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Nahum-Shani I, Greer ZM, Trella AL, Zhang KW, Carpenter SM, Rünger D, Elashoff D, Murphy SA, Shetty V. Optimizing an adaptive digital oral health intervention for promoting oral self-care behaviors: Micro-randomized trial protocol. Contemp Clin Trials 2024; 139:107464. [PMID: 38307224 PMCID: PMC11007589 DOI: 10.1016/j.cct.2024.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Dental disease continues to be one of the most prevalent chronic diseases in the United States. Although oral self-care behaviors (OSCB), involving systematic twice-a-day tooth brushing, can prevent dental disease, this basic behavior is not sufficiently practiced. Recent advances in digital technology offer tremendous potential for promoting OSCB by delivering Just-In-Time Adaptive Interventions (JITAIs)- interventions that leverage dynamic information about the person's state and context to effectively prompt them to engage in a desired behavior in real-time, real-world settings. However, limited research attention has been given to systematically investigating how to best prompt individuals to engage in OSCB in daily life, and under what conditions prompting would be most beneficial. This paper describes the protocol for a Micro-Randomized Trial (MRT) to inform the development of a JITAI for promoting ideal OSCB, namely, brushing twice daily, for two minutes each time, in all four dental quadrants (i.e., 2x2x4). Sensors within an electric toothbrush (eBrush) will be used to track OSCB and a matching mobile app (Oralytics) will deliver on-demand feedback and educational information. The MRT will micro-randomize participants twice daily (morning and evening) to either (a) a prompt (push notification) containing one of several theoretically grounded engagement strategies or (b) no prompt. The goal is to investigate whether, what type of, and under what conditions prompting increases engagement in ideal OSCB. The results will build the empirical foundation necessary to develop an optimized JITAI that will be evaluated relative to a suitable control in a future randomized controlled trial.
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Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, United States of America.
| | - Zara M Greer
- School of Dentistry, University of California, Los Angeles, United States of America
| | - Anna L Trella
- School of Engineering and Applied Sciences, Harvard University, United States of America
| | - Kelly W Zhang
- School of Engineering and Applied Sciences, Harvard University, United States of America
| | | | - Dennis Rünger
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States of America
| | - David Elashoff
- Division of General Internal Medicine and Health Services Research, Department of Biostatistics, and Department of Computational Medicine, University of California, Los Angeles, United States of America
| | - Susan A Murphy
- School of Engineering and Applied Sciences, Harvard University, United States of America
| | - Vivek Shetty
- School of Dentistry, University of California, Los Angeles, United States of America
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van Rookhuijzen M, de Vet E, Gort G, Adriaanse MA. When nudgees become nudgers: Exploring the use of self-nudging to promote fruit intake. Appl Psychol Health Well Being 2023; 15:1714-1732. [PMID: 37335055 DOI: 10.1111/aphw.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
The current study explored (1) the immediate and prolonged effects of self-nudges promoting fruit intake in the home environment, (2) whether the effect of self-nudges on fruit intake persists after self-nudges are no longer used (i.e. a temporal spillover effect) and (3) whether self-nudges can install healthy eating habits that, in turn, explain the temporal spillover effect. Participants (N = 331) were randomly assigned to either a control or self-nudge condition in which they had to choose a self-nudge promoting fruit consumption for 8 weeks. Thereafter, participants were asked to remove the self-nudge for 1 week to assess a possible temporal spillover effect. Results showed a positive effect of the self-nudges on fruit consumption right after implementation that continued during the 8 weeks in which the self-nudge was implemented, which was accompanied by an increase in fruit intake habit strength. However, a mixed picture emerged regarding the temporal spillover effect and no support was found for a mediation effect of habit strength. Although this study is only a first exploration of self-nudging to increase healthy food consumption, results indicate that self-nudging may be a promising extension of traditional nudging that can influence behaviour beyond out-of-home settings.
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Affiliation(s)
- Merije van Rookhuijzen
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Gerrit Gort
- Biometris, Wageningen University and Research, Wageningen, The Netherlands
| | - Marieke A Adriaanse
- Health, Medical and Neuropsychology, Leiden University and Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Feldhacker DR, Ikiugu MN, Fritz H, Schweinle WE, Wang H. Habit Formation Intervention to Improve Type 2 Diabetes Self-Management Behaviors: A Feasibility Study. Am J Occup Ther 2023; 77:7706205100. [PMID: 37994806 DOI: 10.5014/ajot.2023.050351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
IMPORTANCE Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited. OBJECTIVE To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors. DESIGN Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data. SETTING Individual telehealth sessions. PARTICIPANTS Eight adults (ages 29-75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study. INTERVENTION Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity. OUTCOMES AND MEASURES Data gathered included findings on measures of diabetes self-care behaviors and habit formation. RESULTS There was a significant change in self-care behaviors for 6 of the 8 participants (p < .05 for 1 participant, and p < .01 for 5 participants). Group changes were statistically significant (p < .001). Habit strength significantly improved for all areas of diabetes self-management (p < .001 for nutrition, blood glucose monitoring, and medication management and p = .001 for physical activity). CONCLUSIONS AND RELEVANCE Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes.
