The first apparent theme among women’s responses was creating routines. The small nature of the HPB goals enabled women to “fit in” behaviours throughout their days in a repetitive and normalised manner. Despite the diversity of what these routines entailed – and how they were embedded into the day – routines enabled women to integrate this behaviour change into their daily lives. Women’s accounts also revealed that routinely participating in small behaviours enabled them to experience the benefits that they provided and thus realise how the HPBs contributed to their health.
132 Chapter 5 – NLH Outcomes Table 13
Themes for Participant Perceived Outcomes
Theme Sub-theme Excerpt example
Creating routines Building HPBs into routines
Routines highlight the importance of HPBs
It [NLH] made me realise how easy it was to gain more control of my own health. It only takes little changes within your daily life to really make a difference. I incorporate the stress-management and self-care into my thinking patterns.
The importance and benefit of… creating peace and balance in, what can be a hectic lifestyle. Knowing that small changes to lifestyle can make a big difference to overall health. Shifting towards a
holistic health perspective
Health is beyond a physical dimension
A wider view of the physical dimension
More holistic sense of self Realising the integration between health aspects
[NLH] made me think a little more about health as a wider concept, not just physically which is my default thinking around health. Health is more than looking good.
…I looked at exercise mainly before as way to become thinner etc. Now I see as a way to make me stronger, and also de-stress – impact more areas of my life. Definitely gave me a wider view of health, a more holistic view of my own health perception, and the importance and value each of the areas had on health, i.e., not just weight and physicality being the main/primary markers of health
It [NLH] made me think more holistically about my health, in terms of it including stress management and self-care, which I initially thought were less important but once I made changes in these areas I found that it impacted my health (physically and mentally) in positive ways.
I thought more about balance i.e., between all the NLH components and how changes in one may affect changes in another eh. Nutrition and exercise impacting sleep.
I have changed my perspective on what overall health is through achieving a balance between all aspects of health.
Health literacy Functional Interactional Critical
I am in general more aware of the things I can do (and how easy it is) to maintain a healthy lifestyle and good habits I am more self-aware of how I am feeling and why and what to do about it.
Adjust things to my current health – doesn’t have to be all or nothing
Social habits regarding sleep/alcohol eg not feeling the pressure to continue past the point I want to if I’d rather head to bed. Less social guilt for that
Self-actualisation Adopting a positive perspective
Focusing on small steps forward A holistic perspective unveils their potential
I became more aware of all the negative things I would say about myself or my body and have made more of an effort to say or think positive things.
…the self-talk that I would give myself is a lot more positive than before. I’m learning to celebrate the things that I have done well and to look at my failures as an opportunity for learning and growth and to know that it aint a failure unless I decide to give up
The programme doesn’t make me feel I am limited in anyway, which probably comes down to acknowledging every positive step no matter what size (big or small). I have 100% achieved a balance because of this programme. I think this is the best my overall health has ever been.
After NLH, women felt that, opposing to their prior beliefs, health behaviours did not require large amounts of time out of their days, but instead could be easily integrated and become part of their lives. The minute nature of the HPB goals enabled women to achieve these without too many adjustments, and be “more aware of little things I can easily do day-to-day that are healthier options for food, exercise and nutritional activities and sleep patterns” (P52, 25 years, post-intervention). Women described a range of ways in which HPBs became embedded in their days, such as incorporating breakfast into their morning routine, or increasing fruit and vegetable intakes by bringing them as snacks to the office. Other women described building physical activity into their day by taking the stairs or opting to walk as their mode of transport. Such integration enabled women to create positive change for themselves without making significant alterations to their existing schedules. Women often described how making small, healthy adjustments contributed to feeling a greater sense of control over their health. Thus, incorporating small, HPBs within their regular days enabled women to feel more empowered over their health and lives:
It [NLH] made me realise how easy it was to gain more control of my own health. It only takes little changes within your daily life to really make a difference (P9, 20 years, follow up).
The small changes women initially made often led to bigger changes. As women progressed through NLH and accomplished HPBs, women were encouraged to build new HPBs upon existing ones during monthly planning sessions. By the end of NLH, women had created blocks of multiple HPBs within their usual routines. For example, many women described having a sleep routine to wind down before bed that encompassed multiple sleep goals, such as performing a sleep routine and shutting down screen-based activities early. Women’s routine blocks often combined HPBs from different categories. For instance, women described integrating stretching, time for themselves (e.g., reading, journaling, planning for the week) or routine thinking patterns (e.g., reflecting on stress management prompts, positive self-talk) into their sleep ritual before bed. Thus, women began with small changes to their routine that eventually grew into blocks of HPBs:
134 Chapter 5 – NLH Outcomes Q: Thinking about the outcomes you experienced at the end of the programme (6
months), what do you feel you have maintained?
