Making health habitual: the psychology of ‘habit-formation’ and general practice

TLDR

The NHS aims to promote healthy living through brief opportunistic advice, yet traditional behaviour‑change strategies are time‑consuming, difficult to implement, and often yield only transient gains because they rely on conscious, deliberative processes. Brief advice that engages automatic processes may offer a valuable alternative with potential for long‑term impact. The authors propose that simple, clinician‑deliverable habit‑formation advice—repeating a chosen behaviour in the same context until it becomes automatic—provides an easy‑to‑implement, maintenance‑oriented option for routine health care.

Abstract

The Secretary of State recently proposed that the NHS: ‘... take every opportunity to prevent poor health and promote healthy living by making the most of healthcare professionals’ contact with individual patients.’ 1 Patients trust health professionals as a source of advice on ‘lifestyle’ (that is, behaviour) change, and brief opportunistic advice can be effective.2 However, many health professionals shy away from giving advice on modifying behaviour because they find traditional behaviour change strategies time-consuming to explain and difficult for the patient to implement.2 Furthermore, even when patients successfully initiate the recommended changes, the gains are often transient3 because few of the traditional behaviour change strategies have built-in mechanisms for maintenance. Brief advice is usually based on advising patients on what to change and why (for example, reducing saturated fat intake to reduce the risk of heart attack). Psychologically, such advice is designed to engage conscious deliberative motivational processes, which Kahneman terms ‘slow’ or ‘System 2’ processes.4 However, the effects are typically short-lived because motivation and attention wane. Brief advice on how to change, engaging automatic (‘System 1’) processes, may offer a valuable alternative with potential for long-term impact. Opportunistic health behaviour advice must be easy for health professionals to give and easy for patients to implement to fit into routine health care. We propose that simple advice on how to make healthy actions into habits — externally-triggered automatic responses to frequently encountered contexts — offers a useful option in the behaviour change toolkit. Advice for creating habits is easy for clinicians to deliver and easy for patients to implement: repeat a chosen behaviour in the same context, until it becomes automatic and effortless. While often used as a synonym for frequent or customary behaviour in everyday parlance, within psychology, ‘habits’ are defined as actions that …