Leveraging Habits to Improve Adherence to Gout Medications: A Qualitative Study

OBJECTIVE

This study investigates patients' medication-taking routines and the feasibility of harnessing habit formation through context cues and rewards to improve medication adherence.

METHODS

Semistructured qualitative interviews with patients with gout from an urban health care system were conducted to explore typical medication-taking behavior, experiences using electronic pill bottles, barriers to adherence, existing context cues, and potential cues and rewards for habit-forming behavior. Medication-taking patterns were recorded for six weeks using electronic pill bottles before interviews to inform discussion. Transcribed interviews were analyzed to generate themes using codes developed by the study team, with representative quotations selected as illustrations.

RESULTS

We conducted interviews with 15 individuals (mean age 60.6 [SD 20.3] years, three women [20%], and nine White patients [60%]). Pill bottle-recorded adherence to urate-lowering therapy (ULT) was high (mean 0.91 [SD 0.10]), and one patient was experiencing an active gout flare. Five key themes emerged: (1) reasons for nonadherence, (2) internal and external motivations for adherence, (3) structured routines around taking medications, (4) rewards for good medication adherence, and (5) the role of pill cap technology in medication-taking.

CONCLUSION

The importance of a predictable, structured routine in which participants could incorporate their medication-taking behavior emerged as a key factor that promoted consistent adherence. Further, identifying context cues and reminders seemed to promote incorporation of medication-taking into routines. Therefore, habit-based interventions that use context cues to establish routines around medication-taking may be a feasible strategy to improve adherence in patients with chronic conditions such as gout.

Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review

BACKGROUND

With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life.

OBJECTIVE

To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs.

METHODS

The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English.

RESULTS

A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards.

CONCLUSIONS

A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs.

Simplifying social learning

Social learning is complex, but people often seem to navigate social environments with ease. This ability creates a puzzle for traditional accounts of reinforcement learning (RL) that assume people negotiate a tradeoff between easy-but-simple behavior (model-free learning) and complex-but-difficult behavior (e.g., model-based learning). We offer a theoretical framework for resolving this puzzle: although social environments are complex, people have social expertise that helps them behave flexibly with low cognitive cost. Specifically, by using familiar concepts instead of focusing on novel details, people can turn hard learning problems into simpler ones. This ability highlights social learning as a prototype for studying cognitive simplicity in the face of environmental complexity and identifies a role for conceptual knowledge in everyday reward learning.

Print and digital reading habits and comprehension in children with and without special education needs

BACKGROUND

Text comprehension is a major obstacle for many Primary school students with special education needs (SEN). Reading episodes bring students opportunities to be exposed to new vocabulary and knowledge, potentially boosting their development of text comprehension skills.

AIMS

Our study seeks to understand how reading frequency (leisure and academic) and reading medium (print and digital) contribute to the development of text comprehension during Primary school in students with and without SEN.

METHODS AND PROCEDURES

We tested 2289 Spanish students from fourth to sixth grade, from which 212 had an official decision of SEN. Students self-reported their reading frequency (as a measure of their reading habits) and completed a standardized text comprehension test. We employed multiple regression models with a robust maximum likelihood estimator to test associations between reading frequency and comprehension.

OUTCOMES AND RESULTS

Students' comprehension was positively associated with their leisure print reading habits, and negatively associated with their frequency of academic digital reading. Those associations were independent of SEN status.

CONCLUSIONS AND IMPLICATIONS

Results highlight the importance of promoting leisure reading in print to all students, regardless of SEN status. In addition, caution is advised when encouraging Primary school children to use digital texts when the emphasis is on comprehending texts for acquiring knowledge.

Exploring the Behaviour Change Wheel and the Theoretical Domains Framework in interventions for mobile phone driver distraction: A scoping review

Mobile phone use while driving remains a significant traffic safety concern. Although numerous interventions have been developed to address it, there is a gap in the synthesis of relevant information through a comprehensive behaviour change lens. This scoping review uses the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to examine the literature to (a) identify behavioural constructs targeted in interventions for mobile phone use while driving, (b) determine if the intervention success varied by sociodemographic group (e.g., age, gender, driving experience), and (c) map interventions to TDF domains to highlight areas for future research. Following the PRISMA extension for scoping reviews, we searched seven databases and identified 5,202 articles. After screening, 50 articles detailing 56 studies met the following inclusion criteria: (a) intervention studies, (b) providing details on methods and results, (c) written in English, and (d) targeting any driver behaviour related to mobile phone use while driving with a bottom-up approach, using not regulation or law enforcement, but individuals' psychological processes, such as cognitive, behavioural, and emotional. Findings show that most interventions targeted young drivers and were typically effective. Except for a few studies, the effectiveness of interventions targeting different sociodemographic groups either remained untested or revealed nonsignificant differences. This finding points to a gap in the literature, indicating a need for further investigation into the efficacy of interventions for different groups, and for tailoring and testing them accordingly. The interventions also often targeted multiple TDF domains, complicating the interpretation of the relative efficacy of specific domains. Most frequently targeted domains included beliefs and consequences, emotions, knowledge, social influence, social/professional role and identity, and behavioural regulation. Physical skills and optimism domains were not targeted in any intervention. Further, almost all interventions addressed deliberate engagement in mobile phone distractions, while the automatic and fast processes involved in such behaviours were often overlooked. Mobile phone distractions are in part habitual behaviours, yet the existing mitigation efforts mostly assumed intentional engagement. More focus on the habitual nature of mobile phone distractions is needed.