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Affiliation(s)
- Diana R Feldhacker
- Diana R. Feldhacker, PhD, OTD, OTR/L, BCPR, is Founding Program Director and Chair, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Moses N Ikiugu
- Moses N. Ikiugu, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, University of South Dakota, Vermillion
| | - Heather Fritz
- Heather Fritz, PhD, OTR/L, CHC, is Founding Program Director, School of Occupational Therapy, Pacific Northwest University, Yakima, WA
| | - William E Schweinle
- William E. Schweinle, PhD, is Professor, Department of Physician Assistant Studies, University of South Dakota, Vermillion
| | - Hongmei Wang
- Hongmei Wang, PhD, is Associate Professor, Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha
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den Daas C, Dixon D, Hubbard G, Allan J, Johnston M. Habits and Reflective Processes in COVID-19 Transmission-reducing Behaviors: Examining Theoretical Predictions in a Representative Sample of the Population of Scotland. Ann Behav Med 2023; 57:910-920. [PMID: 37319346 PMCID: PMC10578412 DOI: 10.1093/abm/kaad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Based on theory, COVID-19 transmission-reducing behaviors (TRBs) should become habitual because of their frequent performance. Habits have been hypothesized to develop through reflective processes and, to act in conjunction with them. PURPOSE We investigated the existence, development, and consequences of TRB habits, for physical distancing, handwashing, and wearing face coverings. METHODS A representative sample of the Scottish population (N = 1,003) was interviewed by a commercial polling company in August-October 2020 and half were re-interviewed later. Measures included adherence, habit, personal routine tendency, reflective processes, and action control for three TRBs. Data were analyzed using general linear modeling, regression, and mediation analyses. RESULTS Handwashing was most habitual; only face covering became more habitual over time. Routine tendencies predicted TRB habits, and adherence to handwashing and physical distancing. Those reporting greater habits reported better adherence, for physical distancing and handwashing, and this remained true after controlling for previous adherence. Reflective and habit processes independently predicted adherence for physical distancing and handwashing; only reflective processes were independently predictive for face covering. The relationship between planning and forgetting and adherence was partly direct, and partly mediated by habit. CONCLUSIONS The results confirm hypotheses from habit theory including the role of repetition and of personal routine tendency in developing habits. They are consistent with dual processing theory in finding that both reflective and habit processes predict adherence to TRBs. Action planning partly mediated the relation between reflective processes and adherence. The COVID-19 pandemic has enabled the testing and confirmation of several theoretical hypotheses about habit processes in the enactment of TRBs.
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Affiliation(s)
- Chantal den Daas
- Health Psychology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Diane Dixon
- Health Psychology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Julia Allan
- Health Psychology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Stecher C, Pagni BA, Cloonan S, Vink S, Hill E, Ogbeama D, Delaney S, Braden BB. App-based meditation habits maintain reductions in depression symptoms among autistic adults. Autism 2023:13623613231200679. [PMID: 37837362 DOI: 10.1177/13623613231200679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT Existing research has identified an increased risk of depression among autistic adults, which can negatively impact their adaptive functioning abilities and socioeconomic outcomes. Mobile app-based meditation is a feasible, accessible, and effective self-care solution for depression among neurotypical adults, but there is limited evidence for the long-term benefits of app-based meditation among autistic adults. Habits are a key behavioral strategy for maintaining behavior change, and anchoring is one effective habit formation intervention that has yet to be tested among autistic adults. This study demonstrates that it is both feasible and effective to integrate the anchoring habit formation strategy into an app-based meditation intervention for establishing meditation habits among autistic adults. In addition, the study shows that app-based meditation habits were successful at maintaining reductions in depressive symptoms over 6 months. These results demonstrate the power of anchoring-based habit formation interventions for establishing healthy habits among autistic adults, which offers a promising behavioral intervention technique for establishing other healthy habits among autistic adults. The study also shows that app-based meditation habits are an effective long-term self-care solution for managing depressive symptoms among autistic adults that should be used by mental health providers and policymakers. Future research should test this combined anchoring and app-based meditation intervention technique among larger samples of autistic adults and over longer durations to better understand the mechanisms underlying the success of this intervention.
