of the structural and attitudinal barriers experienced by this population. Nonetheless, issues such as digital exclusion and low digital literacy persist. Integrating public and patient involvement, along with behavioural science frameworks, into the design and delivery of digital nutrition interventions can improve their relevance, acceptability, and impact. This review discusses the current and potential role of digital nutrition interventions for individuals with severe mental illness, examining insights, challenges, and future directions to inform research and practice.
Cancer-related fatigue is a common problem among colorectal cancer (CRC) survivors even after completion of treatment. In a randomised trial, we assessed the effect of a person-centred lifestyle programme on cancer-related fatigue among CRC survivors who completed treatment. Survivors who completed treatment at least 6 months but no longer than 5 years ago and who were experiencing cancer-related fatigue were randomised to intervention or control group. The intervention group worked with a lifestyle coach for 6 months during twelve sessions to stepwise increase adherence to the World Cancer Research Fund/American Institute of Cancer Research cancer prevention guidelines on healthy diet and physical activity. The control group did not receive lifestyle coaching. Changes in cancer-related fatigue from baseline to 6 months were assessed with the FACIT (Functional Assessment of Chronic Illness Therapy) – Fatigue Scale. As a secondary outcome, we assessed changes in health-related quality of life (HRQoL). Higher scores indicate less fatigue and better HRQoL. Eighty participants were randomised to the intervention group; eighty-one to the control group. Baseline characteristics were similar: mean age 64·1 (sd 10·9) years; 55·3 % were women; and 72 % had colon cancer. There were favourable changes in dietary behaviours and physical activity in the intervention group; the control group did not show changes to the same extent. The programme did not result in statistically significant differential changes over time between intervention and control group in cancer-related fatigue (0·8; 95 % CI −1·6, 3·2) or HRQoL (1·3; 95 % CI −2·2, 4·8). A person-centred lifestyle programme improved the lifestyle of CRC survivors, but the programme was not effective in reducing cancer-related fatigue or in improving HRQoL.
In different parts of the world the claim is increasingly being made that continuous confinement of pet cats (Felis catus) is beneficial for both wildlife conservation and cat welfare. The first part of the claim is almost incontrovertible, but the second is misleading. The assertion that confined animals have superior welfare is rooted in thinking pre-dating the 1960s that equates welfare with physical health. By contemporary accounts of animal welfare, confinement of animals presents major welfare risks, and this recognition has been a major driver of refinement in livestock industries, e.g. moves towards free-range systems. Yet, these risks have not been widely acknowledged in debates over pet cat management. We argue that the current pervasive rhetoric from conservationists and some regulators that cat confinement is beneficial for wildlife and cats is, at best, confusing health with welfare. At worst, it is a deliberate attempt to mislead the public through portraying a win-win scenario where, instead, a trade-off must be navigated. Failure to recognise this trade-off undermines conservation goals three-fold. First, it limits the efficacy of behaviour change interventions to increase confinement. Second, it erodes public trust in organisations perceived as knowingly misleading the public. Finally, it reduces the incentive to make the one decision yielding long-term benefits for both cats and ecosystems; ceasing to own cats at all. Policy-makers should be wary of the allure of false win-win narratives when tackling contentious issues that require trade-offs to be made.
There is a growing attention towards personalised digital health interventions such as health apps. These often depend on the collection of sensitive personal data, which users generally have limited control over. This work explores perspectives on data sharing and health apps in two different policy contexts, London and Hong Kong. Through this study, our goal is to generate insight about what digital health futures should look like and what needs to be done to achieve them. Using a survey based on a hypothetical health app, we considered a range of behavioural influences on personal health data sharing with the Capability, Opportunity, Motivation model of Behaviour (COM-B) to explore some of the key factors affecting the acceptability of data sharing. Results indicate that willingness to use health apps is influenced by users’ data literacy and control, comfort with sharing health and location data, existing health concerns, access to personalised health advice from a trusted source, and willingness to provide data access to specific parties. Gender is a statistically significant factor, as men are more willing to use health apps. Survey respondents in London are statistically more willing to use health apps than respondents in Hong Kong. Finally, we propose several policy approaches to address these factors, which include the co-creation of standards for using artificial intelligence (AI) to generate health advice, innovating app design and governance models that allow users to carefully control their data, and addressing concerns of gender-specific privacy risks and public trust in institutions dealing with data.
