Habitual instigation and habitual execution: Definition, measurement, and effects on behaviour frequency

A qualitative investigation of individuals' lay representations of habit

Objective: While there have been substantive advances in the conceptualisation, measurement, and effects of habit as a psychological construct, there is limited research on individuals' beliefs and perspectives on habit. The current investigation reports the findings of two studies purposed to explore individuals' lay representations of habit which further inform habit theory and measurement, and interventions designed to promote habits. Methods: Study 1 (N = 158) used an online, open-ended questionnaire to elicit lay beliefs on the salient features of habit. Study 2 (N = 27) involved a series of interviews and focus groups to further explore individuals' representations of habit. Results: Thematic content analysis revealed that participants described habit in terms of its content, salient features or characteristics, and function or consequences. The results also indicated that while collective knowledge converged on expert perspectives, few individuals identified all or most features of habit, suggesting individuals' beliefs are incomplete. Conclusions: Current findings indicate that lay people as a collective hold consistent but largely 'patchy' beliefs about habit. Future research should focus on integrating the beliefs identified in this research with new measures of habit and habit interventions.

Broad versus narrow bandwidth measures of experienced automaticity for physical activity

Objective: Physical activity is important for health, yet most young adults are insufficiently active. Physical activity is regulated in part, by habit, typically operationalised as automaticity. Little is known about the characteristics of automaticity, or whether broad bandwidth unidimensional measures of automaticity for physical activity are superior to narrower bandwidth multi- dimensional measures. Design: This secondary analysis (N = 238) investigated the nature of automaticity, and relations between the dimensions of automaticity, global automaticity, and physical activity.Main Outcome Measures: The structure of the Generic Multifaceted Automaticity Scale (GMAS) was examined by confirmatory factor analyses. Structural equation models were estimated to evaluate relations between automaticity (measured on the GMAS and the Self- Report Behavioral Automaticity Index, SRBAI) and device- measured activity.Results: The hypothesised 3- factor structure of the GMAS was rejected, in favour of a 2- factor solution. Lack of intention/control and efficiency were associated with global automaticity, but not physical activity. Global automaticity was associated with moderate to vigorous physical activity and daily steps, but not light physical activity.Conclusion: Multi- dimensional measures of automaticity may not provide a more nuanced understanding of automaticity when predicting overall physical activity.

A full-factorial test of motivational and volitional intervention strategies for promoting exercise habit formation and exercise maintenance among new users of an online exercise class platform

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.

Combining anchoring with financial incentives to increase physical activity: a randomized controlled trial among college students

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring.

Can-and should-automaticity be self-reported using a single item? A secondary analysis of 16 datasets

Understanding the influence of habit on health behaviour, or the formation or disruption of health habits over time, requires reliable and valid measures of automaticity. The most used measure, the Self-Report Behavioural Automaticity Index (SRBAI; derived from the Self-Report Habit Index [SRHI]), comprises four items, which may be impractical in some research contexts. Responding to demand from fellow researchers, this study sought to identify whether and which single items from the SRBAI adequately detect hypothesised effects of automaticity, via secondary analysis of 16 datasets, incorporating 16,838 participants and seven different behaviours. We assessed construct validity through correlations between each item and the full SRBAI (and where possible, the SRHI) and predictive validity by examining correlations with behaviour. All four single-item measures independently met construct and predictive validity criteria. We recognise compelling conceptual and methodological arguments regarding why people should not attempt to assess automaticity via a single, self-report item. However, where circumstances require brief measures, three SRBAI items each offer a credible and practical one-item measure that can substitute for the SRBAI or SRHI. We recommend one item in particular-'Behaviour X is something I do automatically'-because it tended to most closely replicate the effects of the four-item SRBAI.

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

Testing the moderative role of automatic-reflective affect divergence in predicting physical activity

Dual process theories postulate that behaviour is the product of two distinct cognitive systems, the automatic and reflective, and that congruence/divergence between the two types of cognitions can influence the predictive strength of either system on behaviour. However, the congruence/divergence hypothesis has yet to experience strong empirical support. The aim of this study was to test a novel dual process model to determine the moderating effect of affect divergence on the relationship between automatic affective evaluations-affective judgements, and physical activity. A sample of 315 university students recruited from an undergraduate research pool completed the Affective Misattribution Procedure and Affective Exercise Experiences Questionnaire, followed by a measure of physical activity behaviour one week later. A path analysis revealed a significant moderation effect such that the predictive strength of affective judgements was stronger when participants' automatic affective evaluations and affective judgements were congruent. Findings support current dual process theory and contributes to calls for more interventions, such as evaluative conditioning that target automatic processes alongside consciously held beliefs.

A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions

Adherence to medication in long-term conditions is around 50%. The key components of successful interventions to improve medication adherence remain unclear, particularly when examined over prolonged follow-up periods. Behaviour change theories are increasingly interested in the utility of habit formation for the maintenance of health behaviour change, but there is no documentation on how habit has been conceptualised in the medication adherence intervention literature, or what effect the key technique identified in habit formation theory (context dependent repetition) has in these studies. To examine this, a machine-learning assisted review was conducted. Searches of MEDLINE, EMBASE and PSYCInfo and the reference list of a comprehensive systematic review of medication adherence interventions yielded 5973 articles. Machine learning-assisted title and abstract screening identified 15 independent RCTs published between 1976 and 2021, including 18 intervention comparisons of interest. Key findings indicate that conceptualisations of habit in the medication adherence literature are varied and behaviour change technique coding identified only six studies which explicitly described using habit formation. Future work should aim to develop this evidence base, drawing on contemporary habit theory and with explicit demonstration of what techniques have been used to promote habit formation.