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Ma H, Wang A, Pei R, Piao M. Effects of habit formation interventions on physical activity habit strength: meta-analysis and meta-regression. Int J Behav Nutr Phys Act 2023; 20:109. [PMID: 37700303 PMCID: PMC10498635 DOI: 10.1186/s12966-023-01493-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Interventions aimed at promoting physical activity (PA) behavior through habit formation pathways are gaining popularity, as they differ from conventional interventions that rely on intention pathways. Past research has established a positive correlation between PA habits and behavior. However, the efficacy of current interventions designed to form PA habits and improve PA automaticity is not yet fully ascertained. Additionally, the intervention components that significantly impact the effectiveness of these interventions are yet to be determined. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a search of three databases (PubMed, Embase, and Cochrane Library) from January 2000 to December 2022, with a focus on interventions for developing PA habits. Two independent authors conducted paper selection, quality assessment, data extraction, and coding of behavior change techniques (BCTs). The effect size of interventions was calculated using standardized mean difference. Subgroup analyses were carried out based on follow-up duration, delivery method, sample characteristics, and theory. Furthermore, we employed meta-regression to investigate the association between BCTs and PA habits. RESULTS Ten eligible studies with relatively high quality were included in the final data set. Characteristics of studies varied in intervention sample and delivery way. The habit formation interventions significantly increased PA habit (SMD = 0.31, 95% CI 0.14-0.48, P < .001) compared to the control groups. Subgroup analysis demonstrated that the duration of follow-up ≤ 12 weeks have a higher effect size on PA habit than the duration > 12 weeks. Meta-regression revealed that problem solving has a significant positive association with effectiveness improvement (β = 0.36, 95% CI 0.17-0.55), while social reward is linked with a reduction in effectiveness (β = -0.40, 95% CI -0.74-0.06). CONCLUSIONS Our findings reveal that habit formation interventions are effective in fostering PA habit. Future studies could leverage the insights form this study to optimize the intervention design and achieve better effectiveness.
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Affiliation(s)
- Haoming Ma
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Aoqi Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Runyuan Pei
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Meihua Piao
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing, 100144, People's Republic of China.
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Affiliation(s)
- Benjamin Gardner
- Department of Psychology, Elizabeth Fry Building, University of Surrey, Guildford, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
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Phillips LA, Pironet A, Vrijens B. Evaluating Objective Metrics of habit strength for taking medications. J Behav Med 2023; 46:632-641. [PMID: 36662351 DOI: 10.1007/s10865-023-00392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
Habit strength for taking medication is associated with medication adherence. However, habit strength is typically measured via self-reports, which have limitations. Objective sensors may provide advantages to self-reports. To evaluate whether habit-strength metrics derived from objective sensor data (MEMS® Caps; AARDEX Group) are associated with self-reported habit strength and adherence (objective and self-reported) and whether objective and self-reported habit strength are independently associated with adherence. Patients (N = 79) on oral medications for type 2 diabetes completed self-reports of habit strength and medication adherence and used MEMS® Caps to take their prescribed medication for one month. MEMS® Caps data were used to create five objective metrics of habit strength (e.g., individual-level variance in pill timing) and quantify medication adherence (% days correct dosing). Consistency in behavior from week to week (versus across each day) had the greatest association with self-reported habit strength (r(78) = 0.29, p = 0.01), self-reported adherence (r(78) = 0.32, p = 0.005), and objective adherence (r(78) = 0.61, p < 0.001). Objective and self-reported habit strength were independently associated with adherence. Weekly pill-timing consistency may be more useful than daily pill-timing consistency for predicting adherence and understanding patients' medication-taking habits. Self-reports and objective metrics of habit strength may be measuring different constructs, warranting further research.
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Suls J, Friel CP, Butler M, Duer-Hefele J, Robles PL, Vicari F, Chandereng T, Cheung YK(K, Davidson KW. Protocol of a feasibility study of a virtual personalized (N-of-1) trial for increasing low-intensity physical activity in older adults via habit formation. Contemp Clin Trials Commun 2023; 33:101135. [PMID: 37333978 PMCID: PMC10276207 DOI: 10.1016/j.conctc.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 06/20/2023] Open
Abstract
Background Personalized interventions that can be delivered remotely are needed to increase physical activity (PA) in older adults to reduce risk of CV disease and mortality. Prior research indicates that Behavioral Change Techniques (BCTs) (e.g., goal setting, self-monitoring, behavioral repetition) can instill a habit for increasing daily walking. However, past interventions relied on between-subject randomized clinical trials, which can only only be informative about response of the hypothetical average person. Personalized trial designs can identify the benefits of an intervention for a specific individual although extended periods are required for collecting frequent measurements within-subject. Advances in remote, virtual technologies (e.g., text messaging, activity trackers), integrated with automatic platforms, can meet these requirements because they capacitate delivery of BCT interventions, and collection of data during daily life without personal contact. This Stage I-b trial is designed test whether a virtual, personalized intervention is feasible and acceptable to older adults, can elicit participant adherence and exhibit preliminary evidence for efficacy. Methods A series of up to 60 single-arm, personalized trials, involving no personal contact, will recruit adults, 45-75 years of age, to wear an activity tracker during a 2-week baseline and a 10-week intervention. Five BCT prompts to execute a walking plan will be delivered on a daily basis during the intervention phase. Participants will rate satisfaction with personalized trial components and whether automaticity of the walking plan can be achieved. Step-counts, adherence to the walking plan and self-monitoring of step-count will also be recorded.