Stuck on Intergroup Attitudes: The Need to Shift Gears to Change Intergroup Behaviors

Decades of research on how to improve intergroup relations have primarily examined ways to change prejudiced attitudes. However, this focus on negative intergroup attitudes has yielded few effective solutions. Because intergroup relations are shaped by behavior during intergroup interactions, it is necessary to identify constructs that have a strong causal impact on intergroup behavior change. In this article, I will discuss evidence showing that intergroup attitude change is neither a sufficient nor necessary cause for intergroup behavior change. Empirical research suggests that intergroup attitudes are difficult to change and have a limited effect on intergroup behavior. I also distinguish between constructs that primarily affect intergroup attitude change (e.g., counterstereotypical exemplars, evaluative conditioning) and constructs that primarily affect intergroup behavior change (e.g., social norms, self-efficacy). Further, suggestions for future research will also be provided to advance understanding of the various psychological constructs that influence intergroup behavior change, which will help us develop effective methods of improving intergroup relations.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

Cell phone-related driver distraction: Habits predict behavior over and above the theory of planned behavior variables

INTRODUCTION

Habits have often been overlooked in studies investigating cell phone-related driver distractions. This paper examines the association between habits and cell phone-related driver distractions within a mediation model based on the Theory of Planned Behavior (TPB). Additionally, it explores potential differences in behaviors across urban and rural driving environments and between males and females.

METHOD

We conducted an online survey in China with 1,016 respondents, measuring attitudes, subjective norms, perceived behavioral control, self-reported behavior, and habits associated with cell phone use while driving.

RESULTS

Data was analyzed using a two-stage structural equation modeling approach. Results indicate that the measurement model provided a good fit to the data and was invariant across urban and rural driving environments, as well as across genders. The latent path model investigating mediation also demonstrated a good fit and revealed that TPB variables (attitudes, subjective norms, and perceived behavioral control) partially mediated the relationship between cell phone-related habits and cell phone use while driving. The structural model was invariant across driving environments but not across genders, for which the extent of the differences were limited. Moreover, habits were strongly associated with subjective norms and perceived behavioral control, emerging as the strongest predictor of cell phone-related distractions.

CONCLUSIONS

The findings suggest that habits should be considered in research on phone-related distracted driving behaviors and in the development of intervention designs.

Enriching Psychology by Zooming Out to General Mindsets and Practices in Natural Habitats

Psychology has been "zooming in" on individuals, dyads, and groups with a narrow lens to the exclusion of "zooming out," which involves placing the targeted phenomena within more distal layers of influential context. Here, we plea for a paradigm shift. Specifically, we showcase largely hidden scientific benefits of zooming out by discussing worldwide evidence on inhabitants' habitual adaptations to colder-than-temperate and hotter-than-temperate habitats. These exhibits reveal two different types of theories. Clement-climate perspectives emphasize that generic common properties of stresses from cold and hot temperatures elicit similar effects on personality traits and psychosocial functioning. Cold-versus-heat perspectives emphasize that specific unique properties of stresses from cold and hot habitats elicit different effects on phenomena, such as speech practices and intergroup discrimination. Both zooming-out perspectives are then integrated into a complementary framework that helps identify explanatory mechanisms and demonstrates the broader added value of embedding zooming-in approaches within zooming-out approaches. Indeed, zooming out enriches psychology.

Contextual disruption and exercise: mapping changes to exercise routines and engagement during the COVID-19 pandemic

OBJECTIVE

This study examines the impact of COVID-19 restrictions on exercise routines and engagement in moderate-vigorous physical activity (MVPA).

DESIGN

Individuals (N = 397) who reported meeting recommended guidelines for MVPA prior to COVID-19 completed an online questionnaire during the United States' COVID-19 lockdowns in April/May 2020.

MAIN OUTCOME MEASURES

Participants reported their MVPA currently and before COVID-19, and answered questions about five contextual cues (e.g. time of day, interaction partners, type of workout, surrounding events, location of exercise) that characterized their exercise routines currently and before COVID-19.

RESULTS

Contextual cues were perceived as highly disrupted and less consistent during COVID-19 (vs. before) and these changes were associated with greater declines in MVPA. For each cue, distinct effects predicting MVPA declines also emerged for perceived disruption due to COVID-19 restrictions, perceived importance of cue in getting one to exercise, and cue consistency over time.

CONCLUSION

Building on prior research, COVID-19 restrictions affected the context in which people exercised, and changes in these contextual cues were related to declines in MVPA. Re-establishing consistency in certain cues (e.g. time of day) after a disruption may help to forestall declines in MVPA compared to others (e.g. type of workout).

The Situated Assessment Method (SAM2): Establishing individual differences in habitual behavior

From the perspectives of grounded, situated, and embodied cognition, we have developed a new approach for assessing individual differences. Because this approach is grounded in two dimensions of situatedness-situational experience and the Situated Action Cycle-we refer to it as the Situated Assessment Method (SAM2). Rather than abstracting over situations during assessment of a construct (as in traditional assessment instruments), SAM2 assesses a construct in situations where it occurs, simultaneously measuring factors from the Situated Action Cycle known to influence it. To demonstrate this framework, we developed the SAM2 Habitual Behavior Instrument (SAM2 HBI). Across three studies with a total of 442 participants, the SAM2 HBI produced a robust and replicable pattern of results at both the group and individual levels. Trait-level measures of habitual behavior exhibited large reliable individual differences in the regularity of performing positive versus negative habits. Situational assessments established large effects of situations and large situation by individual interactions. Several sources of evidence demonstrated construct and content validity for SAM2 measures of habitual behavior. At both the group and individual levels, these measures were associated with factors from the Situated Action Cycle known to influence habitual behavior in the literature (consistency, automaticity, immediate reward, long-term reward). Regressions explained approximately 65% of the variance at the group level and a median of approximately 75% at the individual level. SAM2 measures further exhibited well-established interactions with personality measures for self-control and neuroticism. Cognitive-affective processes from the Situated Action Cycle explained nearly all the variance in these interactions. Finally, a composite measure of habitualness established habitual behaviors at both the group and individual levels. Additionally, a composite measure of reward was positively related to the composite measure of habitualness, increasing with self-control and decreasing with neuroticism.

Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity

Purpose –

Research consistently shows that non-scientific bias, equity, and diversity trainings do not work, and often make bias and diversity problems worse. Despite these widespread failures, there is considerable reason for hope that effective, meaningful DEI efforts can be developed. One approach in particular, the bias habit-breaking training, has 15 years of experimental evidence demonstrating its widespread effectiveness and efficacy.

Design/methodology/approach –

This article discusses bias, diversity, equity, and inclusion (DEI) efforts from the author's perspective as a scientist-practitioner - the author draws primarily on the scientific literature, but also integrates insights from practical experiences working in DEI. The author provides a roadmap for adapting effective, evidence-based approaches from other disciplines (e.g. cognitive-behavioral therapy) into the DEI context and reviews evidence related to the bias habit-breaking training as one prominent demonstration of a scientifically-validated approach that effects lasting, meaningful improvements on DEI issues within both individuals and institutions.

Findings –

DEI trainings fail due to widespread adoption of the information deficit model, which is well-known as a highly ineffective approach. Empowerment-based approaches, in contrast, are highly promising for making meaningful, lasting changes in the DEI realm. Evidence indicates that the bias habit-breaking training is effective at empowering individuals as agents of change to reduce bias, create inclusion, and promote equity, both within themselves and the social contexts they inhabit.

Originality/value –

In contrast to the considerable despair and pessimism around DEI efforts, the present analysis provides hope and optimism, and an empirically-validated path forward, to develop and test DEI approaches that empower individuals as agents of 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.

Automaticity mediates the association between action planning and physical activity, especially when autonomous motivation is high

OBJECTIVES

Action planning promotes physical activity (PA). However, mechanisms underlying this association are poorly understood, as are the variables that moderate this link remain unexplored. To fill these gaps, we investigated whether automaticity mediated the association between action planning and PA, and whether autonomous motivation moderated this mediation.

METHODS AND MEASURES

PA was measured by accelerometry over seven days among a sample of 124 adults. Action planning, automaticity, and autonomous motivation were assessed by questionnaires.

RESULTS

Structural equation models revealed that automaticity mediated the association between action planning and PA (total effect, β = .29, p < .001) - action planning was associated with automaticity (a path, β = .47, p < .001), which in turn related to PA (b path, β = .33, p = .003). Autonomous motivation moderated the a path (β = .16, p = .035) - action planning was more strongly associated with automaticity when autonomous motivation was high (+1 standard-deviation [SD]) (unstandardized b = 0.77, p < .001) versus low (-1 SD) (b = 0.35, p = .023).

CONCLUSION

These findings not only support that action planning favors an automatic behavioral regulation, but also highlight that a high autonomous motivation toward PA may reinforce this mechanism.

Selective de-implementation of routine in vivo dosimetry

As cone-beam computed tomography (CBCT) has become the localization method for a majority of cases, the indications for diode-based confirmation of accurate patient set-up and treatment are now limited and must be balanced between proper resource allocation and optimizing efficiency without compromising safety. We undertook a de-implementation quality improvement project to discontinue routine diode use in non-intensity modulated radiotherapy (IMRT) cases in favor of tailored selection of scenarios where diodes may be useful. After analysis of safety reports from the last 5 years, literature review, and stakeholder discussions, our safety and quality (SAQ) committee introduced a recommendation to limit diode use to specific scenarios in which in vivo verification may add value to standard quality assurance (QA) processes. To assess changes in patterns of use, we reviewed diode use by clinical indication 4 months prior and after the implementation of the revised policy, which includes use of diodes for: 3D conformal photon fields set up without CBCT; total body irradiation (TBI); electron beams; cardiac devices within 10 cm of the treatment field; and unique scenarios on a case-by-case basis. We identified 4459 prescriptions and 1038 unique instances of diode use across five clinical sites from 5/2021 to 1/2022. After implementation of the revised policy, we observed an overall decrease in diode use from 32% to 13.2%, with a precipitous drop in 3D cases utilizing CBCT (from 23.2% to 4%), while maintaining diode utilization in the 5 selected scenarios including 100% of TBI and electron cases. By identifying specific indications for diode use and creating a user-friendly platform for case selection, we have successfully de-implemented routine diode use in favor of a selective process that identifies cases where the diode is important for patient safety. In doing so, we have streamlined patient care and decreased cost without compromising patient safety.