Physical activity behaviour change in black prostate cancer survivors: a qualitative study using the Behaviour Change Wheel

PURPOSE

Black individuals have a higher cancer burden and face greater obstacles to access cancer care resources when compared to White individuals. Radical prostatectomy is the standard surgical treatment and a common treatment option for prostate cancer; however, when compared to their White counterparts, Black individuals treated for prostate cancer often experience higher treatment-related side effects, resulting in a difficult recovery period. Physical activity is effective in alleviating treatment-related side effects; however, little is known about the barriers and facilitators to physical activity experienced by Black individuals after surgical management of prostate cancer to inform the design of physical activity interventions.

METHODS

Twelve Black individuals underwent radical prostatectomy for prostate cancer participated in a focus group study. We used the Behaviour Change Wheel, which incorporates Capability, Opportunity, Behaviour (COM-B) model and the complementary Theoretical Domains Framework (TDF), as our guiding theoretical framework. Data was analyzed using deductive qualitative analysis.

RESULTS

Facilitators and barriers were identified for all components of the Behaviour Change Wheel. Capability appeared to be a central factor to how participants described their physical activity engagement. Opportunity and motivation were described as both barriers and facilitators for behaviour change when occurring in isolation; however, when co-occurring with the presence of capability, they were described as facilitators that influence participants' physical activity engagement.

CONCLUSIONS

Our results demonstrate barriers and facilitators that are recognized among Black individuals who have undergone radical prostatectomy for prostate cancer. The design of a physical activity intervention needs to consider the physical and psychological capabilities as the fundamental basis with the additional support of physical activity opportunity and motivation.

IMPLICATIONS FOR CANCER SURVIVORS

Intersectionality across capability, opportunity, and motivation is essential to intervention design and development to increase physical activity in Black individuals surgically treated for prostate cancer.

'It's satisfying but destructive': A qualitative study on the experience of bedtime procrastination in new career starters

BACKGROUND

Bedtime procrastination, the volitional delay of going to bed without any external circumstances causing the delay, is linked to multiple indicators of inadequate sleep. Intervening to reduce bedtime procrastination may be an important avenue to improve sleep outcomes, yet the phenomenon remains poorly understood in populations at risk for bedtime procrastination. New career starters, those who have graduated from tertiary education and started a new full-time job within the past 12 months, may be susceptible to problematic bedtime procrastination and are at an opportune time for a 'fresh start' to change behaviour.

AIMS

The objectives of this study were to understand how bedtime procrastination is experienced and perceived by new career starters, to identify the enablers and barriers to behaviour change in new career starters and to explore themes for future interventions.

MATERIALS & METHODS

Data were collected through in-depth semi-structured interviews with 28 participants.

RESULTS

Inductive thematic analysis was used to find seven themes: (1) negative feelings before and during bedtime procrastination; (2) wanting to versus knowing I shouldn't; (3) difficulty falling asleep; (4) influence of automatic processes; (5) consequences of bedtime procrastination; (6) lack of self-control and (7) technology captures late-night attention. Participants emphasised the need for me-time, self-negotiation to continue procrastinating and knowledge of the value of sleep.

DISCUSSION & CONCLUSION

Findings suggest that bedtime procrastination involves both reflective and automatic cognitive processes. Future interventions would benefit from a dual-process approach, using cognitive and behavioural techniques to reduce bedtime procrastination.

Reflective and non-reflective influences on cannabis use among undergraduate students: A qualitative study

OBJECTIVE

Around 40% of US university students use cannabis, 25% of whom present with cannabis use disorder, which endangers health. We investigated the concurrent contribution of reflective processes, which generate action via conscious deliberation, and non-reflective processes, which prompt behavior automatically, to undergraduates' cannabis consumption.

PARTICIPANTS

Eighteen UK undergraduates who regularly consume cannabis (11 female, 7 male; mean age 20 y).

METHODS

Semi-structured interviews explored cannabis motives, routines, cues, and decision points. Thematic analysis identified themes, in each of which reflective and non-reflective dimensions were coded.

RESULTS

Four themes were identified: cannabis use for relaxation, social bonding, and symbolic-affective significance, and contexts and triggers. Some influences guided cannabis use reflectively in some settings, and non-reflectively in others. Even when cannabis use was consciously driven, non-reflective processes were deployed to execute subservient acts, such as rolling joints.

CONCLUSIONS

Findings highlight specific processes and pathways that might be targeted to reduce cannabis-related harm.

Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study

BACKGROUND

Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments.

OBJECTIVE

The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up.

METHODS

Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models.

RESULTS

On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=-112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=-101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=-.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=-1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=-4.78; P=.02).

CONCLUSIONS

This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors.

Why do people sit? A framework for targeted behavior change

To improve health and wellbeing, it is crucial that people regularly interrupt their sitting. In this paper, we propose a framework for examining and changing sitting behavior that addresses two key steps in the process towards developing effective interventions. First, we suggest that research should move away from its current focus on sitting time, which is an outcome of behavior. Rather, researchers should focus on stand-to-sit and sit-to-stand transitions, which are discrete units of behavior. Second, drawing on goal hierarchy models, we suggest that people rarely engage in stand-to-sit and sit-to-stand transitions for the purpose of being in a sitting or standing position; rather, we suggest that these transitions are means to higher-order goals (e.g., to complete work tasks, to watch television, to eat dinner). To improve adherence to and effectiveness of sitting behavior interventions, intervention designers should aim to increase the frequency of sit-to-stand (and stand-to-sit) transitions. To achieve this aim, intervention designers should capitalize on the higher-order goals that are typically served by these transitions. We suggest four concrete intervention strategies to increase sit-to-stand transitions in congruence with people's everyday goals. We also describe the implications of our framework for theory and methods in sitting behavior research.

How Do Two Types of Exercise Habits Predict Physical Activity with Intention?

