People’s behavior influences health, for example, in the prevention, early detection, and treatment of disease, the management of illness, and the optimization of healthcare professionals’ behaviors. Behaviors are part of a system of behaviors within and between people in that any one behavior is influenced by others. Methods for changing behavior may be aimed at individuals, organizations, communities, and/or populations and at changing different influences on behavior, e.g., motivation, capability, and the environment. A framework that encapsulates these influences is the Behavior Change Wheel, which links an understanding of behavior in its context with methods to change behavior. Within this framework, methods are conceptualized at three levels: policies that represent high-level societal and organizational decisions, interventions that are more direct methods to change behavior, and behavior change techniques that are the smallest components that on their own have the potential to change behavior. In order to provide intervention designers with a systematic method to select the policies, interventions, and/or techniques relevant for their context, a set of criteria can be used to help select intervention methods that are likely to be implemented and effective. One such set is the “APEASE” criteria: affordability, practicability, effectiveness, acceptability, safety, and equity.
Ildiko Tombor and Susan Michie
Nicola D. Ridgers and Samuel K. Lai
Commercially available wearable activity trackers are small, non-invasive electronic devices that are worn on the body for the purposes of monitoring a range of outcomes including steps, energy expenditure, and sleep. These devices utilize sensors to track movement, and these recorded data are provided to the user via a visual display on the device itself and/or by syncing the device with an accompanying app or web-based program. Combined together, these devices and accompanying apps incorporate a broad range of behavior change techniques that are known to change behavior, including self-monitoring, goal setting, and social support. In recent years, wearable activity trackers have become increasingly popular, and the growth in ownership within different populations has occurred at an exponential rate. This growth in appeal has led to researchers and practitioners examining the validity and reliability of wearable activity trackers for measuring a range of outcomes and integrating the results into physical activity promotion strategies. Acceptable validity has been reported for steps and moderate validity for measuring energy expenditure. However, little research has examined whether wearable activity trackers are a feasible and effective method for changing physical activity behaviors in the short- and longer-term, either alone or in combination with additional strategies. Some initial results are promising, though concerns have been raised over longer-term use and impacts on motivation for physical activity. There is a need for research examining the longer-term use of wearable activity trackers in different population groups, and establishing whether this technology has any positive effects on physical activity levels.
Benjamin Gardner and Amanda L. Rebar
Within psychology, the term habit refers to a process whereby contexts prompt action automatically, through activation of mental context–action associations learned through prior performances. Habitual behavior is regulated by an impulsive process, and so can be elicited with minimal cognitive effort, awareness, control, or intention. When an initially goal-directed behavior becomes habitual, action initiation transfers from conscious motivational processes to context-cued impulse-driven mechanisms. Regulation of action becomes detached from motivational or volitional control. Upon encountering the associated context, the urge to enact the habitual behavior is spontaneously triggered and alternative behavioral responses become less cognitively accessible. By virtue of its cue-dependent automatic nature, theory proposes that habit strength will predict the likelihood of enactment of habitual behavior, and that strong habitual tendencies will tend to dominate over motivational tendencies. Support for these effects has been found for many health-related behaviors, such as healthy eating, physical activity, and medication adherence. This has stimulated interest in habit formation as a behavior change mechanism: It has been argued that adding habit formation components into behavior change interventions should shield new behaviors against motivational lapses, making them more sustainable in the long-term. Interventions based on the habit-formation model differ from non-habit-based interventions in that they include elements that promote reliable context-dependent repetition of the target behavior, with the aim of establishing learned context–action associations that manifest in automatically cued behavioral responses. Interventions may also seek to harness these processes to displace an existing “bad” habit with a “good” habit. Research around the application of habit formation to health behavior change interventions is reviewed, drawn from two sources: extant theory and evidence regarding how habit forms, and previous interventions that have used habit formation principles and techniques to change behavior. Behavior change techniques that may facilitate movement through discrete phases in the habit formation trajectory are highlighted, and techniques that have been used in previous interventions are explored based on a habit formation framework. Although these interventions have mostly shown promising effects on behavior, the unique impact on behavior of habit-focused components and the longevity of such effects are not yet known. As an intervention strategy, habit formation has been shown to be acceptable to intervention recipients, who report that through repetition, behaviors gradually become routinized. Whether habit formation interventions truly offer a route to long-lasting behavior change, however, remains unclear.
Nikos Ntoumanis, Cecile Thørgersen-Ntoumani, Eleanor Quested, and Nikos Chatzisarantis
Compelling evidence worldwide suggests that the number of physically inactive individuals is high, and it is increasing. Given that lack of physical activity has been linked to a number of physical and mental health problems, identifying sustainable, cost-effective, and scalable initiatives to increase physical activity has become a priority for researchers, health practitioners, and policymakers. One way to identify such initiatives is to use knowledge derived from psychological theories of motivation and behavior change. There is a plethora of such theories and models that describe a variety of cognitive, affective, and behavioral mechanisms that can target behavior at a conscious or an unconscious level. Such theories have been applied, with varying degrees of success, to inform exercise and physical activity interventions in different life settings (e.g., schools, hospitals, and workplaces) using both traditional (e.g., face-to-face counseling and printed material) and digital technology platforms (e.g., smartphone applications and customized websites). This work has offered important insights into how to create optimal motivational conditions, both within individuals and in the social environments in which they operate, to facilitate long-term engagement in exercise and physical activity. However, we need to identify overlap and synergies across different theoretical frameworks in an effort to develop more comprehensive, and at the same time more distinct, theoretical accounts of behavior change with reference to physical activity promotion. It is also important that researchers and practitioners utilize such theories in interdisciplinary research endeavors that take into account the enabling or restrictive role of cultural norms, the built environment, and national policies on physical activity.
