Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change

Abstract

BackgroundSocial cognitive theories on behaviour change are increasingly being used to understand and predict healthcare professionals’ intentions and clinical behaviours. Although these theories offer important insights into how new behaviours are initiated, they provide an incomplete account of how changes in clinical practice occur by failing to consider the role of cue-contingent habits. This article contributes to better understanding of the role of habits in clinical practice and how improved effectiveness of behavioural strategies in implementation research might be achieved.DiscussionHabit is behaviour that has been repeated until it has become more or less automatic, enacted without purposeful thinking, largely without any sense of awareness. The process of forming habits occurs through a gradual shift in cognitive control from intentional to automatic processes. As behaviour is repeated in the same context, the control of behaviour gradually shifts from being internally guided (e.g., beliefs, attitudes, and intention) to being triggered by situational or contextual cues. Much clinical practice occurs in stable healthcare contexts and can be assumed to be habitual. Empirical findings in various fields suggest that behaviours that are repeated in constant contexts are difficult to change. Hence, interventions that focus on changing the context that maintains those habits have a greater probability of success. Some sort of contextual disturbance provides a window of opportunity in which a behaviour is more likely to be deliberately considered. Forming desired habits requires behaviour to be carried out repeatedly in the presence of the same contextual cues.SummarySocial cognitive theories provide insight into how humans analytically process information and carefully plan actions, but their utility is more limited when it comes to explaining repeated behaviours that do not require such an ongoing contemplative decisional process. However, despite a growing interest in applying behavioural theory in interventions to change clinical practice, the potential importance of habit has not been explored in implementation research.

Collective action for knowledge mobilisation: a realist evaluation of the Collaborations for Leadership in Applied Health Research and Care

“…127 However, it is unclear if some degree of misalignment or tension within the implementation 'system' could potentially act as a form of catalyst for action, which could minimise the potential for entrenchment, habitual thinking and behaviour. 128 It is conceivable, for example, that alignment may stop being a catalytic mechanism if consensus and groupthink develop.…”

Suicide Prevention in Mental Health Services—A Qualitative Study of a Web Based Program for Mental Health Care Staff

“…To prevent suicide, we need to go beyond awareness towards acting and the integration of good habits. Knowledge, skills, attitudes and motivation may be satisfactory, but "old habits die hard" and contextual disturbances are more likely to lead to changing habits [28]. As seen in the present study, even experienced staff appreciated the program, which reminded them of the importance of enquiring into suicidal thoughts, making (good and bad) habits visible.…”

“…Habits yield "tunnel vision" that can reduce the effectiveness of information-based interventions [28]. Nevertheless SPiSS comes across as a useful repetition that strengthens earlier beliefs, rather than challenges them.…”

Prevention and Management of Non-Communicable Disease: The IOC Consensus Statement, Lausanne 2013

“…Habits are automatic responses to contextual cues, acquired through repetition of behaviour in the presence of these cues [50]. In order to change these habits one needs to take into account that a specific cue will trigger action if motivation and ability to perform the task are adequate to result in a physical or psychological reward [51].…”