Study Reveals Complex, Nonlinear Process of Health Behavior Change Among Women With Polycystic Ovary Syndrome

A recent studyopens in new tab/window in the Journal of Nutrition Education and Behavioropens in new tab/window (JNEB), published by Elsevier, provides new insight into how women with polycystic ovary syndrome (PCOS) adopt and maintain healthy eating and physical activity behaviors. Researchers found that behavior change is a nonlinear process shaped by factors that can either support progress or lead to disengagement.

The qualitative study included interviews with 20 women with PCOS, 13 doctors, and four nurses at hospitals in Hunan Province, China. Using grounded theory analysis, researchers developed a framework describing three progressive stages of health behavior change: intention, adoption, and maintenance. They also identified disengagement as a dynamic state that can occur at any stage.

The intention stage was driven by physical and psychological needs, such as concerns about fertility, symptoms, and self-esteem, as well as changes in knowledge and understanding. Moving from intention to action (adoption stage) was supported by factors including self-efficacy, health information literacy, access to resources, and social support. Among the few participants who reached the maintenance stage, goal setting, self-regulation, a sense of identity, and positive feedback helped sustain healthy behaviors.

However, most patients experienced disengagement at some point. Personal limitations, environmental constraints, disease-related barriers, and the time, cost, and complexity of healthy behaviors could outweigh factors supporting change.

“Behavioral disengagement should not simply be viewed as a personal failure of willpower,” said corresponding author, Shujuan Zhu, MSc, RN, Department of Gynecology, The Third XiangYa Hospital of Central South University, Changsha. “It may reflect a dynamic state in which restraining factors outweigh the factors supporting continued behavior change.”

The researchers suggest that health care providers consider where individuals are in the behavior change process and address the specific factors affecting their progress. Tailored interventions that strengthen supportive factors while reducing barriers may help women with PCOS move toward sustained healthy behaviors.

The study also highlights the need for future research to test the framework in other populations and cultural contexts and to further examine how interventions can adapt to changes in individuals’ behavioral status.

Notes for editors

The article is "Revealing the Complexity of Health Behavior Change Among Women with Polycystic Ovary Syndrome: A Qualitative Grounded Theory Study," by Quan Shen, PhD, RN; Xi Zhang, PhD, RN; Enuo Peng, MD; Jia Qu, MSc, RN; Shujuan Zhu, MSc, RN; Jun Lei, MD, FAAN (https://doi.org/10.1016/j.jneb.2026.07.008opens in new tab/window). It appears online in the Journal of Nutrition Education and Behavior in advance of volume 58, issue 10 (October 2026), published by Elsevier.

At the time the study was conducted, the term polycystic ovary syndrome (PCOS) was correct. Following a global medical consensus, the condition has been officially reclassified as polyendocrine metabolic ovarian syndrome (PMOS).

The article is openly available for 90 days at https://www.jneb.org/article/S1499-4046(26)00417-3/fulltextopens in new tab/window.

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 406 1313 or [email protected]opens in new tab/window to obtain a copy. To schedule an interview with the author(s), please contact Shujuan Zhu, MSc, RN, at [email protected]opens in new tab/window.

This work was supported by Health High-level Talent Support Program of Hunan Province of China (20230457).

About the Journal of Nutrition Education and Behavior (JNEB)

The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior (SNEB), is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues, and practices relevant to nutrition education and behavior worldwide and to promote healthy, sustainable food choices. It supports the society’s efforts to disseminate innovative nutrition education strategies and communicate information on food, nutrition, and health issues to students, professionals, policy makers, targeted audiences, and the public.

The Journal of Nutrition Education and Behavior features articles that provide new insights and useful findings related to nutrition education research, practice, and policy. The content areas of JNEB reflect the diverse interests of health, nutrition, education, Cooperative Extension, and other professionals working in areas related to nutrition education and behavior. As the Society's official journal, JNEB also includes occasional policy statements, issue perspectives, and member communications. www.jneb.orgopens in new tab/window

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