Glyn C. Roberts, Christina G. L. Nerstad, and P. Nicolas Lemyre
Motivation is the largest single topic in psychology, with at least 32 theories that attempt to explain why people are or are not motivated to achieve. Within sport psychology research, there are a plethora of techniques of how to increase and sustain motivation (strategies to enhance agency beliefs, self-regulation, goal setting, and others). However, when explaining the conceptual undergirding of motivation in sport, the why of motivation, two theories predominate: Achievement Goal Theory (AGT) and Self-Determination Theory (SDT). Both theories predict the same outcomes, such as increased achievement striving, sustained behavior change, and perceptions of well-being, but they differ in why those outcomes occur. AGT assumes that individuals cognitively evaluate the competence demands and meaningfulness of the activity, and that those perceptions govern behavior. SDT assumes that individuals are driven by three basic needs, competence, autonomy, and relatedness, and the satisfaction of those needs govern behavior. The following discusses both theories and concludes that each has their strengths and weaknesses.
Joanne R. Smith
As social animals, humans are strongly influenced by the opinions and actions of those around them. Group norms are the expectations and behaviors associated with a social group, such as a nationality, an organization, or a sports team. Group norms can emerge during group interaction as group members are exposed to the opinions, or observe the actions, of fellow group members. Group norms can also emerge by comparing the attitudes and actions of the group with other groups. Leaders can also influence what is seen to be acceptable behaviors for group members to exhibit. One of the most dominant approaches to the study of group norms is the social identity approach. The social identity approach proposes that belonging to a social group provides individuals with a definition of who one is, and a description and prescription of what is involved in being a group member. A large body of research has confirmed the power of group norms to determine the form and direction of group members’ attitudes and actions, particularly those individuals strongly attached to the group, across many behavioral domains. In thinking about group norms, it is important to recognize that norms have both prescriptive (i.e., what should be done) and descriptive (i.e., what is done) elements. Research has found that group norms are most influential when aligned, but that misaligned or conflicting norms—either within the group or across multiple groups to which an individual belongs—can be particularly harmful in terms of engagement in a desired behavior. It is critical to appreciate and understand these complexities to be able to change group norms and, therefore, group members’ actions. The insight that group norms are powerful determinants of behavior has been incorporated into behavior change interventions, including so-called “nudge” interventions. However, norms-based campaigns are not always successful, and can even lead to backlash effects, often because change agents have failed to consider identity-related processes, such as the role of leaders, the source of the influence attempt, and threats arising from attempts to change one’s group. Shared identity is a key mechanism through which people internalize (new) understandings of what it means to be a group member into the self-concept, and understanding these processes may lead to more enduring change in underlying motives, beliefs, and behavior.
As technology advances and offers enjoyable sedentary alternatives to sport, active recreation, and transportation, there is a growing need to understand and harness the drivers of physical activity and exercise among children and adolescents. Determining how youth perceive their physical capabilities and their opportunities and what motivates them to be physically active can provide essential information for teachers, coaches, youth leaders, and program planners who are interested in promoting physical activity. Several well-established and also more recently developed behavioral theories offer numerous avenues to gaining a better understanding of the perceptions and motivation of youth with respect to physical activity and exercise behavior, including the social ecological model, social cognitive theory, self-determination theory, habit theory, dual-process theory, and nudge theory, among others. Children and adolescents have individual characteristics that influence their perceptions, motivations, and behavior. They also exist within a multilayered ecological context that helps to shape those perceptions, motivations, and behavior. For youth to be sufficiently physically active and thereby help to reach their full potential, the environment must be conducive to consistent routines of physical activity. Such an environment can be designed to provide easily accessible and enjoyable opportunities for youth to fulfill their basic psychological needs for autonomy, relatedness, and competence to be physically active. There is potential for technology to contribute positively toward the design of conducive environments, and toward fostering motivation and enjoyment of exercise and physical activity among children and adolescents.
Stuart Linke and Elizabeth Murray
Alcohol-use disorders are widespread and associated with a greatly increased risk of health-related and societal harms. The majority of harms associated with consumption are experienced by those who drink above recommended guidelines, rather than those who are alcohol dependent. Brief interventions and treatments based on screening questionnaires and feedback have been developed for this group, which are effective tools for reducing consumption in primary care and in other settings. Most people who drink excessively do not receive help to reduce the risks associated with excessive consumption. Digital versions of brief and extended interventions have the potential to reach populations that might derive benefit from them. Digital interventions utilize the same principles as do traditional face-to-face versions, but they have the advantages of availability, confidentiality, flexibility, low marginal costs, and treatment integrity. The evidence for the feasibility, acceptability, costs, and effectiveness of digital interventions is encouraging, and the evidence for effectiveness is particularly strong in studies of student populations. There are, however, a number of unresolved questions. It is not clear which components of interventions are required to maximize effectiveness, whether digital versions are enhanced by the addition of personal contact from a facilitator or a health professional, or how to increase take up of the offer of a digital intervention and reduce attrition from a program. These questions are common to many online behavior-change interventions and there are opportunities for cross-disciplinary learning between psychologists, health professionals, computer scientists, and e-health researchers.