Your doctor gave you good advice. So why is it so hard to follow?

You leave the doctor's surgery feeling reassured. You know what you need to do.

Perhaps you've been told to lose some weight, move more, eat differently, stop smoking, manage your stress or become more active.

It all sounds perfectly manageable while you're sitting there. Then you get home and somehow, the simple plan becomes considerably less simple.

There is work. There are children. There's dinner to make. There's the commute. Your knee hurts. You didn't sleep well. Someone needs something from you. You're tired. It's raining. Suddenly, the healthy lunch you had carefully planned has somehow been replaced by whatever you can find in the fridge at 2pm.

Nothing about the doctor's advice was necessarily wrong.

So why is doing it so much harder than understanding it?

The space between knowing and doing

We tend to think that if people have the right information, they will make the right choices.

It is an appealing idea. Used by many.

If you know that physical activity is good for your cardiovascular health, you will exercise. If you know that smoking increases your risk of disease, you will stop. If you know that a healthier diet can improve metabolic health, you'll change what you eat.

Except human behaviour doesn't work quite like that.

The World Health Organization now explicitly recognises that health behaviours are influenced by far more than knowledge and motivation. Social norms, culture, access to healthcare, our environment and the way health professionals interact with us can all affect what we actually do.

That's before we get to the very ordinary business of being human.

I believe that nowadays, knowing is relatively easy. Once we know, it’s like we are doing it, right?! …except we are not.

Doing, repeatedly, in the middle of real life is something else entirely.

Advice doesn't arrive in a vacuum

Imagine being told that you need to become more physically active.

On paper, it is excellent advice but what does it mean on Wednesday?

Does it mean joining a gym? Walking for thirty minutes? Going swimming?

Taking the stairs? Starting strength training? Exercising despite pain? Finding childcare? Getting up earlier? …what happens when Wednesday turns into a twelve-hour working day?

The recommendation hasn't changed.

The circumstances around it have.

This is one reason the language of “adherence” can sometimes be unhelpful. It can make the patient sound as though they are either complying with instructions or failing to do so.

Oh gosh, behaviour is more complicated than that!

The WHO has described adherence as a complex behavioural process shaped by factors relating to the person, their environment, the healthcare system, the condition and the treatment itself.

In other words, when a recommended behaviour isn't happening, the most useful question isn't always:

“Why won't they do it?”

It may be:

“What is making it difficult to do?”

That is a very different starting point. From my experience motivation gets blamed by a lot by my clients.

“I just need to be more motivated.”

“I know what I should be doing. I just can't seem to stick to it.”

It sounds plausible, but motivation is an unreliable foundation for any behaviour we want to maintain for months or years. You can be enormously motivated on Monday and by Thursday, life may have other ideas.

Behaviour-change research supports the importance of factors such as autonomy and perceived competence, in other words, feeling that the behaviour is personally meaningful and that you are capable of doing it. A meta-analysis of 56 studies of interventions based on Self-Determination Theory found small but significant effects across several health behaviours, including physical activity, diet and smoking cessation.

That doesn't mean motivation doesn't matter, it only means motivation isn't the whole story.

The missing piece is often feeling isolated, confused and overwhelmed so nothing change and the loop re-starts

A doctor might reasonably say:

“You need to increase your activity.”

The next conversation might be:

“Okay. What would that look like in your life?”

That is where things become interesting.

Perhaps the person already walks their dog twice a day but believes it “doesn't count” as exercise.

Perhaps they used to enjoy swimming but stopped because getting to the pool became impractical.

The biggest I’ve heard far too often is that they are frightened of making their pain worse.

Perhaps they have tried exercising several times before and every attempt ended in exhaustion.

This is why behaviour-change support isn't simply about giving people more health information.

It is about translating good advice into something that can survive contact with real life. We rarely fail because we don't know enough. Think about the things you already know are good for you.

You probably don't need another article explaining why vegetables, movement, sleep or not smoking are beneficial.

