Benjamin Gardner

Promoting habit formation

Abstract Habits are automatic behavioural responses to environmental cues, thought to develop through repetition of behaviour in consistent contexts. When habit is strong, deliberate intentions have been shown to have a reduced influence on behaviour. The habit concept may provide a mechanism for establishing new behaviours, and so healthy habit formation is a desired outcome for many interventions. Habits also however represent a potential challenge for changing ingrained unhealthy behaviours, which may be resistant to motivational shifts. This review aims to provide intervention developers with tools to help establish target behaviours as habits, based on theoretical and empirical insights. We discuss evidence-based techniques for forming new healthy habits and breaking existing unhealthy habits. To promote habit formation we focus on strategies to initiate a new behaviour, support context-dependent repetition of this behaviour, and facilitate the development of automaticity. We discuss techniques for disrupting existing unwanted habits, which relate to restructuring the personal environment and enabling alternative responses to situational cues.

A Systematic Review and Meta-analysis of Applications of the Self-Report Habit Index to Nutrition and Physical Activity Behaviours

BackgroundHealth behaviour models typically neglect habitual action. The Self-Report Habit Index (SRHI) permits synthesis of evidence of the influence of habit on behaviour.PurposeThe purpose of this study is to review evidence around mean habit strength, habit–behaviour correlations, and habit × intention interactions, from applications of the SRHI to dietary, physical activity, and active travel behaviour.MethodElectronic database searches identified 126 potentially relevant papers. Twenty-two papers (21 datasets) passed eligibility screening. Mean scores and correlations were meta-analysed using fixed, random and mixed effects, and interactions were synthesised via narrative review.ResultsTwenty-three habit–behaviour correlations and nine habit × intention interaction tests were found. Typical habit strength was located around the SRHI midpoint. Weighted habit–behaviour effects were medium-to-strong (fixed: r+ = 0.44; random: r+ = 0.46). Eight tests found that habit moderated the intention–behaviour relation.ConclusionMore comprehensive understanding of nutrition and activity behaviours will be achieved by accounting for habitual responses to contextual cues.

Towards parsimony in habit measurement: Testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index

BackgroundThe twelve-item Self-Report Habit Index (SRHI) is the most popular measure of energy-balance related habits. This measure characterises habit by automatic activation, behavioural frequency, and relevance to self-identity. Previous empirical research suggests that the SRHI may be abbreviated with no losses in reliability or predictive utility. Drawing on recent theorising suggesting that automaticity is the ‘active ingredient’ of habit-behaviour relationships, we tested whether an automaticity-specific SRHI subscale could capture habit-based behaviour patterns in self-report data.MethodsA content validity task was undertaken to identify a subset of automaticity indicators within the SRHI. The reliability, convergent validity and predictive validity of the automaticity item subset was subsequently tested in secondary analyses of all previous SRHI applications, identified via systematic review, and in primary analyses of four raw datasets relating to energy‐balance relevant behaviours (inactive travel, active travel, snacking, and alcohol consumption).ResultsA four-item automaticity subscale (the ‘Self-Report Behavioural Automaticity Index’; ‘SRBAI’) was found to be reliable and sensitive to two hypothesised effects of habit on behaviour: a habit-behaviour correlation, and a moderating effect of habit on the intention-behaviour relationship.ConclusionThe SRBAI offers a parsimonious measure that adequately captures habitual behaviour patterns. The SRBAI may be of particular utility in predicting future behaviour and in studies tracking habit formation or disruption.

