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Making health habitual: the psychology of ‘habit-formation’ and general practice
Open accessAbstract
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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“Forming medication taking habits can reduce reliance on memory and help sustain behaviour change.39–42”
From Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: Protocol for a pilot fractional factorial trial (2023) · cites this paper as [41]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“Habit-based advice has been identified as particularly useful in primary care, as it is less time consuming to explain and easier for patients to implement than traditional behaviour change strategies.22”
From A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial (2017) · cites this paper as [22]
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“Interventions targeting automatic actions have application where patients’ level of engagement or motivation means that more traditional behavioural approaches with inherently high demand for commitment achieve limited adherence.22, 23”
From A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial (2017) · cites this paper as [22]
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“This can be because habit formation usually takes 2-3 months [86], and significant HbA1c changes require at least 3 months [87].”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [86]
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“Implementing health related behaviour change also takes time and with any skill, practice is important (Gardner et al., Citation2012).”
From The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. (2023) · cites this paper as Gardner et al., 2012
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Falke, C., Koolen, M. F. J., Timmer, S. L., Karapinar‐Çarkit, F., Bouvy, M. L., Egberts, T. C. G., & Knol, W. (2026) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70311 · Cited by 2
Real-World Meditation App Engagement: Longitudinal Study of the Medito Meditation App
Adams, J. A., Davies, J. N., Wattanatakulchat, P., Galante, J., D’Alfonso, S., & Christodoulides, N. (2026) · JMIR mhealth and uhealth · doi:10.2196/79366 · Cited by 2
“User factors that affect engagement are explorative but broadly reflect theories of habit formation and planned behavior [30,31].”
Cognitive Intervention for Patients with Neurocognitive Impairments
Gagnon, G., & Masson, M. (2019) · Springer eBooks · doi:10.1007/978-3-030-10814-4_26 · Cited by 2
[Diagnostic accuracy of mammography and mammoscintigraphy in multifocal breast cancer].
Криворотько, П. В. (2013) · PubMed · Cited by 2
Changing Behavior Using Control Theory
Mansell, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.009 · Cited by 11
Ee, J. S., Pham, C. K., Shaha, D. P., Rogers, M. C., Cacace, G. S., & Mounts, C. W. (2021) · Military Medicine · doi:10.1093/milmed/usaa306 · Cited by 2
Next Level Health: a holistic health and wellbeing program to empower New Zealand women
Chinn, V., Neely, E., Shultz, S. P., Kruger, R., Hughes, R., Page, R., Coad, J. E., & Thunders, M. C. (2021) · Health Promotion International · doi:10.1093/heapro/daab205 · Cited by 2
Sudaryono, H. N. B., & Kartika, L. (2022) · Among Makarti · doi:10.52353/ama.v15i1.228 · Cited by 2
“Tahap Pelaksanaan program Green-Back Berdasarkan Konsep Gardner et al. (2012), Clear (2018) dan Thaler dan Sunstein (2017) Berdasarkan gambar 4, tahap pelaksanaan program Green-Back secara lebih rinci adalah sebagai berikut : 1) Cue (1 hari) Tahapan ini merupakan tahap partisipan mendapatkan…”
BackgroundMeadows, J., & Sambasivam, S. (2023) · Issues in Informing Science and Information Technology · doi:10.28945/5129 · Cited by 2
“Changing behaviors because of external demands or breaking existing habits is significantly more challenging than creating habits (Gardner et al., 2012).”
BackgroundDeveloping self-care habits through a hybrid coaching framework in higher education
Morel, N. J., Brown, D., & Duke, A. B. (2023) · International Coaching Psychology Review · doi:10.53841/bpsicpr.2023.18.2.40 · Cited by 2
de Passos, T. O. M., Camacho, D. P., Campos, C. P., & Berenguer, S. A. (2024) · Revista de Investigación e Innovación en Ciencias de la Salud · doi:10.46634/riics.282 · Cited by 3
Garvelink, M. M., Mahboubian, A., de Weerdt, O., & van der Nat, P. B. (2024) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2024.04.002 · Cited by 2
Awamleh, Z. (2024) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2023.0292 · Cited by 2
Jones, M., Metse, A. P., Watkins, A., Hermens, D. F., & Driver, C. (2024) · Digital Health · doi:10.1177/20552076241288381 · Cited by 2
“46 An important component of coaching is to use language and goal setting which are positively focused supporting proactive actions rather than removal of a behaviour, i.e. increasing nutritional choices instead of loss of weight.”
BackgroundDeterminants of Self‐Management Behavior in Gout: A Scoping Review
van der Ven, J., van den Bemt, B. J. F., Flendrie, M., Vriezekolk, J. E., & Verhoef, L. M. (2024) · Arthritis Care & Research · doi:10.1002/acr.25449 · Cited by 2
“84 Regarding mode of delivery, eHealth can play an important role because it facilitates delivery of intervention functions in a cost-ef fi cient manner.”
Allen, A., Sanders‐Westerhof, G., Khodadadi, A., & Kannis‐Dymand, L. (2025) · Scandinavian Journal of Psychology · doi:10.1111/sjop.13119 · Cited by 2
“Gardner et al. (2012) propose that such behaviors can bypass conscious thought, leading to reduced metacognitive awareness.”