Most adults aren't walking around thinking:

“If only someone would explain the health benefits of exercise one more time.”

The challenge is usually elsewhere. It might be the evening routine, the emotional association with food or the fear of movement.

The cigarette that has become part of the morning coffee.

The exhaustion that makes cooking feel impossible.

The belief that if you can't do something perfectly, there is no point doing it at all. (this is another big one in my books!) or simply the fact that the behaviour you are being asked to change has been part of your life for years.

The WHO's current work on behavioural and cultural insights reflects this shift in thinking: rather than assuming people behave differently because they have been given enough information, it focuses on understanding what actually drives and prevents behaviour in a particular context.

That is a much more interesting question and, I think, a much kinder one.

What if we stopped calling people “non-compliant”?

There is something quite powerful about changing the question.

Instead of:

Why didn't you follow the advice?

we could ask:

What happened when you tried?

Maybe the person did follow it, for two weeks.

Then something disrupted the routine and that disruption tells us something.

Perhaps the plan was too ambitious. Perhaps there wasn't enough support.

Perhaps the person hadn't anticipated weekends, travel or stress. Perhaps they hadn't found a way of making the behaviour their own.

That doesn't make the two weeks meaningless.

It gives us information for the next version of the plan.

This is one reason behaviour-change interventions are increasingly designed around the realities that influence behaviour rather than information alone.

WHO's European BRIEF programme, for example, specifically addresses behavioural risk factors within primary care and emphasises implementation as part of making brief interventions work in practice.

The goal isn't to become a different person overnight

There is another trap here.

We often approach health change as though we are about to become an entirely new person.

“From Monday:

I will exercise every day.

I will never eat that again.

I will cook everything from scratch.

I will never smoke.”

It feels wonderfully decisive. It is also remarkably fragile. Sustainable change tends to look less dramatic. One behaviour becomes slightly easier, then it happens again, a routine develops, then something becomes familiar.

You learn what gets in the way.

You adapt.

You have a difficult week and learn how to come back rather than starting again from zero.

Over time, the behaviour begins to feel less like something you are trying to do and more like something you do. That distinction matters.

Good healthcare doesn't end when the advice is given

Medical advice is incredibly important. Diagnosis matters. Treatment matters. Medication matters. Clinical expertise matters.

But for many lifestyle-related recommendations, the clinician cannot possibly accompany a patient through every supermarket trip, stressful Tuesday evening, family meal, sleepless night or difficult weekend. And nor should they have to.

There is another role in the healthcare ecosystem: helping people work out how to implement what has been recommended.

Not replacing the doctor. Not prescribing. Not diagnosing.

Not telling someone what they “should” do but helping them turn a recommendation into a behaviour that makes sense in their circumstances.

That is the space health coaching can occupy.

So, the next time you think “I know what I should do…”

Pause there.

Perhaps the more useful question isn't:

“Why can't I make myself do it?”

Perhaps it is:

“What would need to change to make this possible in my real life?”

Because good advice deserves a chance to work and sometimes the difference between knowing what to do and actually doing it isn't more information.

It's having the support to make the information usable.

Ciao Change perspective

At Ciao Change, I don't believe people are lazy, difficult or lacking in willpower simply because they struggle to follow health advice.

People are often trying to change something in the middle of lives that haven't stopped happening.

The goal isn't perfection.

It's finding a way forward that works in real life and building from there knowing you are not alone.

Your goal is yours. Let's make it happen.

Sources and further reading

• World Health Organization Regional Office for Europe. Behavioural and cultural insights: How do behaviours impact our health? 2024.

• World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. 2003.

• Gillison FB, et al. Self-determination theory interventions for health behavior change: Meta-analysis and meta-analytic structural equation modeling of randomized controlled trials. Health Psychology. 2020;39(6):461–472.

• World Health Organization Regional Office for Europe. Integrated brief interventions for noncommunicable disease risk factors in primary care: the BRIEF project. 2022.

"Disclaimer: This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of Ciao Change Ltd unless specified under “The Ciao Change perspective” section."