A review and analysis of the use of ‘habit’ in understanding, predicting and influencing health-related behaviour

The term ‘habit’ is widely used to predict and explain behaviour. This paper examines use of the term in the context of health-related behaviour, and explores how the concept might be made more useful. A narrative review is presented, drawing on a scoping review of 136 empirical studies and 8 literature reviews undertaken to document usage of the term ‘habit’, and methods to measure it. A coherent definition of ‘habit’, and proposals for improved methods for studying it, were derived from findings. Definitions of ‘habit’ have varied in ways that are often implicit and not coherently linked with an underlying theory. A definition is proposed whereby habit is a process by which a stimulus generates an impulse to act as a result of a learned stimulus-response association. Habit-generated impulses may compete or combine with impulses and inhibitions arising from other sources, including conscious decision-making, to influence responses, and need not generate behaviour. Most research on habit is based on correlational studies using self-report measures. Adopting a coherent definition of ‘habit’, and a wider range of paradigms, designs and measures to study it, may accelerate progress in habit theory and application.

Changing diet and physical activity to reduce gestational weight gain: a meta-analysis.

Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. Intervention developers have assumed that adopting a healthier diet and increasing physical activity in pregnancy can limit weight gain, but evaluations of such interventions have yielded mixed results. Recent reviews of this literature have not identified defining characteristics of effective interventions. We systematically reviewed 10 published controlled trials of interventions that aimed to reduce gestational weight gain through changes in diet or physical activity. Characteristics of the sample, intervention content and delivery, and methodology were categorized. Meta‐analysis showed that, overall, diet and physical activity change was effective in reducing gestational weight gain, but there was considerable heterogeneity in outcomes. Our analysis points to sample characteristics and aspects of intervention design, content, delivery and evaluation which differ between studies and may explain variation in effectiveness. Failure to evaluate changes in behaviour or its psychological determinants, and under‐reporting of intervention content, may obscure identification of the processes by which weight change is effected. This limits our ability to discern active intervention ingredients. We suggest that behaviour‐based gestational weight gain reduction interventions be more systematically designed, evaluated and reported to build on insights from behavioural science.

How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults

Sedentary behaviour – i.e., low energy-expending waking behaviour while seated or lying down – is a health risk factor, even when controlling for physical activity. This review sought to describe the behaviour change strategies used within interventions that have sought to reduce sedentary behaviour in adults. Studies were identified through existing literature reviews, a systematic database search, and hand-searches of eligible papers. Interventions were categorised as ‘very promising’, ‘quite promising’, or ‘non-promising’ according to observed behaviour changes. Intervention functions and behaviour change techniques were compared across promising and non-promising interventions. Twenty-six eligible studies reported thirty-eight interventions, of which twenty (53%) were worksite-based. Fifteen interventions (39%) were very promising, eight quite promising (21%), and fifteen non-promising (39%). Very or quite promising interventions tended to have targeted sedentary behaviour instead of physical activity. Interventions based on environmental restructuring, persuasion, or education were most promising. Self-monitoring, problem solving, and restructuring the social or physical environment were particularly promising behaviour change techniques. Future sedentary reduction interventions might most fruitfully incorporate environmental modification and self-regulatory skills training. The evidence base is, however, weakened by low-quality evaluation methods; more RCTs, employing no-treatment control groups, and collecting objective data are needed.

Experiences of habit formation: A qualitative study

Habit formation is an important goal for behaviour change interventions because habitual behaviours are elicited automatically and are therefore likely to be maintained. This study documented experiences of habit development in 10 participants enrolled on a weight loss intervention explicitly based on habit-formation principles. Thematic analysis revealed three themes: Strategies used to support initial engagement in a novel behaviour; development of behavioural automaticity; and selecting effective cues to support repeated behaviour. Results showed that behaviour change was initially experienced as cognitively effortful but as automaticity increased, enactment became easier. Habits were typically formed in work-based contexts. Weekends and vacations temporarily disrupted performance due to absence of associated cues, but habits were reinstated on return to work. Implications for theory and practice are discussed.