This manuscript investigates how conscious intention and unconscious exercise habits influence physical activity behavior. While prior research has predominantly focused on conscious decision-making, this study applied a dual-process model to explore the impact of intention and habit on physical activity engagement. Out of the 300 questionnaires distributed to students from one university, 282 questionnaires were utilized for data analysis after excluding insincere responses. Intention was measured using a 7-point scale, while exercise habits were assessed using the Self-Report Behavioral Automaticity Index. In addition, physical activity was measured using the Weekly Leisure-Time Exercise Questionnaire. The validity and reliability of measurement tools were confirmed. Data were analyzed using SPSS and AMOS, including correlation analysis, multiple regression, and moderation analysis. Intention, exercise preparation habit, and exercise performance habit were all found to influence physical activity levels significantly. Intention demonstrated the strongest impact, followed by exercise preparation habit and exercise performance habit. This suggests that the research efforts regarding intention conducted before the emergence of the dual process model, which proposes the importance of unconscious thinking patterns, were not in vain. The analysis revealed a statistically significant moderating effect of exercise preparation habit, but not exercise performance habit, in the relationship between intention and physical activity. Exercise preparation habit was identified as a significant moderator, enhancing the relationship between intention and physical activity. This study underscores the importance of considering both conscious intention and unconscious exercise habits in promoting physical activity. The findings challenge the prevailing emphasis on conscious decision-making and highlight the need for a more comprehensive understanding of unconscious behavior in health behavior interventions. This study is expected to arouse academic interest in the often-neglected area of unconscious behavior.

Medication adherence in youths with CKD: habits for success

BACKGROUND

Poor adherence habits are key contributors to nonadherence but there are few clinically feasible methods for evaluating adherence habits, particularly for youths with chronic kidney disease (CKD). This study investigated how participants' qualitative responses to three interview questions about adherence habits mapped to primary principles of habit formation and objectively measured medication adherence in youths with CKD.

METHODS

Participants (ages 11-21 years) were recruited from a pediatric nephrology clinic as part of a larger study. Participants' daily objective antihypertensive medication adherence was measured with an electronic pill bottle over a 4-week baseline period. Qualitative interviews about adherence habits and routines were conducted with a subset of participants (N = 18).

RESULTS

Clear qualitative differences emerged in how participants with high-medium adherence (80-100%) discussed adherence habits compared to participants with low adherence (0-79%). Participants with high-medium adherence discussed situational cues for taking medicine, including locations that cue adherence, step-by-step events leading up to taking medicine, and people who cue adherence. Participants with high-medium adherence regularly described taking medicine as "automatic," "second nature," and a "habit." Participants with low adherence rarely discussed these habit features nor did they explicitly acknowledge currently missing doses. Participants with low adherence tended to discuss challenges with organization and routines for taking medicine.

CONCLUSIONS

Evaluating patient responses to questions about adherence habits may uncover challenges with adherence habit formation, provide direction for habit-strengthening intervention focused on developing automatic cues for taking medication, and support adherence successes for youths with CKD.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03651596. A higher resolution version of the Graphical abstract is available as Supplementary information.

Stress buffering after physical activity engagement: An experience sampling study

OBJECTIVES

While encountering daily hassles is a normative experience, it poses a threat to individuals' daily affective well-being. However, physical activity engagement may help to reduce the current stress-related impact on affective well-being (i.e. stress buffering), which we investigate in this study. Furthermore, we examined the possible moderating role of people's global stress context (i.e. exposure to major life events and chronic stress) on this within-person stress-buffering effect.

DESIGN

We approached these ideas using six-times-a-day experience sampling assessments over a period of 22 days.

METHODS

Drawing on a broad national sample of 156 middle-aged adults from the EE-SOEP-IS study, we aimed to elucidate the naturally occurring within-person dynamics of current stress, physical activity engagement, and momentary affect within individuals' everyday lives. Major life events and chronic stress were measured as between-person variables.

RESULTS

Multilevel analyses revealed significant within-person associations of current stress and physical activity engagement with momentary affect. Stress-related negative affect was lower when individuals engaged in physical activity, in accordance with the idea of a within-person stress-buffering effect of physical activity engagement. For individuals exposed to more severe major life events, the stress-buffering effect of physical activity engagement for negative affect was lower. Chronic stress did not moderate the within-person stress-buffering effect.

CONCLUSIONS

Overall, results add to the existing literature that links physical activity to increased stress resilience and emphasizes the need for taking the global between-person stress context into account.

Ramifications of behavioural complexity for habit conceptualisation, promotion, and measurement

Behavioural theories, predictions, and interventions should be relevant to complex, real-world health behaviours and conditions. Habit theory and habit formation interventions show promise for predicting and promoting, respectively, longer-term behaviour change and maintenance than has been attained with theories and interventions focused only on deliberative behavioural factors. However, the concept of habit has largely been treated as uniform across different types of behaviours. In this conceptual review, we contend that the definitional aspects of habit differ at a conceptual level for simple versus more complex behaviours, with ramifications for prediction, promotion, and measurement of habits. Specifically, habits are defined as direct context-response associations learned through repeatedly rewarded responding - but what is meant by 'response' and 'reward' depends upon the complexity of the behaviour. We review literature that suggests (1) responses in complex habits have separable and substitutable components (vs a single and static, unitary component) and (2) rewards for complex habits are necessarily continued and intrinsic (vs temporary and extrinsic, respectively). We discuss some empirical and theoretical questions raised by these issues around behavioural complexity and habit. Lastly, we outline the ramifications of these issues for habit measurement (habit strength and habit formation) via self-report and objective measures.

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective

Background

Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour.

Methods

Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A).

Results

Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP.

Conclusion

EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours.

Do nutrition knowledge, food preferences, and habit strength moderate the association between preference for intuition and deliberation in eating decision-making and dietary intake?