This paper introduces Setting-Driven Design (SDD) and supporting tool – the Behaviour Setting Canvas (BSC) – which together address a critical gap in behavioural design by shifting the focus from individual behaviour to the broader context in which behaviour occurs. Rooted in behaviour setting theory, SDD is a powerful approach to behavioural design that offers an end-to-end structure for understanding and intervening in a behavioural design challenge. The process comprises three iterative phases: scoping the behavioural challenge, understanding the setting and intervention development. The process structure revolves around the BSC, a tool for mapping key contextual elements such as roles, motives, norms and routines. While SDD is particularly effective for behaviour change interventions, its utility extends to other design challenges, including introducing new products, shifting social norms and enhancing existing systems where behaviour remains constant. The approach integrates a theory of change to guide intervention development, prototyping and evaluation, ensuring alignment with behavioural objectives and contextual realities. A case study on handwashing in low-income Tanzanian households illustrates the method’s utility, culminating in the creation of Tab Soap, a single-use, biodegradable soap designed to improve hygiene behaviours. The study demonstrates how SDD facilitates insight generation and iterative refinement and complements user-centred design. SDD advances behavioural design by combining theoretical rigour with practical application, offering a scalable and adaptable framework for addressing complex design challenges across diverse fields.
Overconsumption of unhealthy, discretionary, foods and beverages are associated with an increased risk of weight gain and non-communicable diseases, including diabetes, heart disease, and cancer. This cross-sectional study explored preferences for setting goals to reduce discretionary food and beverage consumption. The online survey included items about discretionary food and beverage intake, goal setting preferences to reduce intake, habit strength, personality traits, and demographic characteristics. A total of 2664 Australian adults completed the survey. The sample was mostly female (65.9%), half (52.8%) were aged between 30–49 years, and the median intake of discretionary food and beverages was 4.9 (IQR: 3.6 to 7.2) serves per day. Multinomial logistic regression and ordinal logistic regression models were used to explore demographic and psychological predictors of the helpfulness of long-term and short-term goals, elimination and gradual goals, specific food goals, specific eating occasion and food goals, self-set goals, collaboratively set goals, and assigned goals. The results showed participants with higher habit strength had greater odds of finding short-term (OR 1.40, 95% CI 1.06–1.86), gradual (OR 1.14, 95% CI 1.01–1.29), specific (OR 1.35, 95% CI 0.84–1.76), assigned (OR 1.38, 95% CI 1.14–1.66) and collaborative goals (OR 1.24, 95% CI 1.01–1.53) helpful. The results also indicated that age and gender were important predictors of goal setting preferences, particularly for long-term goals, elimination goals, broad goals, and collaborative goals. Interventions to reduce discretionary food and beverage intake are needed and consideration of goal setting preferences could be a novel way to developing more tailored and effective dietary interventions.
Using audit to identify where improvement is needed and providing feedback to healthcare professionals to encourage behaviour change is an important healthcare improvement strategy. In this Element, the authors review the evidence base for using audit and feedback to support improvement, summarising its historical origins, the theories that guide it, and the evidence that supports it. Finally, the authors review limitations and risks with the approach, and outline opportunities for future research. This title is also available as open access on Cambridge Core.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Group consultations are a form of community-integrated care that involve patients with similar health issues meeting with a clinician in a group setting. This approach enhances self-care and co-production, as patients learn from each other and participate in shared decision making. Group consultations have been shown to improve patient activation and evidence-based outcomes for long-term conditions such as diabetes and COPD, often at lower costs than individual consultations. Group consultations can be delivered in different ways, depending on the needs and preferences of the patients and the clinicians, including virtual sessions that allow for holistic care in the home environment. Case studies from various settings illustrate the effectiveness of group consultations in managing conditions like hypertension and diabetes. Group consultations are therefore a valuable method that combines the best of traditional care with the advantages of peer support and education, leading to better health outcomes in an efficient way.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Brief interventions are quick, targeted interventions to support individuals to change their health behaviour and reduce future disease risk. Brief interventions are delivered opportunistically in a consultation often initiated for other reasons, and can be as short as 30 seconds. Brief interventions differ from longer and more complex interventions such as health coaching, motivational interviewing, or cognitive behavioural therapies. Brief interventions are effective and cost-effective for smoking cessation, reducing hazardous drinking, weight loss in obesity, and increasing physical activity. Brief interventions typically involve asking about the behaviour, advising on the best way to change it, and assisting by providing or referring to support. Brief interventions can be enhanced by using conversational strategies that avoid stigmatising, create hope and self-efficacy, and facilitate referral or treatment. Brief interventions can be used across a range of health behaviours, such as harmful substance use, using screening tools, and referral to more intensive treatment where necessary. Making Every Contact Count (MECC) is a UK health campaign that aims to use every interaction in healthcare settings to support behaviour change, drawing on motivational interviewing techniques.