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Affiliation(s)
- Jerry Suls
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ciarán P. Friel
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Mark Butler
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Joan Duer-Hefele
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Patrick L. Robles
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Frank Vicari
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Thevaa Chandereng
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ying Kuen (Ken) Cheung
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Karina W. Davidson
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
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Stecher C, Cloonan S, Linnemayr S, Huberty J. Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e39930. [PMID: 37115610 PMCID: PMC10182474 DOI: 10.2196/39930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app. OBJECTIVE This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app. METHODS This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors. RESULTS Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16. CONCLUSIONS This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39930.
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Affiliation(s)
- Chad Stecher
- Arizona State University, Phoenix, AZ, United States
| | - Sara Cloonan
- Arizona State University, Phoenix, AZ, United States
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Gardner B, Arden MA, Brown D, Eves FF, Green J, Hamilton K, Hankonen N, Inauen J, Keller J, Kwasnicka D, Labudek S, Marien H, Masaryk R, McCleary N, Mullan BA, Neter E, Orbell S, Potthoff S, Lally P. Developing habit-based health behaviour change interventions: twenty-one questions to guide future research. Psychol Health 2023; 38:518-540. [PMID: 34779335 DOI: 10.1080/08870446.2021.2003362] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Department of Psychology, Sociology & Politics, Sheffield Hallam University, Sheffield, UK
| | - Daniel Brown
- Department of Applied Psychology, Griffith University, Brisbane, Australia
| | - Frank F Eves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - James Green
- School of Allied Health and Physical Activity for Health Research Cluster (Health Research Institute), University of Limerick, Limerick, Ireland
| | - Kyra Hamilton
- Griffith University and Menzies Health Institute Queensland, Mt Gravatt, Qld, Australia
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jan Keller
- Division Health Psychology, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Hans Marien
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Radomír Masaryk
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University Bratislava, Bratislava, Slovakia
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Barbara A Mullan
- Behavioural Science and Health Research Group, Curtin University, Perth, Australia
| | - Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Sheina Orbell
- Department of Psychology, University of Essex, Essex, UK
| | - Sebastian Potthoff
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
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van de Vijver I, Verhoeven AAC, de Wit S. Individual Differences in Corticostriatal White-matter Tracts Predict Successful Daily-life Routine Formation. J Cogn Neurosci 2023; 35:571-587. [PMID: 36724394 DOI: 10.1162/jocn_a_01967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite good intentions, people often fail to cross the "intention-behavior gap," especially when goal achievement requires repeated action. To bridge this gap, the formation of automatized routines may be crucial. However, people may differ in the tendency to switch from goal-directed toward habitual control. To shed light on why some people succeed in forming routines while others struggle, the present study related the automatization of a novel, daily routine to individual differences in white-matter connectivity in corticostriatal networks that have been implicated in goal-directed and habitual control. Seventy-seven participants underwent diffusion-weighted imaging and formed the daily routine of taking a (placebo) pill for 3 weeks. Pill intake was measured by electronic pill boxes, and participants filled out a daily online questionnaire on the subjective automaticity of this behavior. Automatization of pill intake was negatively related to striatal (mainly caudate) connectivity with frontal goal-directed and cognitive control regions, namely, ventromedial pFC and anterior cingulate gyrus. Furthermore, daily pill intake was positively related to individual differences in striatal (mainly caudate) connectivity with cognitive control regions, including dorsolateral and anterior pFC. Therefore, strong control networks may be relevant for implementing a new routine but may not benefit its automatization. We also show that habit tendency (assessed with an outcome-devaluation task), conscientiousness, and daily life regularity were positively related to routine automatization. This translational study moves the field of habit research forward by relating self-reported routine automatization to individual differences in performance on an experimental habit measure and to brain connectivity.