Psychological Correlates of Perceived Physical Activity Engagement During the COVID-19 Pandemic Among Previously Active Individuals

The COVID-19 pandemic altered daily life in the United States and disrupted how people engage in routine health behaviors, such as physical activity (PA). This study investigates factors that may have helped people sustain recommended levels of moderate to vigorous PA (MVPA) during this time. Using a cross-sectional design, we recruited from Amazon's Mechanical Turk in April/May 2020 a sample of individuals who reported that they had met recommended PA guidelines (≥ 150 weekly MVPA minutes; N = 397) prior to structural changes brought about by COVID-19. We assessed via self-report whether these individuals were meeting recommended levels of MVPA during the COVID-19 pandemic, their intrinsic motivation and identified regulation for exercise, exercise self-efficacy, perceived disruption to their exercise routine, and access to resources for PA. Higher identified regulation, self-efficacy, access to PA resources, and lower perceived disruption were associated with meeting PA guidelines during COVID-19. These findings provide insight into factors that may be important for continued engagement in MVPA when one experiences major disruptions to their exercise routine.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1929811 .

A cross-national and longitudinal analysis of handwashing and its predictors during the COVID-19 pandemic in France and Belgium

Background: Using a longitudinal design, we investigate how the adherence to handwashing and its underlying socio-psychological predictors evolved over time during the COVID-19 pandemic and under distinct circumstances (e.g. when the crisis was more acute or chronic). Method: We collected data (N = 753) in Belgium and France at the onset of the COVID-19 pandemic when the crisis was at its peak (April 2020), and almost a year later (February 2021), when the outbreak was more manageable. Results: Regression models suggest that the compliance with handwashing and its pattern of underlying predictors remained remarkably stable over time despite the variations in contextual factors such as the severity of the health crisis and the stringency of health measures. As such, the findings also highlight the robustness of the models that predict it, namely the Theory of Planned Behavior. The intentions to perform the behavior, the perceived control over it, and being part of the (para)medical field were among the strongest predictors. Conclusions: In practice, the stability of the underlying factors suggests a set of action levers that can be used in communication campaigns aimed at fostering its adherence throughout the pandemic.

Physical Movement Habit Formation in Sedentary Office Workers: Protocol Paper

Engaging in physical movement has a number of mental and physical health benefits, and yet 45% of Australia's population do not meet the recommended guidelines for physical activity. The current study aims to develop an online habit-based intervention designed to reduce sedentary behavior within the workplace, using environmental cues to instigate simple behavioral changes. Participants in this study will include full time office workers who self-report as having a highly sedentary job and work from either a commercial office, home office, or a mixture of both. Participants will complete a habit-based intervention over a four-week period designed to reduce sedentary behavior by increasing habitual responses to simple physical movement behaviors cued by their environment. Analysis will involve mixed methods ANOVAs to test the efficacy of the intervention. A successful intervention will show a reduction in sedentary behavior as a response to habitual simple physical movement behaviors.

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.

Increased Habit Frequency in the Daily Lives of Patients with Acute Anorexia Nervosa

Strict eating routines and frequent rigid behavior patterns are commonly observed in patients with anorexia nervosa (AN). A recent theory proposes that while these behaviors may have been reinforced initially, they later become habitual. To date, however, research has been overly focused on eating-disorder (ED)-related habits. Over the course of seven days, we applied an ecological momentary assessment (EMA) to investigate the habit frequency and strength of ED-specific (food intake) and ED-unspecific (hygiene) habits in the daily lives of a sample of n = 57 AN and n = 57 healthy controls (HC). The results of the hierarchical models revealed that habits were significantly more likely in patients compared with HC for both categories, independently. Furthermore, a lower body mass index (BMI) was associated with increased habit frequency in AN. Our study strengthens the habit theory of AN by showing the relevance of habits beyond ED-specific behavioral domains. This also supports the development of innovative therapeutic interventions targeting habitual behavior in EDs.

Improving Hand Hygiene Behavior Using a Novel Theory-Based Intervention During the COVID-19 Pandemic

Background

Promoting the adoption of personal hygiene behaviors known to reduce the transmission of COVID-19, such as avoiding touching one’s face with unwashed hands, is important for limiting the spread of infections.

Purpose

We aimed to test the efficacy of a theory-based intervention to promote the avoidance of touching one’s face with unwashed hands to reduce the spread of COVID-19.

Methods

We tested effects of an intervention employing imagery, persuasive communication, and planning techniques in two pre-registered studies adopting randomized controlled designs in samples of Australian (N = 254; Study 1) and US (N = 245; Study 2) residents. Participants were randomly assigned to theory-based intervention or education-only conditions (Study 1), or to theory-based intervention, education-only, and no-intervention control conditions (Study 2). The intervention was delivered online and participants completed measures of behavior and theory-based social cognition constructs pre-intervention and one-week postintervention.

Results

Mixed-model ANOVAs revealed a significant increase in avoidance of touching the face with unwashed hands from pre-intervention to follow-up irrespective of intervention condition in both studies, but no significant condition effects. Exploratory analyses revealed significant effects of the theory-based intervention on behavior at follow-up in individuals with low pre-intervention risk perceptions in Study 2.

Conclusions

Results indicate high adoption of avoiding touching one’s face with unwashed hands, with behavior increasing over time independent of the intervention. Future research should confirm risk perceptions as a moderator of the effect theory-based interventions on infection-prevention behaviors.