An intuitive style in eating decision-making, for example, basing decisions on one's gut feeling, has been related to a less healthy diet, whereas deliberately deciding what to eat, such as making plans about eating behavior, has been related to a healthier diet. The present study investigated whether nutrition knowledge, food preferences, and habit strength for healthy and unhealthy eating moderate these relationships. In total, 1245 participants took part in a preregistered cross-sectional online survey. Results revealed that neither nutrition knowledge, nor liking of healthy or unhealthy foods, nor habit strength for healthy or unhealthy eating interacted with the preference for intuition or deliberation in eating decision-making in affecting dietary intake (βs ≤ |.06|; ts ≤ |2.11|; ps ≥ .035). Instead, including the potential moderating variables in analyses rendered the effect of a preference for intuition largely non-significant. In contrast, the positive effect of a preference for deliberation was largely stable even when including the potential moderating variables. Thus, the present study confirms the general health-promoting effect of a preference for deliberation in eating decision-making. In contrast, results speak in favor of a generally minor role of a preference for intuition for healthy or unhealthy eating.

Developing habit-based health behaviour change interventions: twenty-one questions to guide future research

OBJECTIVE

Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours.

METHODS

Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour.

RESULTS

In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions).

CONCLUSIONS

While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change.

The Role of Habit Formation and Automaticity in Diabetes Self-Management: Current Evidence and Future Applications

PURPOSE OF REVIEW

Diabetes is a chronic condition that requires consistent self-management for optimal health outcomes. People with diabetes are prone to burnout, cognitive burden, and sub-optimal performance of self-management tasks. Interventions that focus on habit formation have the potential to increase engagement by facilitating automaticity of self-management task performance. The purpose of this review is to (1) clarify the conceptualizations of habit formation and behavioral automaticity in the context of health behavior interventions, (2) review the evidence of habit in relation to behaviors relevant to diabetes self-management, and (3) discuss opportunities for incorporating habit formation and automaticity into diabetes self-management interventions.

RECENT FINDINGS

Modern habit research describes a habit as a behavior that results over time from an automatic mental process. Automatic behaviors are experienced as cue-dependent, goal-independent, unconscious, and efficient. Habit formation requires context-dependent repetition to form cue-behavior associations. Results of diabetes habit studies are mixed. Observational studies have shown positive associations between habit strength and target self-management behaviors such as taking medication and monitoring blood glucose, as well as glycemic outcomes such as HbA1c. However, intervention studies conducted in similar populations have not demonstrated a significant benefit of habit-forming interventions compared to controls, possibly due to varying techniques used to promote habit formation. Automaticity of self-management behaviors has the potential to minimize the burden associated with performance of self-management tasks and ultimately improve outcomes for people with diabetes. Future studies should focus on refining interventions focused on context-dependent repetition to promote habit formation and better measurement of habit automaticity in diabetes self-management.

Establishing Healthy Eating 'Habits': A Pilot Randomised Controlled Trial of a Habit-Based Dietary Intervention following Oral Rehabilitation for Older Adults

An ageing population presents significant nutritional challenges, particularly for partially dentate adults. This two-armed pilot randomised controlled trial (RCT) compared habit formation (automaticity) for healthy eating behaviours between control and intervention groups after participation in a habit-based dietary intervention for older adults, following oral rehabilitation in the United Kingdom (UK). n = 54 participants were randomised to receive a habit-based dietary intervention (intervention group n = 27, IG) or standard dietary advice in a leaflet (control group n = 27, CG). The IG attended three sessions over six weeks, which focused on habit formation for three healthy eating behaviours (increasing fruit and vegetables, wholegrains, and healthy proteins). Participants were assessed for habit strength (using the Self-Report Behavioural Automaticity Index (SRBAI)) alongside health and nutrition outcomes at six weeks, four months and eight months. Forty-nine participants completed all follow-up visits. The IG compared to the CG had significant increases in automaticity at six weeks, four months (primary outcome) and eight months for eating ≥3 portions of fruit and vegetables; choosing wholegrain sources over white alternatives, and choosing healthy protein sources over red/processed meat. The mean change in the Mini Nutritional Assessment total score was greater in the IG compared with the CG at six weeks only (p = 0.03). A habit-based dietary intervention following oral rehabilitation increased automaticity for healthy dietary behaviours, which could translate into clinically meaningful benefits in this cohort of older adults.

Feasibility and acceptability of a personalised script-elicitation method for improving evening sleep hygiene habits

Background

Attempts to improve evening sleep hygiene have overlooked that sleep preparation behaviours are often undertaken automatically with little awareness; that is, habitually. This mixed-methods study assessed aspects of the feasibility and acceptability of a novel behavioural intervention procedure ('script elicitation'), which encourages reflection on and reorganisation of the content and sequencing of habitual evening pre-sleep routines.

Methods

The study was advertised via social media, and circular lists at a UK university. Twenty-four UK-based adults, reporting <6 h/night sleep, were recruited. At baseline, they completed sleep hygiene and quality measures, then participated in an online, one-to-one script elicitation interview. This involved the interviewer working with the participant to generate a fine-grained description of the content, organisation and variability of their typical pre-sleep routine, and plan a more sleep-conducive alternative routine to follow over the next week. One week later, participants completed sleep quality and hygiene measures, and a semi-structured interview about the intervention. Feasibility was assessed using quantitative data on response rates and attrition, and acceptability via sleep hygiene and quality scores, and qualitative data on intervention experiences.

Results

All criteria were met. The target response rate was exceeded, none of the 24 participants dropped out, and sleep hygiene and quality scores either improved or remained stable. In interviews, all participants reported finding script elicitation useful. Script elicitation raised participants' awareness of habitual sleep hygiene routines, which gave many a newfound sense of autonomy over changing their sleep hygiene habits. While the habitual nature of existing routines obstructed change for some participants, most reported successfully changing aspects of their routine, and achieving behaviour, sleep and wellbeing improvements.

Discussion

Script elicitation is a promising and acceptable method for tackling poor evening sleep hygiene habits. A more rigorous trial is warranted.

Changes in virus-transmission habits during the COVID-19 pandemic: a cross-national, repeated measures study

OBJECTIVE

The COVID-19 pandemic saw promotion of novel virus transmission-reduction behaviours, and discouragement of familiar transmission-conducive behaviours. Understanding changes in the automatic nature of such behaviours is important, because habitual behaviours may be more easily reactivated in future outbreaks and disrupting old habits may discontinue unwanted behaviours.