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Rebar AL, Lally P, Verplanken B, Diefenbacher S, Kwasnicka D, Rhodes RE, Lanzini P, Koutoukidis DA, Venema TAG, Gardner B. Changes in virus-transmission habits during the COVID-19 pandemic: a cross-national, repeated measures study. Psychol Health 2022; 37:1626-1645. [PMID: 35899368 PMCID: PMC9615635 DOI: 10.1080/08870446.2022.2097682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/25/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Amanda L. Rebar
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
| | | | - Svenne Diefenbacher
- Department of Social Psychology, Ulm University, Ulm, Germany
- Department of Social Monitoring and Methodology, German Youth Institute, Munich, Germany
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, University of Melbourne, Melbourne, Australia
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - Ryan E. Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Pietro Lanzini
- Department of Management, Ca’ Foscari University, Venice, Italy
| | - Dimitrios A. Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tina A. G. Venema
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Benjamin Gardner
- Department of Psychology, King’s College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
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Neter E, Glass-Marmor L, Wolkowitz A, Miller A. Medication habits among persons with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104224. [PMID: 36242806 DOI: 10.1016/j.msard.2022.104224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Though habitual behavior is part of medication-taking behavior, studies of adherence to medication among persons with relapsing remitting multiple sclerosis (PwRRMS) have not prospectively examined habit in relation to disease-modifying treatments (DMTs). OBJECTIVES 1. Examine habit dimensions - repetition, lack of awareness, and lack of control - across time and route of administration (oral vs. injectable). 2. Examine the association (prospective and cross sectional) of the dimension of repetition and the habit index with adherence and persistence in medication taking and to medication perceptions. METHODS PwMS (n = 140), in their first year of treatment with a DMT, were prospectively assessed at three time points: at baseline, 6 months later (Time 1), and 12 months later (Time 2). Clinical and demographic information were obtained in-person, as were patient-reported medication habits and medication perceptions. Adherence and persistence were assessed with a combination of self-reporting and retrospective review of medication claims. RESULTS Repeated measures analysis of variance (ANOVA), with dimension as the within-subject factor at each time point, indicated that the repetition dimensions at all points were significantly higher than lack of awareness and lack of control dimensions. Repeated measures ANOVA, with time as the within-subject factor and route of administration as between-subject factor, yielded a significant time effect in repetition and lack of awareness dimensions so that they increased across time but not in lack of control; administration route effects were found to be nonsignificant in all dimensions. Repetition at Time 1 was positively associated with patient-reported adherence at this time point (rs = 0.33, p = 0.002) but this was not consistently found at other time points . Likewise, reported repetition at Time 1 was higher among PwRMS who persisted with their medication a year later than among those who did not persist. Perceptions of medication (concern, harm, and overtreatment) were significantly negatively associated with reported repetition. CONCLUSIONS Over time, PwRMS reported an increase in two habit dimensions, repetition and lack of awareness, in medication taking. No significant differences in habit by administration modality were found. The habit dimension of repetition was significantly associated with perceptions of medication, adherence, and prospectively predicted persistence. However, the low values obtained for lack of awareness and lack of control, compared with the higher levels of repetition, indicate that the habit is not well ingrained. Hence, intervention to target habit formation and maintenance, to be tailored to the individual, are a promising venue for enhancing medication adherence and improving disease outcomes.
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Diefenbacher S, Lally P, Gardner B. Habit formation in context: Context‐specific and context‐free measures for tracking fruit consumption habit formation and behaviour. Br J Health Psychol 2022; 28:499-512. [PMID: 36437536 DOI: 10.1111/bjhp.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Interventions promoting habitual fruit consumption have the potential to bring about long-term behaviour change. Assessing the effectiveness of such interventions requires adequate habit and behaviour measures. Habits are based on learned context-behaviour associations, so measures that incorporate context should be more sensitive to expected habit and behaviour changes than context-free measures. This study compared context-specific and context-free measures of fruit consumption habit and behaviour following a 3-week habit formation intervention. DESIGN Prospective online study (n = 58). METHODS Behaviour frequency was assessed across five timepoints, retrospectively (Time 1 [T1], T5) or via daily diary data (uploaded weekly at T2, T3 and T4). Habit strength was assessed before (T1) and immediately after the intervention (T4), and again 2 weeks later (T5). Analyses of variance were run, with time and context specificity as within-subject factors, and habit and behaviour frequency as dependent measures. RESULTS An interaction between time and context specificity was found in both analyses (habit: F(2,114) = 12.848, p < .001, part.η2 = .184; behaviour: F(2,114) = 6.714, p = .002, part.η2 = .105). Expected habit formation patterns 5 weeks post-baseline were only detected by the context-specific habit measure. Likewise, increased behaviour frequency was only found when the target context was specified (p's < .001). CONCLUSIONS Assessments of purposeful dietary habit and behaviour change attempts should incorporate context-specific measurement.
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Affiliation(s)
| | - Phillippa Lally
- Research Department of Behavioural Science and Health University College London London UK
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Potter K, Rajala C, Chase CJ, LeBlanc R. Testing Leash Walking Training as a Physical Activity Intervention for Older Adult Dog Owners: A Feasibility Study. Geriatrics (Basel) 2022; 7. [PMID: 36412609 DOI: 10.3390/geriatrics7060120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022] Open
Abstract
Dog walking is a physical activity (PA) with many health benefits for older adults. Dog behavior issues can be a barrier to dog walking. This study piloted leash manners training as a PA intervention for dog owners ages 60+ years. Fourteen dog owners (mean age = 65 years, female = 71%) enrolled in a leash manners training course. Process evaluation data were collected to determine feasibility and acceptability of the intervention and study procedures. Twelve of fourteen enrolled participants (86%) completed the course, and most were highly engaged with the program, as evidenced by high class attendance (92% of participants who completed the course attended ≥5 of 6 classes) and a majority (64%) reporting frequent skills practice at home. Further, most participants (73%) reported their leash walking skills improved. The PA assessment protocol (7 days of 24 h data collection using activPAL monitors) was well tolerated, with all participants who completed assessments at each time point (pre-program, post-program, 4-week follow-up) providing ≥6 valid days of data. In sum, the intervention approach and study procedures were feasible and acceptable in this sample of older adults. More research is needed to determine the effectiveness of leash manners training for increasing PA in this population.