Chronotype and trait self-control as unique predictors of sleep quality in Chinese adults: The mediating effects of sleep hygiene habits and bedtime media use

This study examined the distinctive roles of chronotype and trait self-control in predicting sleep quality and the mediation of sleep hygiene habits and bedtime media use of the relations between chronotype, trait self-control and sleep quality. Self-report questionnaire measuring chronotype, trait self-control, sleep hygiene behaviors, bedtime media use and sleep quality was administered to 224 Chinese adult participants (83.5% female). A multiple mediation model was estimated with sleep hygiene habits and bedtime media use as parallel mediators of the relations between chronotype, trait self-control, and sleep quality. Chronotype and trait self-control positively predicted sleep quality. Results of mediation analyses indicated that trait self-control predicted sleep quality both directly and indirectly through pre-sleep stress management and keeping a restful sleep environment, whereas chronotype predicted sleep quality indirectly through pre-sleep stress management and bedtime media use. This study provides evidence for the possible mechanism through which eveningness and low trait self-control undermine sleep quality: Whereas bedtime media use and sleep timing irregularity are linked to poor sleep quality in evening types, environmental interference (e.g., noise or disorganization) appears to be more relevant to poor sleep quality in individuals low in self-control. These findings can inform the design of personalized sleep hygiene recommendations appropriate for the target population. Practical implications regarding sleep hygiene education and interventions are discussed.

Smart Chemical Engineering-Based Lightweight and Miniaturized Attachable Systems for Advanced Drug Delivery and Diagnostics

Smart attachable systems have attracted much attention owing to their capabilities in terms of body performance evaluation, disease diagnostics, and drug delivery. Recent advances in chemical and engineering techniques provide many opportunities to improve device fabrication and applications owing to the advantages of being lightweight and easy to control as well as their battery absence and functional diversity. This review highlights the latest developments in the field of chemical engineering-based lightweight and miniaturized attachable systems, which are mainly inspired by the natural world. Their applications for real-time monitoring, point-of-care sampling, biomarker detection, and controlled release are discussed thoroughly with respect to specific products/prototypes. The perspectives of the field, including persistence guarantee, burden reduction, and personality improvement, are also discussed. It is believed that chemical engineering-based lightweight and miniaturized attachable systems have good potential in both clinical and industrial fields, indicating a large potential to improve human lives in the near future.

Digitally characterizing the dynamics of multiple health behavior change

OBJECTIVE

We applied the ORBIT model to digitally define dynamic treatment pathways whereby intervention improves multiple risk behaviors. We hypothesized that effective intervention improves the frequency and consistency of targeted health behaviors and that both correlate with automaticity (habit) and self-efficacy (self-regulation).

METHOD

Study 1: Via location scale mixed modeling we compared effects when hybrid mobile intervention did versus did not target each behavior in the Make Better Choices 1 (MBC1) trial (n = 204). Participants had all of four risk behaviors: low moderate-vigorous physical activity (MVPA) and fruit and vegetable consumption (FV), and high saturated fat (FAT) and sedentary leisure screen time (SED). Models estimated the mean (location), between-subjects variance, and within-subject variance (scale).

RESULTS

Treatment by time interactions showed that location increased for MVPA and FV (Bs = 1.68, .61; ps < .001) and decreased for SED and FAT (Bs = -2.01, -.07; ps < .05) more when treatments targeted the behavior. Within-subject variance modeling revealed group by time interactions for scale (taus = -.19, -.75, -.17, -.11; ps < .001), indicating that all behaviors grew more consistent when targeted.

METHOD

Study 2: In the MBC2 trial (n = 212) we examined correlations between location, scale, self-efficacy, and automaticity for the three targeted behaviors.

RESULTS

For SED, higher scale (less consistency) but not location correlated with lower self-efficacy (r = -.22, p = .014) and automaticity (r = -.23, p = .013). For FV and MVPA, higher location, but not scale, correlated with higher self-efficacy (rs = .38, .34, ps < .001) and greater automaticity (rs = .46, .42, ps < .001).

CONCLUSIONS

Location scale mixed modeling suggests that both habit and self-regulation changes probably accompany acquisition of complex diet and activity behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using an Integrated Social Cognition Model to Explain Green Purchasing Behavior among Adolescents

Strengthening pro-environmental behaviors such as green purchasing behavior is important for environmental sustainability. An integrated social cognition model which incorporates constructs from habit theory, health action process approach (HAPA), and theory of planned behavior (TPB) is adopted to understand Iranian adolescents’ green purchasing behavior. Using a correlational-prospective design, the study recruited Iranian adolescents aged between 14 and 19 years (N = 2374, n = 1362 (57.4%) females, n = 1012 (42.6%) males; Mean (SD) age = 15.56 (1.22)). At baseline (T1), participants self-reported on the following constructs: past behavior; habit strength (from habit theory); action planning and coping planning (from HAPA); and intention, perceived behavioral control, subjective norm, and attitude (from TPB) with respect to green purchasing behavior. Six months later (T2), participants self-reported on their actions in terms of purchasing green goods. Our findings reported direct effects of perceived behavioral control, subjective norms, attitude, and past behavior on intention; intention and perceived behavioral control on green purchase behavior; intention on two types of planning (i.e., action and coping planning); both types of planning on green purchase behavior; and past green purchase behavior and habits on prospectively measured green purchase behavior. These results indicate that adolescent green purchasing behavior is underpinned by constructs representing motivational, volitional, and automatic processes. This knowledge can help inform the development of theory-based behavior change interventions to improve green purchasing in adolescents, a key developmental period where climate change issues are salient and increased independence and demands in making self-guided decisions are needed.

Randomised controlled trial targeting habit formation to improve medication adherence to daily oral medications in patients with gout

INTRODUCTION

Medication adherence for patients with chronic conditions such as gout, a debilitating form of arthritis that requires daily medication to prevent flares, is a costly problem. Existing interventions to improve medication adherence have only been moderately effective. Habit formation theory is a promising strategy to improve adherence. The cue-reward-repetition principle posits that habits are formed by repeatedly completing an activity after the same cue and having the action rewarded every time. Over time, cues become increasingly important whereas rewards become less salient because the action becomes automatic. Leveraging the cue-reward-repetition principle could improve adherence to daily gout medications.