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Self-care is a broad concept that refers to the actions taken to preserve or improve health, which can vary depending on the academic literature. A useful framework to understand self-care is the Self-Care Matrix, which consists of four dimensions: activities, behaviours, context, and environment. Self-care activities are the specific practices that promote health, such as physical activity, healthy eating, hygiene, and rational use of health products. Self-care behaviours are the principles and actions that guide positive health behaviours and lifestyle choices. Self-care context is the degree of dependence or independence from external healthcare resources. Self-care environment is the external factor that influences self-care practices within the community. Self-care is closely related to Lifestyle Medicine, which supports individuals in adopting sustainable health practices and prioritises preventive strategies over reactive measures. Lifestyle Medicine and self-care play a crucial role in both primary and secondary prevention of diseases. The future of self-care envisions a healthcare landscape where technology and personalised approaches enhance self-care and Lifestyle Medicine. However, there are also challenges to address, such as potential inequalities and misconceptions that may arise as health systems pivot towards self-care.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Lifestyle Medicine is an evidence-based medical discipline that emphasises behaviour change to improve overall health, focusing on mental wellbeing, social connections, healthy eating, physical activity, sleep, and minimising harmful behaviours. The approach bridges clinical practice with public health interventions, targeting both individual and population health. It is effective in preventing, treating, and sometimes reversing chronic diseases through lifestyle modification. Clinicians practising Lifestyle Medicine support actions beyond clinical consultations, advocating for healthy environments and policies. The discipline also addresses the challenges of non-communicable diseases and enhances resilience against infectious diseases. It offers an alternative to over-medicalisation, promoting self-care and lifestyle changes alongside traditional medical treatments. The new medical paradigm recognises the modifiability of gene expression and the importance of lifestyle factors in health outcomes. Lifestyle Medicine is increasingly integrated into medical education and healthcare delivery systems. It aligns with the shift towards person-centred care that focuses on patients’ values and goals, contributing to a more holistic approach to health and wellbeing.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
A person-centred approach is central to effective lifestyle discussions, avoiding stigma and blame that can undermine patient motivation and self-efficacy. This involves shifting from a clinician-led model to collaborative consultations that respect patient values and goals, and fosters a partnership between the clinician and the patient. Compassionate care is essential for this approach. To prepare for consultations, health professionals must consider factors such as language, accessibility, and reception staff attitude that can influence the patient’s perception of person-centred care. Health professionals should use open-ended questions and active listening to gather a comprehensive lifestyle history that aligns with patient values and preferences. They should also understand patient concerns and expectations, and use them to build rapport and develop shared treatment goals. Moreover, health professionals must assess relationships and support systems that can significantly impact health outcomes, and explore positive mental states and life satisfaction to assess mental wellbeing comprehensively. By establishing a therapeutic relationship through compassionate history taking, health professionals can lay the foundations for effective behaviour change interventions.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Behaviour change science is a central concept in Lifestyle Medicine. It focuses on modifying lifestyle risk factors through evidence-based interventions. The COM-B model provides a framework that considers Capability, Opportunity, and Motivation as key components influencing health behaviours. In clinical settings, understanding and modifying patient behaviours are crucial for better health outcomes. Identifying internal and external factors that influence behaviour is essential for effective intervention. Various approaches, such as education, persuasion, and enablement, are used to target different aspects of behaviour change. Behaviour Change Techniques (BCTs) play a vital role in creating specific strategies for behaviour modification. Contextual understanding recognises the importance of considering the patient’s environment and circumstances. Additionally, addressing health inequalities acknowledges the role of wider determinants of health and emphasises the need for interventions that do not exacerbate disparities. Using behaviour change science in the practice of Lifestyle Medicine enhances patient-centred care and health outcomes.