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Phillips LA, More KR. Evaluating behavior change factors over time for a simple vs. complex health behavior. Front Psychol 2022; 13:962150. [PMID: 36160596 PMCID: PMC9499174 DOI: 10.3389/fpsyg.2022.962150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/22/2022] [Indexed: 12/27/2022] Open
Abstract
Background Researchers are working to identify dynamic factors involved in the shift from behavioral initiation to maintenance-factors which may depend on behavioral complexity. We test hypotheses regarding changes in factors involved in behavioral initiation and maintenance and their relationships to behavioral frequency over time, for a simple (taking a supplement) vs. complex (exercise) behavior. Methods Data are secondary analyses from a larger RCT, in which young adult women, new to both behaviors, were randomly assigned to take daily calcium (N = 161) or to go for a daily, brisk walk (N = 171), for 4-weeks. Factors (intentions, self-efficacy, intrinsic motivation, self-identity, habit strength) were measured weekly. Multi-level modeling evaluated their change over time. Bivariate correlations and multiple regression determined the relationships between factors and the subsequent-week behavioral frequency (self-report and objective). Finding Results were partly in-line with expectations, in that individuals' intentions and self-efficacy predicted initial behavioral engagement for both behaviors, and habit strength increased for both behaviors, becoming a significant predictor of behavioral frequency in later weeks of the study in some analyses. However, results depended on whether the outcome was self-reported or objectively measured and whether analyses were bivariate or multivariate (regression). Discussion The factors theorized to play a role in behavioral maintenance (intrinsic motivation, self-identity, and habit strength) started to develop, but only habit strength predicted behavioral frequency by study-end, for both behaviors. Differences in initiation and maintenance between behaviors of differing complexity may not be as stark as theorized, but longer follow-up times are required to evaluate maintenance factors.
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Affiliation(s)
- L. Alison Phillips
- Department of Psychology, Iowa State University, Ames, IA, United States,*Correspondence: L. Alison Phillips,
| | - Kimberly R. More
- Department of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, United Kingdom
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Vogelsang A, Hinrichs C, Fleig L, Pfeffer I. Study protocol for the description and evaluation of the "Habit Coach" - a longitudinal multicenter mHealth intervention for healthy habit formation in health care professionals. BMC Public Health 2022; 22:1672. [PMID: 36058904 PMCID: PMC9440859 DOI: 10.1186/s12889-022-13986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adoption of a healthy lifestyle plays a crucial role for the health and well-being of health care professionals. Previous e- and mHealth interventions relied on deliberative psychological processes (e.g., intention, planning) to target lifestyle changes, while revealing mixed efficacy. The additional potential of non-deliberative, automatic processes (i.e., habits) for behavior change has been understudied in interventions so far. The Habit Coach mHealth intervention combines deliberative and non-deliberative processes to support health care professionals in forming healthy physical activity, nutrition and mindfulness habits in daily life. The aim of this paper is to outline the study protocol including a detailed description of the mHealth intervention, evaluation plan, and study design. The purpose of this trial is to understand healthy habit formation in health care professionals over time. METHODS A one-arm, multicenter mHealth intervention study will be conducted. Behavioral and psychosocial predictors will be collected via within-app questionnaires across a 100-day period at baseline, post, as well as at weekly assessments. To understand habit formation across time, linear mixed models will be used. DISCUSSION This trial aims to unravel the role of motivational and volitional determinants for healthy habit formation across multiple health behaviors in health care professionals embedded in a mHealth intervention. TRIAL REGISTRATION This trial is registered in the German Clinical Trials Register, DRKS-ID DRKS00027156. Date of registration 17 November 2021.
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Affiliation(s)
- Anna Vogelsang
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany. .,Faculty of Sport Science - Department of eHealth and Sports Analytics, Ruhr-University Bochum, Gesundheitscampus - Nord 10, 44801, Bochum, Germany.
| | - Clara Hinrichs
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Lena Fleig
- Faculty of Natural Sciences- Department of Psychology, Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Ines Pfeffer
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
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Kilb M, Labudek S. Effects of behavioral performance, intrinsic reward value, and context stability on the formation of a higher-order nutrition habit: an intensive longitudinal diary study. Int J Behav Nutr Phys Act 2022; 19:105. [PMID: 35962435 PMCID: PMC9372943 DOI: 10.1186/s12966-022-01343-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/28/2022] [Indexed: 01/04/2023] Open
Abstract
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 (Mage = 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.
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Affiliation(s)
- Michael Kilb
- Department of Psychology, School of Social Sciences, University of Mannheim, L13, 17, 68161, Mannheim, Germany. .,Department of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Haid-und-Neu-Straße 9, 76131, Karlsruhe, Germany.
