Our data show that unobtrusive observation of behavior in a natural setting can help identify the most effective interventions for changing behaviors of public health importance. The gender differences we found suggest that public health interventions should target men and women differently.

Abstract:Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases.

What is already known on this subject? The formation of habit - that is, a learnt automatic response to contextual cues - requires initiation of a behaviour and repetition in a constant context. A recent formation study showed variation in habit strength despite equal repetitions, indicating that factors other than repetition may be important in habit development. From studies of routine behaviour, the boundaries between sub-routines are characterized by different processes than the middle of sub-routines, suggesting that placement of behaviour within existing routines may affect the likelihood of habit formation. What does this study add? Greater prospective memory ability predicted more frequent dental flossing. Initiating flossing after rather than before tooth-brushing promoted stronger habits. Positive attitudes impacted directly on habit formation, independent of behaviour repetition.

Objectives'Habit' is a process whereby situational cues generate behaviour automatically, via activation of learned cue-behaviour associations. This article presents a conceptual and empirical rationale for distinguishing between two manifestations of habit in health behaviour, triggering selection and initiation of an action ('habitual instigation'), or automating progression through subactions required to complete action ('habitual execution'). We propose that habitual instigation accounts for habit-action relationships, and is the manifestation captured by the Self-Report Habit Index (SRHI), the dominant measure in health psychology. DesignConceptual analysis and prospective survey. MethodsStudent participants (N = 229) completed measures of intentions, the original, non-specific SRHI, an instigation-specific SRHI variant, an execution-specific variant, and, 1 week later, behaviour, in three health domains (flossing, snacking, and breakfast consumption). Effects of habitual instigation and execution on behaviour were modelled using regression analyses, with simple slope analysis to test habit-intention interactions. Relationships between instigation, execution, and non-specific SRHI variants were assessed via correlations and factor analyses. ResultsThe instigation-SRHI was uniformly more predictive of behaviour frequency than the execution-SRHI and corresponded more closely with the original SRHI in correlation and factor analyses. ConclusionsFurther, experimental work is needed to separate the impact of the two habit manifestations more rigorously. Nonetheless, findings qualify calls for habit-based interventions by suggesting that behaviour maintenance may be better served by habitual instigation and that disrupting habitual behaviour may depend on overriding habits of instigation. Greater precision of measurement may help to minimize confusion between habitual instigation and execution. AbstractObjectives. 'Habit' is a process whereby situational cues generate behaviour automatically, via activation of cue-behaviour associations developed through past performance. This paper presents a conceptual and empirical rationale for distinguishing between two manifestations of habit in health behaviour, triggering selection and initiation of an action ('habitual instigation'), or automating progression through sub-actions required to complete action ('habitual execution'). We propose that habitual instigation accounts for habit-action relationships, and is the manifestation captured by the Self-Report Habit Index (SRHI), the dominant measure in health psychology.Design. Conceptual analysis, and prospective survey.Methods. Student participants (N = 229) completed measures of intentions, the original, non-specific SRHI, an instigation-specific SRHI variant, an execution-specific variant, and, one week later, behaviour, in three health domains (flossing, snacking, breakfast consumption). Effects of habitual instigation and execution on behaviour were modelled using regression analyses, with simple slopes an...

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February-October 2015 were eligible. 3133 women aged 24-29

BackgroundHabits (learned automatic responses to contextual cues) are considered important in sustaining health behaviour change. While habit formation is promoted by repeating behaviour in a stable context, little is known about what other variables may contribute, and whether there are variables which may accelerate the habit formation process. The aim of this study was to explore variables relating to the perceived reward value of behaviour – pleasure, perceived utility, perceived benefits, and intrinsic motivation. The paper tests whether reward has an impact on habit formation which is mediated by behavioural repetition, and whether reward moderates the relationship between repetition and habit formation.MethodsHabit formation for flossing and vitamin C tablet adherence was investigated in the general public following an intervention, using a longitudinal, single-group design. Of a total sample of 118 participants, 80 received an online vitamin C intervention at baseline, and all 118 received a face-to-face flossing intervention four weeks later. Behaviour, habit, intention, context stability (whether the behaviour was conducted in the same place and point in routine every time), and reward variables were self-reported every four weeks, for sixteen weeks. Structured equation modelling was used to model reward-related variables as predictors of intention, repetition, and habit, and as moderators of the repetition-habit relationship.ResultsHabit strength and behaviour increased for both target behaviours. Intrinsic motivation and pleasure moderated the relationship between behavioural repetition and habit. Neither perceived utility nor perceived benefits predicted behaviour nor interacted with repetition. Limited support was obtained for the mediation hypothesis. Strong intentions unexpectedly weakened the repetition-habit relationship. Context stability mediated and for vitamin C, also moderated the repetition-habit relationship.ConclusionsPleasure and intrinsic motivation can aid habit formation through promoting greater increase in habit strength per behaviour repetition. Perceived reward can therefore reinforce habits, beyond the impact of reward upon repetition. Habit-formation interventions may be most successful where target behaviours are pleasurable or intrinsically valued.Electronic supplementary materialThe online version of this article (10.1186/s40359-018-0270-z) contains supplementary material, which is available to authorized users.

SUMMARYAlthough many studies have investigated bacteria on the hands of health-care workers and caregivers, few have looked at microbiological contamination on the hands of the general adult public. This study investigated faecal bacteria on the hands of commuters in five UK cities. Of the 404 people sampled 28% were found to have bacteria of faecal origin on their hands. A breakdown by city showed that the proportion of people with contaminated hands increased the further north the city of investigation (P<0 . 001), an effect which was due in large part to a significant trend in men but not in women. Bus users were more contaminated than train users. The results of this exploratory study indicate that hand hygiene practices in the UK may be inadequate and that faecal indicator bacteria on hands may be used to monitor the effect of hand-washing promotion campaigns.

ObjectivesTo examine how the frequency of information regarding a real disease threat influences hand washing with soap.Design and settingThe authors installed wireless devices in highway service station lavatories in England to record the proportion of individuals washing hands with soap from May 2009 to January 2010.ParticipantsParticipants were users of men's and women's toilets. Combined there was an average of 6800 participant entrances into the lavatories daily.Primary outcome measureThe primary outcome measure is the proportion of soap usage to the number of entries into the lavatories.ResultsHand-washing rates were positively related to both H1NI coverage in blogs and the news; however, these relationships were stronger for men than for women.ConclusionsHand washing with soap increases proportionally to the frequency of media key words related to H1N1. Women's hand washing was more strongly associated with incidence of media keywords than men's.