Cited by 591Behavioral Health and InterventionsBehavioral and Psychological StudiesPro-Environmental Behavior and Attitudes

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

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Gardner, Benjamin, Lally, Phillippa, Wardle, Jane·2012·British Journal of General Practice

DOI 10.3399/bjgp12x659466PMC PMC3505409

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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 …

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“As daily activities result from routines that are imposed by fixed environmental factors such as group paternal behaviors and individual habits [7], it is expected to observe some degree of consistency in time, duration, and types of activities of a person over a year.”
BackgroundMethod
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“This was based on evidence from behavior psychology research which estimates the average time required for a new behavior to become automatic (assuming that the patients will start the new healthy behaviors at the time of their diagnosis, although some may be already engaged in HE and PA before their diagnosis) to be…”
Method
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Ruiter, R. A. C., Crutzen, R., de Leeuw, E., & Kok, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.018 · Cited by 20
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“On this matter, interventionists can teach and encourage participants to apply best practices from the psychology of habits to aid habit formation (Gardner et al., 2012).”
Background
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“Hence, maintaining motivation to consistently perform the new behaviour is only necessary until the habit forms and the new behaviour becomes ‘second nature’.(24)”
BackgroundInfluential
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“Habit formation has been suggested as a mechanism to reduce perceived effort and burden with treatment.(79) This has been supported within the literature for inhaled therapies in pwCF with a reduced perceived treatment burden in those with established and stronger treatment habits.”
Background
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“Research on habit formation suggests that consistency, choosing the same time and place for the target behavior, is of particular importance (eg, [28]).”
Background
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Ling, J., Chen, S., Zhang, N., Robbins, L. B., & Kerver, J. M. (2023) · Nursing Research · doi:10.1097/nnr.0000000000000697 · Cited by 19
“The 14-week duration was selected because 14 weeks provided a reasonable period for behavior habit formation (Gardner et al., 2012).”
Background
An online mind-body program improves mental health and quality of life in primary biliary cholangitis: A randomized controlled trial
Watt, M., Hyde, A. M., Johnson, E., Wright, G. M., Well, S. V., Sadasivan, C., Lee‐Baggley, D., Spence, J. C., Mason, A. L., Ko, H. H., et al. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000316 · Cited by 16
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“53,54 Our findings suggest survivors need more practical support with integrating self-management into daily life and forming new habits, which allows them to maintain other important aspects of their lives.”
Background
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“Generic components might include developing positive ‘habits’ that refer to a situation in which a stimulus (eg, going outside) generates an impulse to act as a result of a learnt stimulus response, with a positive cue-action link leading to protective behaviours.(36) Habit formation training could involve action plan…”
Background
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“Research has shown that exercise is a habit that requires significant effort to establish and can take several months to become a routine behavior [32, 50].”
Background
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“with respiratory disease are urgently needed [36].”
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“This would not only produce the possible benefits of intersectoral synergy and efficiency but could also enhance the health status of the people [17].”
Background
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“For example, we know that repeating a chosen behavior in the same context, until it becomes automatic and effortless, will lead to persistence of the healthy behavior when motivation wanes.(15) This advice can be used by pediatricians, child and adolescent psychiatrists, and other providers to promote healthy habit fo…”
Background
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“Alternatively, these changes could be linked to the psychological and social development of young adolescents (Gardner et al., 2012).”
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“As previously mentioned, a satisfying outcome strongly encourages repetition and may even induce positive spillovers (e.g. when it helps to create an image of a certain type of person, cf. Gardner et al. 2012).”
Background
Examining the Priorities, Needs and Preferences of Men with Metastatic Prostate Cancer in Designing a Personalised eHealth Exercise Intervention
Evans, H. E. L., Forbes, C. C., Vandelanotte, C., Galvao, D. A., Newton, R. U., Wittert, G., Chambers, S. K., Kichenadasse, G., Brook, N. R., Girard, D., et al. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09932-2 · Cited by 14
“As du Coeur” study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease
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Changing activity behaviours in vocational school students: the stepwise development and optimised content of the ‘let’s move it’ intervention
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The Effect of a Consumer-Based Activity Tracker Intervention on Accelerometer-Measured Sedentary Time Among Retirees: A Randomized Controlled REACT Trial
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“…prompts and self-monitoring of sedentary behavior, additional theory-based BCTs such as sedentary behavior-specific goal-setting, problem-solving, habit formation, and/or social support may be needed to achieve more robust, and possibly long-term reductions in sedentary time (15,25,27,56).”
Monitoring Interventions
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Facilitators and barriers to behavior change in overweight and obesity management using the COM-B model
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“…maintenance of behavior (Gardner and Rebar, 2019), it needs to be considered that even when people successfully initiate the recommended changes, the gains are often transient as few of the traditional behavior change strategies have built-in mechanisms for maintenance (Gardner et al., 2012).”
Background

Authors: Gardner, B., Lally, P., & Wardle, J.
Affiliations: University College London (GB)
ORCID: Gardner, Benjamin
Lally, Phillippa
Wardle, Jane
Venue: British Journal of General Practice
Publisher: Royal College of General Practitioners
Published: 2012-12
Volume: 62
Issue: 605
Pages: 664-666
ISSN: 0960-1643 (ISSN-L)
1478-5242
DOI: 10.3399/bjgp12x659466
PMC: PMC3505409
OpenAlex: W1987192180
Cited by: 591
References: 22
Citations by year: 2026: 63 · 2025: 57 · 2024: 61 · 2023: 51 · 2022: 58 · 2021: 61 · 2020: 92 · 2019: 47 · 2018: 37 · 2017: 23 · 2016: 23 · 2015: 8 · 2014: 4 · 2013: 6
FWCI: 8.07
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: British Journal of General Practice (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: Cancer Research UK (14133)
Medical Research Council (MR/J000396/1)
Topics: Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Physical Sciences › Environmental Science › Management, Monitoring, Policy and Law › Pro-Environmental Behavior and Attitudes
Keywords: habit formation, health behavior change, general practice, automatism, maintenance of behaviour change, lifestyle advice, health promotion
MeSH terms: Counseling, Habits, Health Promotion, Humans, Motivation, Health Behavior, Risk Reduction Behavior, General Practice

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

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