METHODS AND ANALYSIS

This three-arm parallel randomised controlled trial tests an adaptive intervention that leverages the repetition cue-reward principle. The trial will began recruitment in August 2021 in Boston, Massachusetts, USA. Eligible patients are adults with gout who have been prescribed a daily oral medication for gout and whose most recent uric acid is above 6 mg/dL. Participants will be randomised to one of three arms and given electronic pill bottles. In the two intervention arms, participants will select a daily activity to link to their medication-taking (cue) and a charity to which money will be donated every time they take their medication (reward). Participants in Arm 1 will receive reminder texts about their cue and their charity reward amount will be US$0.50 per day of medication taken. Arm 2 will be adaptive; participants will receive a US$0.25 per adherent-day and no reminder texts. If their adherence is <75% 6 weeks postrandomisation, their reward will increase to US$0.50 per adherent-day and they will receive reminder texts. The primary outcome is adherence to gout medications over 18 weeks.

ETHICS AND DISSEMINATION

This trial has ethical approval in the USA. Results will be published in a publicly accessible peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT04776161.

Predictors of school students' leisure-time physical activity: An extended trans-contextual model using Bayesian path analysis

The present study aimed to examine effects of motivational and social cognition constructs on children’s leisure-time physical activity participation alongside constructs representing implicit processes using an extended trans-contextual model. The study adopted a correlational prospective design. Secondary-school students (N = 502) completed self-report measures of perceived autonomy support from physical education (PE) teachers, autonomous motivation in PE and leisure-time contexts, and social cognition constructs (attitudes, subjective norms, perceived behavioral control), intentions, trait self-control, habits, and past behavior in a leisure-time physical activity context. Five weeks later, students (N = 298) self-reported their leisure-time physical activity participation. Bayesian path analyses supported two key premises of the model: perceived autonomy support was related to autonomous motivation in PE, and autonomous motivation in PE was related to autonomous motivation in leisure time. Indirect effects indicated that both forms of autonomous motivation were related to social cognition constructs and intentions. However, intention was not related to leisure-time physical activity participation, so model variables reflecting motivational processes did not account for substantive variance in physical activity participation. Self-control, attitudes, and past behavior were direct predictors of intentions and leisure-time physical activity participation. There were indirect effects of autonomous motivation in leisure time on intentions and physical activity participation mediated by self-control. Specifying informative priors for key model relations using Bayesian analysis yielded greater precision for some model effects. Findings raise some questions on the predictive validity of constructs from the original trans-contextual model in the current sample, but highlight the value of extending the model to incorporate additional constructs representing non-conscious processes.

From ability to behavior: A scenario-based assessment of health competence predicts daily health behaviors

Recent findings have suggested that we can gain new insights into health decision-making and behavior through the use of a scenario-based approach to health competence (HC). The present research sought to investigate whether and how such individual differences would matter in the conduct of daily life, within two daily diary studies (N = 260). In Study 1, participants receiving higher HC scores were more active in dealing with daily stressors or problems; by contrast, low-HC individuals were more prone to impulsive and antisocial behaviors. Based on these promising results, the Study 2 protocol was a more extensive one. Participants who received higher HC scores thought about their health more often and engaged in diverse healthy behaviors more frequently. Conversely, low-HC individuals were prone to risky and unhealthy daily behaviors. In total, the findings provide key evidence in favor of a new approach to HC and its behavioral manifestations.

Working from home during the COVID-19 crisis: How self-control strategies elucidate employees' job performance

Employees around the globe experience manifold challenges to maintain job performance during the so‐called work‐from‐home experiment caused by the COVID‐19 crisis. Whereas the self‐control literature suggests that higher trait self‐control should enable employees to deal with these demands more effectively, we know little about the underlying mechanisms. In a mixed‐methods approach and two waves of data collection, we examine how self‐control strategies elucidate the link between teleworking employees' trait self‐control and their job performance. Using a qualitative approach, we explored which strategies employees use to telework effectively (N = 266). In line with the process model of self‐control, reported strategies pertained to situation modification (i.e., altering the physical, somatic, or social conditions) and cognitive change (i.e., goal setting, planning/scheduling, and autonomous motivation). Subsequent preregistered, quantitative analyses with a diverse sample of 106 teleworkers corroborated that higher trait self‐control is related to job performance beyond situational demands and prior performance. Among all self‐control strategies, modifying somatic conditions and autonomous motivation was significantly associated with job performance and mediated the self‐control‐performance link. This research provides novel insights into the processes by which employees productively work from home and inspires a broad(er) view on the topic of self‐control at work.

Enhancing Consumer Experience through Development of Implicit Attitudes Using Food Delivery Applications

In the context created by the COVID-19 pandemic, the aim of the research in this article is to highlight how the consumer experience is constructed, starting from the consumer’s attitudes—which we consider to be implicitly positive—and from the formation of habits of using mobile applications for food supply. Data were collected from 610 people—users of applications for food delivery in urban areas—in the spring of 2021, using a quantitative type of research in the form of a field survey based on questionnaire completion; for the model validation, we used confirmatory factor analysis. The online questionnaire link was sent out in April 2021, followed by the consumers’ completion of the questionnaire in the same month. The proposed theoretical model highlights the influence of variables that are specific for technology acceptance models on the perceived utility and development of implicit attitudes based on it, as well as the habits of using the application. The results of the research validate the proposed model, showing that attitudes in the form of an implicit-type attitudes developed in time are influencing habits and aid the development of a certain usage behavior depicted by a consumption experience that has specific content. Our paper contributes to a better understanding of the consumer experience development process within the context of technology acceptance in the field of food delivery services, emphasizing the importance of satisfying hedonic motivations as an integral part of the compensatory mechanisms determined by the effects of the pandemic.