DESIGN

A repeated-measures, multi-national design tracked virus-transmission habits and behaviour fortnightly over six months (Apr-Sept 2020) among 517 participants (age M = 42 ± 16y, 79% female).

MAIN OUTCOME MEASURES

Within-participant habit trajectories across all timepoints, and engagement in transmission-reduction behaviours (handwashing when entering home; handwashing with soap for 20 seconds; physical distancing) and transmission-conducive behaviours (coughing/sneezing into hands; making physical contact) summed over the final two timepoints.

RESULTS

Three habit trajectory types were observed. Habits that remained strong ('stable strong habit') and habits that strengthened ('habit formation') were most common for transmission-reduction behaviours. Erosion of initially strong habits ('habit degradation') was most common for transmission-conducive behaviours. Regression analyses showed 'habit formation' and 'stable strong habit' trajectories were associated with greater behavioural engagement at later timepoints.

CONCLUSION

Participants typically maintained or formed transmission-reduction habits, which encouraged later performance, and degraded transmission-conducive habits, which decreased performance. Findings suggest COVID-19-preventive habits may be recoverable in future virus outbreaks.

The relationship between exercise intention and behavior of Chinese college students: A moderated mediation model

Inconsistency between intention and behavior is very common in daily life. This study explored the intention-behavior relationship in exercise, focusing on the mediating effect of action planning and the moderating effects of habit strength and gender. For the purpose of providing theoretical reference for the implementation of intervention strategies in the volitional phase, a total of 489 college students (M-age = 20.61, 57.46% female) from Hubei Province, China, were recruited to complete the questionnaire at two time points. The findings showed that exercise intention could positively predict exercise behavior via the mediating effect of action planning, with the mediating effect accounting for 48.52% of the total effect. The predictive effect of action planning × habit strength interaction on exercise behavior was statistically significant. As individuals’ levels of habitual strength increased, so did the relationship between action plans and exercise behavior. The action planning-exercise behavior relationship was stronger in males than in females. In summary, action planning is a very important predictor of the post-intentional phase and has many advantages. For individuals whose exercise has become habitualized, forming a plan is not counterproductive and can still promote more exercise rather than in a mutually compensating manner.

The art of forming habits: applying habit theory in changing physical activity behaviour

Background

Habits are obtained as a consequence of cue-contingent behavioural repetition. Context cues stimulate strong habits without an individual contemplating that action has been initiated. Because of its health-enhancing effects, making physical activity a part of one’s life is essential. This study examined the associations of physical activity (PA) behaviours with PA habits and the role of autonomous motivation in developing PA habits.

Methods

This study used a cross-sectional design. A structured questionnaire was implemented through emails to 226 university students, where PA levels, habits and autonomous motivation were self-reported.

Results

Binary logistic regression identified age groups, gender and participants who were trying to lose weight as the significant predictors in meeting physical activity guidelines. Path analysis showed that moderate-intensity physical activity (β = 0.045, CI = 0.069–0.248) and strength training exercises (β = 0.133, CI = 0.148–0.674) were significantly associated with PA habits (p < 0.01). Autonomous motivation was directly associated with PA habits (β = 0.062, CI = [0.295–0.541], p < 0.01) and was also significantly related to moderate-intensity physical activity (β = 0.243, CI = [0.078–0.266], p < 0.01) and strength training exercises (β = 0.202, CI = [0.033–0.594], p < 0.05).

Conclusions

The emphasis on experiment-based logic and interest in habit formation in the research community is extensive. As the college years offer an excellent opportunity to establish healthy behavioural interventions, encouraging students in regular PA and exhibiting an autonomous motivation towards PA may be necessary.

Effects of behavioral performance, intrinsic reward value, and context stability on the formation of a higher-order nutrition habit: an intensive longitudinal diary study

Background

Habits drive many of our health behaviors in our daily lives. However, little is known about the relative contribution of different key factors for habit formation in real-world contexts. We examined the effects of behavioral performance, intrinsic reward value (operationalized as tastiness), and context stability on the formation of a higher-order nutrition habit.

Methods

Participants were recruited via mailing lists and posts on social media platforms. N = 199 participants (M_age = 37.10 years, SD = 13.00, 86.93% female) received an online intervention for building the higher-order habit of filling half of their plates with vegetables at dinner and completed one daily online survey for up to 56 days, including the assessment of habit strength, behavioral performance, intrinsic reward value, and context stability, providing a total of N = 6352 daily measurements. N = 189 participants (N = 4175 measurements) could be included in the primary analysis. Utilizing multilevel modeling, we analyzed the impact of behavioral performance, intrinsic reward value, and context stability, as well as their interaction effects, on habit strength on the next day.

Results

Habit strength significantly increased over time. This effect was strengthened in persons with high mean levels of behavioral performance. Furthermore, mean levels of behavioral performance, intrinsic reward value, and context stability were all positively related to mean levels of habit strength. There were no positive effects of daily intraindividual variations in the three examined factors on habit strength at the next day. There was an unexpected negative effect of daily behavioral performance on habit strength at the next day. We found little to no evidence for our expected and pre-registered interaction effects. In an additional exploratory analysis, there were positive effects of daily intraindividual variations in the three factors on habit strength at the same day.

Conclusions

We found that behavioral performance, intrinsic reward value, and context stability were all independent predictors of habit strength of a higher-order habit at the between-person level. However, we did not find the expected associations at the within-person level. Habit interventions should promote the consistent performance of the target behaviors in stable contexts.

Trial registration

https://aspredicted.org/blind.php?x=vu2cg4. Registered 28.04.2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01343-8.