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Traditional clinical training has often lacked the leadership and management skills necessary for practitioners to effectively drive change. Despite facing systemic pressures and resource limitations, clinicians can be agents of change by innovating within their work environments. Practising self-care and understanding the benefits of Lifestyle Medicine are essential for healthcare practitioners to sustain their wellbeing and energy for these changes. The transformation of healthcare environments to encourage healthier choices can profoundly affect the wellbeing of both staff and patients. Large-scale change can be fostered by engaging with the community and connecting patients to local groups and activities. The UK has seen examples of successful Lifestyle Medicine projects and we explore some examples of success in this chapter. To innovate in healthcare, one must be clear about their motivation, be prepared to initiate projects without initial funding, plan for their evaluation, and ensure that the projects are enjoyable for all participants involved.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Modern Lifestyle Medicine can trace its roots from ancient practices to modern applications. Ancient systems, including Ayurveda and traditional Chinese medicine emphasised nutrition, sleep, and stress management, while Greco-Roman and Middle Eastern traditions also recognised the importance of lifestyle in health. The term ‘Lifestyle Medicine’ emerged in the late twentieth century, reflecting a shift towards addressing long-term conditions through lifestyle changes rather than pharmaceuticals. There are challenges on multiple fronts. Firstly, the question of whether research bias is favouring pharmaceutical and surgical interventions over lifestyle changes. Secondly, socio-economic factors exacerbate health inequities, impacting the effectiveness of Lifestyle Medicine. Thirdly, there are education gaps, with healthcare workers lacking knowledge and skills for lifestyle interventions. Fourthly, providers face time constraints and financial incentives that prioritise medications or surgery. Lastly, regulatory issues arise, necessitating quality education and evidence-based practices to distinguish Lifestyle Medicine from alternative approaches.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
The rapid development of information and communication technologies since the 1990s has had far-reaching impacts on health behaviours and healthcare. There are many opportunities for Lifestyle Medicine. The Gartner Hype Cycle offers a useful model to understand the adoption stages of technologies such as wearable activity trackers and telemedicine in Lifestyle Medicine. Technology can enhance mental wellbeing, social connections, physical activity, healthy eating, sleep quality, and harm reduction.
However, technology use also poses risks, such as encouraging sedentary behaviours, social isolation, and digital exclusion. Data analysis in technology can be challenging, and ensuring cybersecurity and commercial surveillance protection is essential. Technology can help deliver personalised interventions that match patient needs. Technology can also provide holistic health support to patients beyond traditional consultations.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Health coaching and motivational interviewing (MI) are evidence-based approaches to support behaviour change and self-care in people with long-term conditions. Health coaching is a patient-centred process that involves goal setting, self-discovery, health education, and accountability mechanisms. Motivational interviewing is a conversational style that strengthens a person’s own motivation and commitment to change by exploring and resolving ambivalence. Health coaching and MI have been shown to improve health outcomes in various settings and populations, such as addiction, chronic disease, psychological health, oral health, and paediatric care. Health coaching and MI require training and practice to develop the necessary skills and competencies, as well as feedback and supervision to maintain and improve them. Health coaching and MI are important components of Lifestyle Medicine, helping clinicians to facilitate and enable healthy behaviour change.
The COVID-19 pandemic provided a stark reminder that societies will struggle to address global challenges unless they are able to change behaviour at scale. The widely adopted ‘nudge’ approach epitomizes an individualistic, deficit model of human cognition and motivation that leverages or overcomes people’s weaknesses and biases to get them to do things they would otherwise not. By contrast, we argue that tackling the challenges facing humanity requires a collective, capacity-building approach – one that boosts the competences, opportunities, and motivations of individuals to act together.
Littering involves throwing away waste in places not designated for it, harming the environment. This study introduces a strategy to encourage more use of Littergram, an app designed to fight littering. Littergram allows users to photograph litter and share these images publicly, alerting local councils to clean up the waste. The study aimed to increase user engagement with Littergram by implementing an intervention designed using the Behaviour Change Wheel (BCW), a comprehensive framework for developing behaviour change interventions. We developed and applied a digital campaign through emails, following BCW guidelines. The process began with identifying the behaviour we wanted to change. We conducted a survey to understand what influences this behaviour and selected techniques for changing behaviour based on these insights. The campaign involved sending targeted emails to Littergram users. There was an increase in the use of Littergram during the campaign, and growth returned to initial levels after the campaign ended. This outcome shows that the approach can effectively increase engagement temporarily. Future research should focus on challenges in maintaining long-term behaviour change.