A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation

BACKGROUND

There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse.

METHODS

This explanatory, sequential, mixed-methods study collected survey data (n= 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n=19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n=5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted a descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process.

RESULTS

Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not perceive to have experienced overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that reducing overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may contribute to overscreening. Providers identified potential strategies to reduce overscreening including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may receive less health benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop standard processes of care around mammography screening.

CONCLUSIONS

Multi-level factors contributing to mammography overuse are dynamic, interconnected, and reinforced. To ensure equitable de-implementation, there is a need for more refined and empirical testing of theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process.

Sedentary work and participation in leisure-time physical activity

Objective

Demanding psychosocial work characteristics, such as high job demands, can have a detrimental impact on leisure–time physical activity (LTPA), with adverse consequences for employee health and well-being. However, the mechanisms and moderators of this crossover effect are still largely unknown. We therefore aimed to identify and test potential mediating and moderating factors from within and outside the work environment. Based on the previous research, we expected job demands to be negatively related to LTPA through fatigue. In addition, we expected that job control and worktime control would attenuate the relationship between job demands and fatigue. Furthermore, we hypothesized that autonomous exercise motivation and spontaneous action planning would attenuate the relationship between fatigue and LTPA. In addition to these cross-sectional hypotheses, we expected the same effects to predict a change in LTPA in the following year.

Methods

To investigate these assumptions, a preregistered longitudinal survey study was conducted among a large sample of Dutch employees in sedentary jobs. Participants reported on the constructs of interest in 2017 and 2018 (N = 1189 and 665 respectively) and the resulting data were analyzed using path analyses.

Results

Our cross-sectional analyses confirm a weak indirect, negative association between job demands and LTPA, via fatigue. However, this finding was not observed in our longitudinal analyses and none of the other hypotheses were confirmed.

Conclusion

This study shows that, among employees with relatively healthy psychosocial work characteristics (i.e., high job control), the evidence for an impact of these work characteristics on participation in LTPA is limited.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01750-7.

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.

Does alcohol-related desire thinking predict in-the-moment drinking behaviours?

Desire thinking (voluntary thinking involving a perseverative focusing on desired target-related memories, images, and information), is an important factor in the experience of drinking urges and cravings. Research has not examined the relationship between desire thinking, behavioural intention and the implementation of that behaviour into action, nor how one's past repeated behaviour in situ (expressed as habit) may moderate these relationships. We employed an ad libitum drinking paradigm to provide indirect measures of in-the-moment drinking behaviours (amount poured [mls] and amount consumed [mls]) in a group of eighty-eight self-defined social drinkers immediately after measuring self-reported drinking habit, drinking-related desire thinking, and general drinking behaviour. Results confirmed the predicted positive relationship between desire thinking and in-the-moment drinking behaviour with the effects increasing as a function of rising drinking habit strength. We also observed a dissociation between desire thinking components (verbal perseveration and imaginal prefiguration) in the moderating effects of habit strength on drinking behaviour. For imaginal prefiguration (thoughts related to construction of mental images of a desired target or of its context for consumption) a direct effect on drinking behaviours was shown. In comparison, the effect for verbal perseveration (repetitive self-talk regarding the need to achieve a desired target) was not shown to independently predict drinking-related behaviour but was significantly moderated by increasing drinking-related habit strength. Future work should formulate the nature of this moderating influence on perseverative goal-directed thinking.

Personality-informed intervention design: Examining how trait regulation can inform efforts to change behavior

Research that helps people change their behavior has the potential to improve the quality of lives, but it is too often approached in a way that divorces behavior from the people who need to enact it. In this paper, we propose a personality-informed approach to classifying behavior-change problems and designing interventions to address them. In particular, we argue that interventions will be most effective when they target the appropriate psychological process given the disposition of the participant and the desired duration of change. Considering these dimensions can help to reveal the differences among common types of behavior-change problems, and it can guide decisions about what kinds of intervention solutions will most effectively solve them. We review key concepts and findings from the personality literature that can help us understand the dynamic nature of dispositions and to identify the psychological processes that best explain both short-term variance in behavior and long-term development of personality. Drawing on this literature, we argue that different types of behavior-change problems require different forms of “trait regulation,” and we offer a series of propositions to be evaluated as potential guides for the design of intervention strategies to address them.

Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda

Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors.

The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19-Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey

BACKGROUND

The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people's mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19.

OBJECTIVE

The objectives of this study were to (1) examine the regional differences in mental health and COVID-19-related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19-related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19-related worry, attention to news, and stress.

METHODS

A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19-related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19-related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19-related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects.

RESULTS

The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19-related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001).

CONCLUSIONS

Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.

Evolution of physical activity habits after a context change: The case of COVID-19 lockdown

Objective

Habits, defined as well‐learned associations between cues and behaviours, are essential for health‐related behaviours, including physical activity (PA). Despite the sensitivity of habits to context changes, little remains known about the influence of a context change on the interplay between PA habits and behaviours. We investigated the evolution of PA habits amidst the spring COVID‐19 lockdown, a major context change. Moreover, we examined the association of PA behaviours and autonomous motivation with this evolution.

