DISCUSSION
Nelson et, stroke
CVD, STROKE
“Waking up” to the need for health behavior change appears to be a crucial precursor to and facilitator of long‐term health behavior change. Seeing the bigger picture, recognizing health risks and understanding how those risks might affect disability, level of independence, and quality of life were all acknowledged as important. This supports previous findings on the association between the patient awareness of their risk factors and their ability and readiness to change behaviors over time and reduce their risk of subsequent stroke (Eames et al., Using tools to support decision‐making and learning new skills in prioritizing self, establishing routines, goal‐setting, problem‐solving, and time‐management were found to be significant facilitators of long‐term behavior change. Similar findings were reported in an employer‐offered pilot study of HWC coaching where goal‐setting, improved personal awareness, and motivation were seen as key values of health coaching (Nelson et al., A key finding is that HWC should not just focus on physical health; it should be person‐centered, responsive to individual need, and inclusive of all areas of well‐being, further illustrating the model put forward by Lennon et al. (Community engagement was seen as a good distraction from unhealthy habits, whilst also potentially being a barrier in terms of participants being too busy with community participation to follow through with planned exercise routines. Overwhelmingly though, community engagement and participation appeared to have a positive impact on self‐esteem, identity, fulfillment, and happiness, which in turn impacted on long‐term motivation to stay well. This is not surprising as community participation and social connectedness have been shown to be associated with enhanced mental well‐being (Ding et al., Accountability to self and others was an important facilitator of long‐term behavior change both during HWC and afterward. This finding is supported by Nelson et al. (The authors did not identify any differences in experiences based on CVD risk, gender, ethnicity, or age. The timing of the intervention, self‐awareness, community engagement, and accountability appeared to be more significant factors in the achievement of long‐term behavior change than personal characteristics, such as age, gender, ethnicity, or CVD risk.