What helps to form a healthy nutrition habit? Daily associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity

BACKGROUND

High automaticity in healthy nutrition behaviors is related to long-term maintenance of these behaviors. Drawing upon theoretical frameworks of habit formation, proposed antecedents such as intrinsic reward, anticipated regret, and self-efficacy are important correlates of automaticity, but not much is known about their day-by-day relationships with automaticity in healthy nutrition behaviors. This study tested previous-day within-person (i.e., from one day to the next) and same-day within-person associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity of a healthy nutrition behavior, for which participants attempted to form a new habit.

METHODS

Secondary analyses of a randomized controlled trial with two planning intervention conditions including a longitudinal sample of n = 135 participants (age: M = 24.82 years; SD = 7.27) are reported. Participants formed a plan on a self-selected healthy nutrition behavior to become a new habit and were followed up over 12 weeks assessing daily levels of plan-specific intrinsic reward, anticipated regret, self-efficacy, and automaticity. Lagged multilevel models with 84 study days nested in participants estimated previous-day within-person, same-day within-person, and between-person relationships of intrinsic reward, anticipated regret, and self-efficacy with automaticity.

FINDINGS

Regarding within-level relationships, higher-than-usual levels of intrinsic reward, anticipated regret, and self-efficacy of the same day but not of the previous day were associated with higher within-person automaticity. With respect to between-level relationships, higher between-levels (i.e., higher person mean levels across the study period) of intrinsic reward, anticipated regret, and self-efficacy were linked with higher automaticity.

DISCUSSION

Findings point towards the potential to intervene on intrinsic reward, anticipated regret, and self-efficacy when aiming to promote a new healthy nutrition habit.

Context Stability in Habit Building Increases Automaticity and Goal Attainment

In this paper, we investigate the effects of context stability on automaticity and goal attainment in intentional habit building. We used hierarchical growth curve modeling and multilevel mediation to test our hypotheses on two datasets. In Study 1, N = 95 university students (N = 2,482 habit repetitions) built new study habits over a period of 6 weeks with manipulated context stability. One group was instructed to constantly vary the context of their habit repetitions by changing rooms and times and the other group was instructed to keep the context of habit performance stable. In Study 2, N = 308 habits (N = 2,368 habit repetitions) from N = 218 users of a published habit building app were analyzed without manipulating but measuring context stability. We found the same pattern in both datasets: Context stability predicted more automaticity and higher habit repetition goal attainment. We also found that the effect of context stability on habit repetition goal attainment was partially mediated by automaticity in both datasets. These results show that context does not only act as a trigger for habit instigation but also has an ongoing effect on habit execution.

Young Swiss men's risky single-occasion drinking: Identifying those who do not respond to stricter alcohol policy environments

BACKGROUND

Previous research has demonstrated a preventive effect of the alcohol policy environment on alcohol consumption. However, little is known about the heterogeneity of this effect. Our aim was to examine the extent of heterogeneity in the relationship between the strictness of alcohol policy environments and heavy drinking and to identify potential moderators of the relationship.

METHODS

Cross-sectional data from 5986 young Swiss men participating in the cohort study on substance use risk factors (C-SURF) were analysed. The primary outcome was self-reported risky single-occasion drinking in the past 12 months (RSOD, defined as 6 standard drinks or more on a single occasion at least monthly). A previously-used index of alcohol policy environment strictness across Swiss cantons was analysed in conjunction with 21 potential moderator variables. Random forest machine learning captured high-dimensional interaction effects, while individual conditional expectations captured the heterogeneity induced by the interaction effects and identified moderators.

RESULTS

Predicted subject-specific absolute risk reductions in RSOD risk ranged from 16.8% to - 4.2%, indicating considerable heterogeneity. Sensation seeking and antisocial personality disorder (ASPD) were major moderators that reduced the preventive relationship between stricter alcohol policy environments and RSOD risk. They also were associated with the paradoxical observation that some individuals displayed increased RSOD risk in stricter alcohol policy environments.

CONCLUSION

Whereas stricter alcohol policy environments were associated with reduced average RSOD risk, additionally addressing the risk conveyed by sensation seeking and ASPD would deliver an interlocking prevention mix against young Swiss men's RSOD.

Changing healthcare professionals' non-reflective processes to improve the quality of care

RATIONALE

Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation.

OBJECTIVES

To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed.

METHODS

Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes.

RESULTS

From a psychological perspective 'habit' is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them.

CONCLUSION

Combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.

An app with brief behavioural support to promote physical activity after a cancer diagnosis (APPROACH): study protocol for a pilot randomised controlled trial

Background

There are multiple health benefits from participating in physical activity after a cancer diagnosis, but many people living with and beyond cancer (LWBC) are not meeting physical activity guidelines. App-based interventions offer a promising platform for intervention delivery. This trial aims to pilot a theory-driven, app-based intervention that promotes brisk walking among people living with and beyond cancer. The primary aim is to investigate the feasibility and acceptability of study procedures before conducting a larger randomised controlled trial (RCT).

Methods

This is an individually randomised, two-armed pilot RCT. Patients with localised or metastatic breast, prostate, or colorectal cancer, who are aged 16 years or over, will be recruited from a single hospital site in South Yorkshire in the UK. The intervention includes an app designed to encourage brisk walking (Active 10) supplemented with habit-based behavioural support in the form of two brief telephone/video calls, an information leaflet, and walking planners. The primary outcomes will be feasibility and acceptability of the study procedures. Demographic and medical characteristics will be collected at baseline, through self-report and hospital records. Secondary outcomes for the pilot (assessed at 0 and 3 months) will be accelerometer measured and self-reported physical activity, body mass index (BMI) and waist circumference, and patient-reported outcomes of quality of life, fatigue, sleep, anxiety, depression, self-efficacy, and habit strength for walking. Qualitative interviews will explore experiences of participating or reasons for declining to participate. Parameters for the intended primary outcome measure (accelerometer measured average daily minutes of brisk walking (≥ 100 steps/min)) will inform a sample size calculation for the future RCT and a preliminary economic evaluation will be conducted.

