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So, these factors, which include

low perceived self-efficacy,

attribution error,

poor memory,

inadequate skills and resources and

previous failures

all conspire to place considerable resistance in the path of people seeking change. While most health education programmes try to address the deficits in memory, skills and resources, few extend to addressing low perceived self-esttem and challenge both attribution errors and redressing previous failure. Finally, of course, there has to be sufficient motivation to change.