Design

Three‐wave observational longitudinal design.

Methods

PA habits, behaviours, and autonomous motivation were collected through online surveys in 283 French and Swiss participants. Variables were self‐reported with reference to three time‐points: before‐, mid‐, and end‐lockdown.

Results

Mixed effect modelling revealed a decrease in PA habits from before‐ to mid‐lockdown, especially among individuals with strong before‐lockdown habits. Path analysis showed that before‐lockdown PA habits were not associated with mid‐lockdown PA behaviours (β = −.02, p = .837), while mid‐lockdown PA habits were positively related to end‐lockdown PA behaviours (β = .23, p = .021). Autonomous motivation was directly associated with PA habits (ps < .001) and withto before‐ and mid‐lockdown PA behaviours (ps < .001) (but not with end‐lockdown PA behaviours) and did not moderate the relations between PA behaviours and habits (ps > .072).

Conclusion

PA habits were altered, and their influence on PA behaviours was impeded during the COVID‐19 lockdown. Engagement in PA behaviours and autonomous motivation helped in counteracting PA habits disruption.

Self-control and beliefs surrounding others’ cooperation predict own health-protective behaviors and support for COVID-19 government regulations: Evidence from two European countries

In the current pandemic, both self-regulated health-protective behavior and government-imposed regulations are needed for successful outbreak mitigation. Going forward, researchers and decision-makers must therefore understand the factors contributing to individuals’ engagement in health-protective behavior, and their support for government regulations. Integrating knowledge from the literatures on self-control and cooperation, we explore an informed selection of potential predictors of individuals’ health-protective behaviors as well as their support for government regulations during the COVID-19 pandemic. Aiming for a conceptual replication in two European countries, we collected data in Switzerland (N = 352) and the UK before (N = 212) and during lockdown (n = 132) and conducted supervised machine learning for variable selection, followed by OLS regression, cross-sectionally and, in the UK sample, across time. Results showed that personal importance of outbreak mitigation and beliefs surrounding others’ cooperation are associated with both health-protective behavior and support for government regulations. Further, Swiss participants high in trait self-control engaged in health-protective behavior more often. Interestingly, perceived risk, age, and political orientation consistently displayed nonsignificant weak to zero associations with both health-protective behavior and support. Together, these findings highlight the contribution of self-control theories in explaining COVID-19-relevant outcomes, and underscore the importance of contextualizing self-control within the cooperative social context.

Ego effectiveness: A novel individual difference approach to health behavior and coping

Taking care of one's health can require trading current feelings for longer-term considerations of health and well-being. The present research (total N = 366) sought to assess ego operations of this type in terms of the extent to which the self would be capable of responding to health-challenging situations in ways deemed to be effective. Ego effective individuals engaged in a greater frequency of health-protective behaviors as well as a lesser frequency of risky behaviors, both with respect to a peer protocol (Study 1) and a daily life protocol (Study 2). Findings are informative concerning multiple self-regulation perspectives on health.

Social-cognitive predictors of parental supervised toothbrushing: An application of the health action process approach

BACKGROUND

We examined the social cognition determinants of parental supervised toothbrushing guided by the health action process approach (HAPA).

METHODS

In a prospective correlational survey study, participants (N = 185, 84.3% women) completed HAPA social cognition constructs at an initial time point (T1), and 12 weeks later (T2) self-reported on their parental supervised toothbrushing behaviour, toothbrushing habit, and action control.

RESULTS

Structural equation models exhibited adequate fit with the data when past behaviour and habit were either excluded or included. Intention, self-efficacy, planning, and action control were predictors of parental supervised toothbrushing; intention predicted action planning and coping planning; and self-efficacy and attitude were predictors of intention. Indirect effects of social cognition constructs through intentions, and intentions through planning constructs were also observed. Inclusion of past behaviour and habit attenuated model effects.

CONCLUSION

Results indicate that parental supervised toothbrushing is a function of motivational and volitional processes. This knowledge can be used to inform behaviour change interventions targeting parental supervised toothbrushing.

The Association Between Healthy Lifestyle Behaviours and Coronavirus Protective Behaviours

BACKGROUND

Based on models of cross-behavioural associations and the role of past behaviour in predicting behaviour, an association was hypothesized between healthy lifestyle behaviours prior to the COVID-19 pandemic and adherence to coronavirus protective behaviours. Self-assessed health was also examined as a potential moderator.

METHODS

A cross-sectional sample (N = 463) completed online questionnaires during a COVID-19-related lockdown that measured engagement in healthy lifestyle behaviours (e.g., exercising and eating fruits and vegetables), adherence to coronavirus protective behaviours (e.g., wearing a face mask and practicing social distancing), and self-assessed health (subjective evaluation of overall health).

RESULTS

As predicted, higher engagement in healthy lifestyle behaviours prior to the pandemic was significantly correlated with higher adherence to coronavirus protective behaviours (Pearson r(459) = .308, p < .001). Adherence levels were higher than engagement in healthy lifestyle behaviours, and self-assessed health was related to the latter but not to the former. Moderation was examined using model 1 in PROCESS for SPSS; as expected, the association was stronger among individuals with higher levels of self-assessed health (coefficient 95% CI [.04, .20]).

CONCLUSIONS

The findings highlight cross-behavioural facilitating processes, specifically between lifestyle behaviours and adherence to recommended protective behaviours during the pandemic. They also draw attention to the need to address individuals whose poorer evaluations of their general health might prevent them from implementing their behavioural intentions.