A: Making small changes to begin with and building on it (P21, 26 years, follow up).
After NLH, women felt more competent in adding to, and carrying out regular health routines. For instance, women reported greater competency for their routines. Some women mentioned organising their HPBs by planning their routines. For instance, women incorporated increasing levels of skills regarding their HPBs such as routinely adding healthy foods to grocery shopping, adding healthier meals to their meal planning schedules or scheduling in physical activity and self-care. Women even reported that despite changing circumstances that would have normally disrupted “healthy routines”, they were able to maintain these behaviours by adapting them to the new situation; for instance, by “maintain[ing] healthy eating (increased veges), regular exercise, good stress management and regular sleep cycles (even when travelling)” (P53, 26 years, follow up). Additionally, after NLH, women managed to achieve their HPBs when their routines fluctuated on a more regular basis. For example, some women reported their continued achievement for self-care, physical activity and nutrition HPBs even when their schedules became busy. Women’s incorporation of HPBs into their dynamic lives demonstrated that the changes were manageable:
Making healthy food choices even in busy situations is easier. More often than not I choose healthier options and make exercise a routine (P41,35 years, post- intervention).
It is important to note, however, that women did not always report solidifying their HPBs into their daily lives and routines. After NLH, women often noted that the fluctuation of their routines impacted their HPB achievement:
I have not maintained a lot – was doing great for the three months that followed the end of the programme. Had a big change of routine with a new job and did not maintain as many habits immediately. Preparing meals and including lots of veges I have kept up mostly – Nutrition. Physical activity for 3 months following the finish (P4, 25 years, follow up).
Women also reported on their “foundation routines”, which represented their comfort level for HPBs without added cognitive effort of developing or maintaining HPBs. Women’s accounts revealed that developing their foundation routine was seen as a point of success. In the following excerpt, a woman describes how, despite her difficulty maintaining new HPBs, she had reinforced a holistic foundation:
I don’t think my physical health has improved much if at all, yet- because I have not been good at sticking to goals and making them habits, and changes have been small. But I feel I have a really good foundation on which to continue to build. I think my mental health has improved a lot, because the programme has helped me to prioritise it: I was aware that exercise, good eating etc. were important but never truly took on board how important, or put those needs first (P36, 29 years, post-intervention).
Women continued to described their HPB routines at follow up. Most of the women reported specific HPBs they sustained. Several women noted continuing with their HPBs, but to a lesser degree compared the outcomes they accomplished at post-intervention. Others explained maintaining a loose approach to their HPB routines, such as focusing on those that were most relevant at a given time:
I haven’t maintained a very strict goals method but I have kept using the tools and knowledge learned in the 6 months of the programme that helps me keep on top of my health and well-being (P9, 20 years, follow up).
136 Chapter 5 – NLH Outcomes Following NLH, women were more likely to appreciate the importance of regularly engaging in HPBs because they experienced the benefits they gained with frequent HPB repetition. This repetitive nature of routines supported women to identify changes to their health after integrating small HPB changes, “…knowing that small changes to lifestyle can make a big difference to overall health” (P45, 21 years, follow up).
Women indicated becoming more aware of a wide range of positive outcomes across health dimensions that they attributed to making healthy changes to their routines. For example, women noted feeling more energised from consistently winding down before bed, “less out of breath” from regularly walking up the stairs and “mentally less chaotic” from reflecting on their stressors. Women explained that the ability to see these benefits from making small, healthy, changes was motivating. Moreover, identifying their progress over time reinforced the idea that small changes held potential to achieve notable outcomes:
More conscious of the impact small changes can have on my overall health (P7, 36 years, post-intervention).
Overall, NLH enabled women to make changes to their health practices in everyday life by integrating HPBs into their daily routines. Despite encountering a variety of changes to their “regular day”, women were able to maintain their HPBs by adjusting them to the given situations. Women’s ability to embed and sustain health changes in their daily routines enabled them to feel more in control of their health. The repetition of routines enabled women to discover the benefits of making small health changes to their daily lives. This satisfaction encouraged women to continue their HPB achievement.