Making health habitual: the psychology of ‘habit-formation’ and general practice

The Secretary of State recently proposed that the NHS: ‘... take every opportunity to prevent poor health and promote healthy living by making the most of healthcare professionals’ contact with individual patients.’ 1 Patients trust health professionals as a source of advice on ‘lifestyle’ (that is, behaviour) change, and brief opportunistic advice can be effective.2 However, many health professionals shy away from giving advice on modifying behaviour because they find traditional behaviour change strategies time-consuming to explain and difficult for the patient to implement.2 Furthermore, even when patients successfully initiate the recommended changes, the gains are often transient3 because few of the traditional behaviour change strategies have built-in mechanisms for maintenance. Brief advice is usually based on advising patients on what to change and why (for example, reducing saturated fat intake to reduce the risk of heart attack). Psychologically, such advice is designed to engage conscious deliberative motivational processes, which Kahneman terms ‘slow’ or ‘System 2’ processes.4 However, the effects are typically short-lived because motivation and attention wane. Brief advice on how to change, engaging automatic (‘System 1’) processes, may offer a valuable alternative with potential for long-term impact. Opportunistic health behaviour advice must be easy for health professionals to give and easy for patients to implement to fit into routine health care. We propose that simple advice on how to make healthy actions into habits — externally-triggered automatic responses to frequently encountered contexts — offers a useful option in the behaviour change toolkit. Advice for creating habits is easy for clinicians to deliver and easy for patients to implement: repeat a chosen behaviour in the same context, until it becomes automatic and effortless. While often used as a synonym for frequent or customary behaviour in everyday parlance, within psychology, ‘habits’ are defined as actions that …

Forming a flossing habit: An exploratory study of the psychological determinants of habit formation

OBJECTIVES Habit formation has been proposed as a means to promote maintenance of healthy behaviours, but there have been few investigations into how habits are formed. This exploratory study sought to model determinants of the formation of a dental flossing habit, including placement of the behaviour within the routine (before vs. after tooth-brushing), past behaviour, prospective memory ability, and motivational factors. DESIGN AND METHOD All participants (N = 50) received a motivational intervention designed to initiate behaviour change and habit formation. Half of the participants were instructed to floss before brushing, and half after. Participants subsequently self-reported flossing behaviour daily and, 4 weeks later, flossing automaticity. Automaticity and flossing frequency were also measured at 8-month follow-up. RESULTS Participants with stronger prospective memory ability, higher levels of past behaviour, and a more positive attitude flossed more frequently during the study. Stronger automaticity was predicted by positive attitudes, and increased behaviour frequency during and prior to the study. Those who flossed after brushing (rather than before) tended to form stronger flossing habits and, at 8-month follow-up, had stronger habits and flossed more frequently. CONCLUSIONS Habit forming interventions might usefully consider features of everyday routines and how behaviour may be reinforced. Suggestions for further research using more methodologically rigorous designs are offered. STATEMENT OF CONTRIBUTION What is already known on this subject? The formation of habit - that is, a learnt automatic response to contextual cues - requires initiation of a behaviour and repetition in a constant context. A recent formation study showed variation in habit strength despite equal repetitions, indicating that factors other than repetition may be important in habit development. From studies of routine behaviour, the boundaries between sub-routines are characterized by different processes than the middle of sub-routines, suggesting that placement of behaviour within existing routines may affect the likelihood of habit formation. What does this study add? Greater prospective memory ability predicted more frequent dental flossing. Initiating flossing after rather than before tooth-brushing promoted stronger habits. Positive attitudes impacted directly on habit formation, independent of behaviour repetition.

Does intrinsic motivation strengthen physical activity habit? Modeling relationships between self-determination, past behaviour, and habit strength

Habit formation is thought to aid maintenance of physical activity, but little research is available into determinants of habit strength aside from repeated performance. Previous work has shown that intrinsically motivated physical activity, underpinned by inherent satisfaction derived from activity, is more likely to be sustained. We explored whether this might reflect a tendency for self-determined activity to become more strongly habitual. A sample of 192 adults aged 18–30 completed measures of motivational regulation, intention, behaviour, and habit strength. Results showed that self-determined regulation interacted with past behaviour in predicting habit strength: prior action was more predictive of habit strength among more autonomously motivated participants. There was an unexpected direct effect of self-determined regulation on habit strength, independently of past behaviour. Findings offer possible directions for future habit formation work.