Discussion

This pilot study will inform the design of a larger RCT to investigate the efficacy and cost-effectiveness of this intervention in people LWBC.

Trial registration

ISRCTN registry, ISRCTN18063498. Registered 16 April 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01028-w.

Effectiveness, Moderators and Mediators of Self-regulation Intervention on Older Adults' Exercise Behavior: a Randomized, Controlled Crossover Trial

Background

Although self-regulation interventions are effective in promoting exercise behaviors, moderators and mediators of interventions among older adults are not well established. This study aimed to examine whether (1) self-regulation intervention promoted exercise behavior, (2) health literacy and habit strength moderated the intervention effect, and (3) self-regulation and habit strength mediated the intervention effect among older adults.

Methods

This study was a randomized, non-blinded, controlled crossover trial. The baseline questionnaire survey assessed the average amount of exercise time per day, self-regulation, habit strength, health literacy, and socio-demographic factors. After the baseline survey, 393 community-dwelling older adults were randomly assigned to either the immediate intervention or the delayed intervention group. For the immediate group, print-based materials were provided once a week for 7 weeks before a second questionnaire survey. For the delayed group, the materials were provided only after the second survey. Finally, a third survey was conducted for both groups.

Results

The mixed models showed that the average exercise time was increased after the intervention in both groups. Multiple regression analyses revealed that no factor moderated the intervention effect. From the path analyses, the mediating effect of self-regulation on the relationship between intervention and changes in average exercise time was supported, but the mediating role of habit strength was not clearly indicated.

Conclusions

Although the mediating roles of habit strength for the intervention effects are still inconclusive, self-regulation intervention can promote exercise behavior among older adults, regardless of their health literacy level, habit strength, and socio-demographic characteristics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10049-3.

Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial

BACKGROUND

Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence.

OBJECTIVE

The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm.

METHODS

We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength.

RESULTS

A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor's or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007).

CONCLUSIONS

The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530.

Associations Between Planned Exercise, Walking, Incidental Physical Activity, and Habit Strength in Older People: A Cross-Sectional Study

Habits play an important role in physical activity (PA) engagement; however, these associations in older people are not well understood. The present study aimed to investigate the relationship between engagement in types of PA and their automaticity in older people, using an observational, cross-sectional design. Current hours engaged in planned exercise (excluding walking), planned walking, and incidental activities and the automaticity of those PA behaviors were measured in 127 community-dwelling Australians aged 65 years and older via an online questionnaire. After controlling for demographic and health factors (age, gender, education level, body mass index, history of falls, and anxiety and depression symptoms), higher automaticity scores were associated with more hours undertaking planned walking and incidental activity but not planned exercise. Although preliminary, these findings indicate that the role of habit in maintaining PA in older people may, therefore, differ depending on the type of activity.

Multi-Process Action Control in Physical Activity: A Primer

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control (M-PAC) framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes (reflective, regulatory, reflexive) build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit (differences in outcome vs. behavioral goals; balancing multiple behavioral goals) and automatic tendencies (approach-avoidance, conservation of energy expenditure). Regulatory processes (prospective and reactive tactics) are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes (habit, identity) begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms (e.g., mobile health), and at different levels of scale (clinical, group, population).

A Dual-Process Model Applied to Two Health-Promoting Nutrition Behaviours

We tested a dual process model incorporating constructs that reflect both performing the target behaviour (behaviour directed habit) and habits that run counter to the target behaviour (opposing behaviour habit) in accounting for variance in two health behaviours: eating the recommended serves of fruits and vegetables a day and restricting sugar-sweetened beverage consumption. A prospective correlational design with two waves of data collection separated by one week was adopted. Participants (N = 606) comprising middle school students (n = 266) and university students (n = 340) completed an initial survey comprising self-report measures of past behaviour, intention, and habit to perform the target behaviour and habits that run counter to the target behaviour. One week later, participants (N = 414) completed a self-reported measure of behaviour. Results revealed that behaviour directed habits predicted fruit and vegetable consumption in both samples, while opposing behaviour habits predicted restriction of sugar-sweetened beverages in the middle-school sample only, with a moderating effect also observed. Current findings indicate that habits specifying avoidance of the target behaviour did not predict future behaviour. However, the moderating effect observed provides preliminary evidence that strong habits to perform a behaviour may override habit to avoid the behaviour.

Identifying App-Based Meditation Habits and the Associated Mental Health Benefits: Longitudinal Observational Study

Background

Behavioral habits are often initiated by contextual cues that occur at approximately the same time each day; so, it may be possible to identify a reflexive habit based on the temporal similarity of repeated daily behavior. Mobile health tools provide the detailed, longitudinal data necessary for constructing such an indicator of reflexive habits, which can improve our understanding of habit formation and help design more effective mobile health interventions for promoting healthier habits.

Objective

This study aims to use behavioral data from a commercial mindfulness meditation mobile phone app to construct an indicator of reflexive meditation habits based on temporal similarity and estimate the association between temporal similarity and meditation app users’ perceived health benefits.

Methods

App-use data from June 2019 to June 2020 were analyzed for 2771 paying subscribers of a meditation mobile phone app, of whom 86.06% (2359/2771) were female, 72.61% (2012/2771) were college educated, 86.29% (2391/2771) were White, and 60.71% (1664/2771) were employed full-time. Participants volunteered to complete a survey assessing their perceived changes in physical and mental health from using the app. Receiver operating characteristic curve analysis was used to evaluate the ability of the temporal similarity measure to predict future behavior, and variable importance statistics from random forest models were used to corroborate these findings. Logistic regression was used to estimate the association between temporal similarity and self-reported physical and mental health benefits.