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, Heidelberg, Germany
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Di Maio S, Keller J, Kwasnicka D, Knoll N, Sichert L, Fleig L. What helps to form a healthy nutrition habit? Daily associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity. Appetite 2022; 175:106083. [PMID: 35580819 DOI: 10.1016/j.appet.2022.106083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
- Sally Di Maio
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Aleksandra Ostrowskiego 30B, 53-238, Wroclaw, Poland; NHMRC Centre in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, 5/ Exhibition Street, Melbourne, VIC, 3004, Australia.
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Lena Sichert
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Hochschule für Gesundheit und Medizin, Rüdesheimer Straße 50, 14197, Berlin, Germany.
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Comino I, Soares P, Martínez-Milán MA, Caballero P, Davó-Blanes MC. School Fruit and Vegetables Scheme: Characteristics of Its Implementation in the European Union from 2009/10 to 2016/17. Nutrients 2022; 14:nu14153069. [PMID: 35893920 PMCID: PMC9370373 DOI: 10.3390/nu14153069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
The “School Fruit and Vegetables Scheme” (SFVS) was proposed in 2009/10 as a strategy to support the consumption of Fruit and Vegetables (FV), decrease rates of obesity, improve agricultural income, stabilize markets, and ensure the current and future supply of these foods. However, there is little information about how it was carried out in the EU. Given the potential of the SFVS to support healthier, more sustainable food systems, the objective of this study was to identify the characteristics of SFVS implementation from 2009/10 to 2016/17 in the EU. A longitudinal, observational, and retrospective study was carried out based on secondary data. A total of 186 annual reports of the Member States (MS) participating in the SFVS from 2009/10 to 2016/17 were consulted: European and national budget, funds used from the EU, participating schools and students, duration of the SFVS, FV offered, and application of sustainability criteria, expenditure per student, days of the week, the quantity of FV offered per student and other indicators were calculated. The majority of MS participated in the SFVS during the study period with a heterogeneous implementation pattern in terms of funds used, coverage, duration, quantity (totals and by portion), and cost of FV distributed per student. The sustainability criteria for the FV distribution were also not applied uniformly in all the MS. Establishing minimum recommendations for SFVS implementation are recommended to maximize the benefits of the SFVS. The results may be useful for planning new strategies to help address and improve current health and environmental problems.
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Affiliation(s)
- Iris Comino
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - Panmela Soares
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - María Asunción Martínez-Milán
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Correspondence:
| | - María Carmen Davó-Blanes
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
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Domke A, Keller J, Knoll N, Sniehotta FF, Heuse S, Wiedemann AU. Plan pursuit in the context of daily fruit and vegetable consumption: The importance of cue detection and the execution of the planned behaviour for overall behaviour change. Br J Health Psychol 2022; 27:1172-1187. [PMID: 35318775 DOI: 10.1111/bjhp.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In action planning interventions, individuals specify and link cues with behavioural responses to implement behaviour change. To date, not much is known about how and how much the detection of the planned cue (entering and identifying the planned situation) and the execution of the planned behaviour (behavioural response exactly as planned) contribute to overall behavioural changes (changes in target behaviour) achieved by individuals. Using data from an intervention on daily fruit and vegetable (FV) action planning, this study aimed to test whether individuals' cue detection and execution of the planned behaviour are positively related to overall FV intake. DESIGN Secondary data analyses examined diary data of the intervention condition of a randomized controlled trial. Ninety participants (80% female, aged 19-63 years) formed one FV plan and completed a 13-days post-intervention self-report diary assessing daily FV consumption and situational characteristics of each consumed FV serving. Based on these self-reports and participants' FV plan, day-to-day cue detection and the execution of the planned behaviour were coded. METHODS With two-level models, cue detection and the execution of the planned behaviour were examined as between- and within-person predictors of daily FV intake. RESULTS Higher between-person execution of the planned behaviour (+1.68 daily servings), higher-than-usual within-person cue detection (+0.46 daily servings), and higher-than-usual within-person execution of the planned behaviour (+0.29 daily servings) were associated with more overall FV intake. CONCLUSIONS Detecting planned cues (within-person) and executing the planned behaviour (between- and within-person) are important for overall FV intake.
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Affiliation(s)
- Antonia Domke
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Falko F Sniehotta
- Department of Public Health, Preventive and Social Medicine, Mannheim Medical Faculty, Heidelberg University, Germany
| | - Silke Heuse
- University of Europe for Applied Sciences, Hamburg, Germany
| | - Amelie U Wiedemann
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
- DearEmployee GmbH, Berlin, Germany
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Duggan NM, Hasdianda MA, Baker O, Jambaulikar G, Goldsmith AJ, Condella A, Azizoddin D, Landry AI, Boyer EW, Eyre AJ. The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study. JMIR Form Res 2022; 6:e28353. [PMID: 35315781 PMCID: PMC8984824 DOI: 10.2196/28353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/06/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being. Objective We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift. Methods Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights’ sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post–overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls. Results In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights’ sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI –0.90 to –0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI –0.81 to –0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores. Conclusions Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions’ effect on other populations of shift workers’ post–night shift alertness, users’ long-term physical and mental health, and patient outcomes.