Ali, N. A., Hudson, J., Straton, G., & Mullins, J. M. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-090384 · Cited by 2
Abildgren, L., Lebahn-Hadidi, M., Mogensen, C. B., Toft, P., Steffensen, S. V., & Hounsgaard, L. (2025) · Advances in Simulation · doi:10.1186/s41077-025-00356-0 · Cited by 5
“Without a transfer process, focusing on meaning, motivation or conscious attention, the new or trained skill(s) will diminish, and the HP will return to usual habits and routines [16].”
Tan, R. E. J. H., Lim, W. S., Tay, C. H., Liew, K. W., Yeow, J. A., Chong, P. L., & Ng, Y. J. (2025) · Inventions · doi:10.3390/inventions10030042 · Cited by 2
Vadiveloo, M. K., Tovar, A., Elenio, E. G., Eickhoff, C., Soucie, J. S., Ewing, S. W. F., Gans, K. M., & Thorndike, A. N. (2025) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2025.07.010 · Cited by 2
Integrating neuro-psychological habit research into consumer choice models
Webb, R., Fong, J., Landry, P., Levine, J., Wellsjo, A., Natan, O., Mazar, A., Zhao, C., Lally, P. J., de Wit, S., et al. (2025) · International Journal of Research in Marketing · doi:10.1016/j.ijresmar.2025.10.002 · Cited by 2
Self-citationThe 10 best practices for remote software engineering
Sochat, V. (2021) · Communications of the ACM · doi:10.1145/3459613 · Cited by 2
“The more that you are able to repeat a behavior in a specific environment, the more likely it is to become effortless.(12) For example, if you immensely enjoy browsing the Internet for pleasure, you might teach yourself to look forward to this activity after dinner, and choose to browse at a different location with a…”
BackgroundEntrenamiento en casa durante el aislamiento
Arabia, J. J. M., & Naranjo, P. A. B. (2020) · Vitae (Universidad de Antioquia) · Cited by 2
Kusumastuti, A. E., & Putritamara, J. A. (2022) · The International Journal of Social Sciences and Humanities Invention · doi:10.18535/ijsshi/v9i02.03 · Cited by 2
Kim, J.-K., & Gu, M. O. (2016) · Journal of Korean Academy of Fundamentals of Nursing · doi:10.7739/jkafn.2016.23.3.245 · Cited by 2
“황적 자극(contextual cues)에 의해 유도되는 자동적인 반응으 로서 같은 상황에서 반복적인 행위를 통해 상황적 자극과 행 위의 연관성이 강화되므로써 형성된다[17].”
Authorship Attribution using Rough Sets based Feature Selection Techniques
Ikechukwu, I., & Olutayo, V. A. (2016) · International Journal of Computer Applications · doi:10.5120/ijca2016911889 · Cited by 2
“Habitual tendencies become irresistible over time and the urge to exhibit the promptings become very hard to control because they are autonomic and are not within the control of the individual [40; 12; 15] and as [40] puts it, ―habits are activated in memory in an autonomous fashion without requiring executive control…”
BackgroundThomson, D., Gowing, F., English, M., & Hassenkamp, A.-M. (2017) · International Journal of Practice-based Learning in Health and Social Care · doi:10.18552/ijpblhsc.v5i2.394 · Cited by 2
Strategies to Promote Walking Among Community-Dwelling Individuals With Major Mental Disorders
Swarbrick, M. A., Nemec, P. B., Brandow, C. L., & Spagnolo, A. B. (2017) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20171205-01 · Cited by 2
Raison, H., Corcoran, R., & Harris, R. V. (2018) · Community Dental Health · doi:10.1922/cdh_4174raison10 · Cited by 2
“Indeed measures such as self-reported behavioural automaticity index (SRBAI) would be important to consider, as well as longer follow-up periods in future intervention work in order to help determine the level of automaticity established to predetermined cues for infrequent behaviours.”
Behavior Change in Community Contexts
Trickett, E. J., & Paterson, S. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.028 · Cited by 2
Odake, Y., Fukutani, N., Shimoura, K., Morino, T., Matsumura, N., Niu, Q., Shinohara, Y., Mukaiyama, K., Nagai‐Tanima, M., & Aoyama, T. (2021) · Environmental and Occupational Health Practice · doi:10.1539/eohp.2020-0024-oa · Cited by 2
Znaczenie dobrostanu nauczyciela w procesie kształtowania wartości poznawczych i społecznych
Wójcik, A. (2022) · Studia Paedagogica Ignatiana · doi:10.12775/spi.2022.1.004 · Cited by 2
Kunjir, H., Shetty, L., Palekar, T. J. K., Basu, S., & Kunjir, G. (2022) · Journal of Maxillofacial and Oral Surgery · doi:10.1007/s12663-022-01774-7 · Cited by 2
“Whereas, according to Maxwell Maltz, any habits can be created by completing an activity for 21 days in a row [4, 5].”
Method
Metadata
- Authors
- Gardner, B., Lally, P., & Wardle, J.
- Affiliations
- University College London (GB)
- Venue
- British Journal of General Practice
- Published
- 2012-12
- Volume
- 62
- Issue
- 605
- Pages
- 664-666
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- 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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