Results

The temporal similarity of users’ daily app use before completing the survey, as measured by the dynamic time warping (DTW) distance between app use on consecutive days, significantly predicted app use at 28 days and at 6 months after the survey, even after controlling for users’ demographic and socioeconomic characteristics, total app sessions, duration of app use, and number of days with any app use. In addition, the temporal similarity measure significantly increased in the area under the receiver operating characteristic curve (AUC) for models predicting any future app use in 28 days (AUC=0.868 with DTW and 0.850 without DTW; P<.001) and for models predicting any app use in 6 months (AUC=0.821 with DTW and 0.802 without DTW; P<.001). Finally, a 1% increase in the temporal similarity of users’ daily meditation practice with the app over 6 weeks before the survey was associated with increased odds of reporting mental health improvements, with an odds ratio of 2.94 (95% CI 1.832-6.369).

Conclusions

The temporal similarity of the meditation app use was a significant predictor of future behavior, which suggests that this measure can identify reflexive meditation habits. In addition, temporal similarity was associated with greater perceived mental health benefits, which demonstrates that additional mental health benefits may be derived from forming reflexive meditation habits.

Physical Activity Maintenance: A Critical Narrative Review and Directions for Future Research

A clear rationale can be made for promoting long-term regular physical activity (PA), yet despite some attempts to operationalize "maintenance," no robust definition has been agreed upon, beyond arbitrary time frames of regular PA. This has likely impaired the advancement of theory and practice. The purpose of this critical narrative review was to first overview the conception of maintenance and co-requisite theoretical constructs in theories used in PA research. Our subsequent aims were to engage in a critical analysis of this literature to propose a working definition of PA maintenance followed by recommendations for future research. Relevant behavioral theories were parsed for references to maintenance or maintenance-specific constructs and constructs most likely associated with maintenance were overviewed from a recent systematic review. Based on this information, we suggest PA maintenance be operationalized as a process marked by a shift in the mechanisms of action determining behavioral performance, that engender greater perceived behavioral enactment efficiency. We suggest that maintenance should not be considered an absolute state of behavioral performance (e.g., a stage), as some constructs that were critical to behavioral performance during initiation will still be critical during PA continuation. Based on this definition, we propose a method of falsifiability hypothesis testing of theoretical constructs that may determine the maintenance process. Finally, the review concludes with suggestions for future research using this operationalization of maintenance including measure development, tests of latency to reach the peak maintenance process, validating constructs critical to determining maintenance, exploration of the contextual and individual moderators of maintenance formation, and the development of an omnibus dynamic model of initiation, continuation, and maintenance in PA behavior change.

Applying the Science of Habit Formation to Evidence-Based Psychological Treatments for Mental Illness

Habits affect nearly every aspect of our physical and mental health. Although the science of habit formation has long been of interest to psychological scientists across disciplines, we propose that applications to clinical psychological science have been insufficiently explored. In particular, evidence-based psychological treatments (EBPTs) are interventions targeting psychological processes that cause and/or maintain mental illness and that have been developed and evaluated scientifically. An implicit goal of EBPTs is to disrupt unwanted habits and develop desired habits. However, there has been insufficient attention given to habit-formation principles, theories, and measures in the development and delivery of EBTPs. Herein we consider whether outcomes following an EBPT would greatly improve if the basic science of habit formation were more fully leveraged. We distill six ingredients that are central to habit formation and demonstrate how these ingredients are relevant to EBPTs. We highlight practice points and an agenda for future research. We propose that there is an urgent need for research to guide the application of the science of habit formation and disruption to the complex "real-life" habits that are the essence of EBPTs.

What we repeatedly do: Evaluating the determinants and consequences of habit enactment during daily goal-pursuit

Many theorists have stressed the benefits of goal-conducive habits. However, past research has not yet demonstrated that habits benefit goal-pursuit in daily life independently of more effortful forms of goal-pursuit. Additionally, it is unclear if habits are triggered independently of conscious self-regulatory processes. To address these issues, we conducted three intensive experience sampling studies. We found that habitual behaviours facilitated goal-progress independently of effortful goal-directed behaviours. Additionally, we evaluated three sets of predictions regarding the relationship between habits and other effortful self-regulatory processes. The goal-independent account suggests that habits function independently of planning and testing processes. The goal-dependent account suggests that habits are influenced by these processes, and the hybrid account suggests that these processes indirectly influence habits through their association with contextual cue exposure. The results were consistent with the hybrid account, in that planning and testing were associated with habit enactment, but this association was mediated by contextual cue exposure. Collectively, our results suggest that one must consider both conscious self-regulatory processes and automatic cue-response associations to understand how the benefits of goal-conducive habits are realized in daily life.

Predicting the physical activity of new parents who participated in a physical activity intervention

RATIONALE

The demands of early parenthood may limit the pursuit of moderate-to-vigorous intensity physical activity (MVPA); thus, understanding the predictors of MVPA among this population could help build targeted intervention programs.

OBJECTIVE

The purpose of this study was to examine the correlates of MVPA, in the form of constructs subsumed within the theory of planned behavior (TPB) and multi-process action control (M-PAC) framework, among new parents participating in in a couple-based PA promotion randomized trial across a six-month period in the first year after birth.

METHODS

In total, 264 participants (132 couples) at the two-month point of parenting their first child were enrolled in the trial through advertisements. MVPA, TPB, and M-PAC constructs were assessed via self-report at baseline, and six-week, three-month, and six-month after baseline time-periods.

RESULTS

Dyadic path modeling of the TPB showed that intention only predicted MVPA for mothers and PBC did not predict MVPA. Most of the sample had intentions to be physically active, although the extent to which intentions predicted subsequent MVPA was dependent on mothers and fathers reported strength of planning, habits, and exercise identity (M-PAC variables). Intention was subsequently predicted by affective attitude and PBC for mothers and fathers.

CONCLUSIONS

Interventions targeting affective attitude and perceived behavioral control may assist in improving MVPA intentions of new parents; yet, additional intervention strategies to increase planning, habit, and especially exercise identity seems warranted for many parents to close the gap between intention and PA. The findings highlight the complementary approach of intention formation and intention translation theories among new parents.