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Affiliation(s)
- Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - M Adrian Hasdianda
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Olesya Baker
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, United States
| | - Guruprasad Jambaulikar
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Andrew J Goldsmith
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Anna Condella
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Desiree Azizoddin
- Health Promotion Research Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adaira I Landry
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Andrew J Eyre
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
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24
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Affiliation(s)
- Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Amanda L. Rebar
- Physical Activity Research Group, Appleton Institute, School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
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Andrews SC, Parekh D, Brady B, Delbaere K, Hamidul Huque M, Killcross S, Anstey KJ. Associations Between Planned Exercise, Walking, Incidental Physical Activity, and Habit Strength in Older People: A Cross-Sectional Study. J Aging Phys Act 2021;:1-11. [PMID: 34929661 DOI: 10.1123/japa.2021-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
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.
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Keller J, Kwasnicka D, Wilhelm LO, Lorbeer N, Pauly T, Domke A, Knoll N, Fleig L. Hand Washing and Related Cognitions Following a Brief Behavior Change Intervention During the COVID-19 Pandemic: a Pre-Post Analysis. Int J Behav Med 2021; 29:575-586. [PMID: 34843096 PMCID: PMC8628490 DOI: 10.1007/s12529-021-10042-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/12/2022]
Abstract
Background Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention. Methods A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data. Results Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level. Conclusions Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries. Trial Registration German Clinical Trials Register; https://www.drks.de; registration number: DRKS00022067. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10042-w.
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Affiliation(s)
- Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Noemi Lorbeer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Theresa Pauly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Antonia Domke
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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27
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Warner LM, Fleig L, Wolff JK, Keller J, Schwarzer R, Nyman SR, Wurm S. What makes implementation intentions (in)effective for physical activity among older adults? Br J Health Psychol 2021; 27:571-587. [PMID: 34609039 DOI: 10.1111/bjhp.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For most populations, implementation intentions (IIs) facilitate physical activity (PA). However, for older adults, previous studies found mixed evidence for the effectiveness of this behaviour change technique. To examine which characteristics of IIs predict successful enactment, the content of older participants' IIs formed within a self-regulatory intervention to prompt PA was analysed. DESIGN A sample of N = 126 German speaking adults aged 64 and older formed up to six IIs for PA and reported their enactment 5 weeks later. METHODS Controlling for age and sex, multilevel models tested associations between characteristics of IIs (e.g., chronological rank of II, hetero- and homogeneity, specificity, presence of certain cues) and enactment. RESULTS Significantly related to enactment were: the chronological rank of an II (first IIs superior to last IIs), greater heterogeneity in activities, greater specificity of when-cues, and greater use of pre-existing routines. CONCLUSIONS Participants were more likely to enact their IIs 5 weeks later if they planned different (heterogeneous) activities, created IIs with more specific when-cues (e.g., on Monday at 9 am), and in particular a routine (e.g., after breakfast). They also enacted the first three IIs (chronological rank of II) more often than the last three IIs. Future experimental studies should test whether providing instructions to create IIs based on the above significant characteristics lead to more effective health behaviour change among older adults.
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Affiliation(s)
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Germany
| | - Julia Katharina Wolff
- IGES Institute Berlin, Germany.,Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Jan Keller
- Health Psychology, Freie Universität Berlin, Germany
| | - Ralf Schwarzer
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Bournemouth University, UK
| | - Susanne Wurm
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
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Abstract
Efforts to guide peoples' behavior toward environmental sustainability, good health, or new products have emphasized informational and attitude change strategies. There is evidence that changing attitudes leads to changes in behavior, yet this approach takes insufficient account of the nature and operation of habits, which form boundary conditions for attitude-directed interventions. Integration of research on attitudes and habits might enable investigators to identify when and how behavior change strategies will be most effective. How might attitudinally driven behavior change be consolidated into lasting habits? How do habits protect the individual against the vicissitudes of attitudes and temptations and promote goal achievement? How might attitudinal approaches aiming to change habits be improved by capitalizing on habit discontinuities and strategic planning? When and how might changing or creating habit architecture shape habits directly? A systematic approach to these questions might help move behavior change efforts from attitude change strategies to habit change strategies. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Bas Verplanken
- Department of Psychology, University of Bath, Bath BA2 7AY, United Kingdom;
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester CO4 3SQ, United Kingdom;
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29
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Rhodes RE, Sui W. Physical Activity Maintenance: A Critical Narrative Review and Directions for Future Research. Front Psychol 2021; 12:725671. [PMID: 34552537 PMCID: PMC8450373 DOI: 10.3389/fpsyg.2021.725671] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/12/2021] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Ryan E Rhodes
- Behavioural Medicine Laboratory, Physical and Health Education, School of Exercise Science, University of Victoria, Victoria, BC, Canada
| | - Wuyou Sui
- Behavioural Medicine Laboratory, Physical and Health Education, School of Exercise Science, University of Victoria, Victoria, BC, Canada
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