title: Investigating the Role of Past Behaviour and Habits in Health Behaviour
Creators: name: Brown, Daniel
Publisher: name: Griffith University
Year: 2020
Subjects: subject: Habit
subject: automaticity
subject: dual-process theories
subject: integrated models

description: Globally, there is a significant burden of disease due to unhealthy patterns of behaviours. Poor quality nutrition, over-exposure to the sun, insufficient oral hygiene practices, and excessive alcohol consumption are but a few examples of health-related behaviours that affect mortality and quality of life. To effectively modify people’s health behaviour, mechanisms of change must be isolated and tested. Previous research has often used theories of social cognition to understand, explain, and predict health behaviour. More recently, however, researchers are attempting to overcome the notable criticisms of such theories; for example, the tendency to focus on conscious, deliberative processes. To this end, understanding the role of non-conscious, automatic processes have come under the spotlight. The current thesis attempts to contribute to this literature by addressing three main aims. First, this thesis aimed to understand the effect of past behaviour in an integrated, dual-phase model of health behaviour that focuses on multiple deliberative processes. Second, this thesis aimed to explain the effects of past behaviour on future behaviour, with a focus on the role of habit. The final aim was to explore lay representations of habit. As a thesis presented by a series of publications, the four papers that comprise this program of research are presented as journal manuscripts. Paper 1 aimed to understand the effect of past behaviour in an integrated, multi-theory, dual phase model of health behaviour, exploring fruit and vegetable consumption of Australian heavy goods vehicle drivers (n = 212). The model integrated and tested constructs from self-determination theory (i.e., autonomous motivation), the theory of planned behaviour (i.e., attitudes, subjective norms, perceived behavioural control, and intention), and the health action process approach (i.e., action planning and coping planning), with the addition of past behaviour. Structural equation modelling identified the relative contributions of motivation, social cognition, and volition to the prediction of fruit and vegetable consumption, one week later. Importantly, past behaviour was shown to attenuate model effects, particularly to the intention-behaviour relationship. This study explicitly demonstrated the effect of past on future behaviour and found significant residual variance unexplained by the conscious, deliberative processes. To address the second aim of the thesis by seeking to understand which elements of past behaviour exert influence on future behaviour, Paper 2 tested a dual-process model that incorporated constructs that underpinned reasoned action and automatic constructs across three distinct health behaviours and populations: binge drinking in university students (n = 319), dental flossing in adults (n = 251), and parental sun safety behaviour of children 2 – 5 years of age (n = 184). Furthermore, Paper 2 sought to use a measure of past behaviour that combined long-term, recent, and routine patterns of behaviour. This was used to best model potentially distinct patterns of past behaviour; but, to also overcome criticisms that argue past-future behaviour effects are inflated by shared-method variance. The study adopted a prospective design with two waves of data collection, spaced six weeks apart. Structural equation modelling found that the automatic, but not reasoned action constructs, mediated the past-to-future behaviour relationship across all three behaviours. In further addressing the second aim of the thesis, Paper 3 aimed to explore the role of two different types of habits (i.e., goal-directed and counter-intentional) simultaneously with a reasoned action measure (i.e., intention) in two health-promoting nutrition behaviours (i.e., eating the recommended serves of fruits and vegetables and restricting sugar sweetened beverages) in two populations (i.e., middle school students aged 11 – 14 years (n = 266) and university students aged 17 – 24 years (n = 340)). Results revealed different patterns of effects whereby intentions predicted both behaviours in both samples and goal-directed habits and counter-intentional habits only predicted fruit and vegetable consumption in the middle-school sample. This study highlighted how automatic processes may play a significant role in explaining and predicting health behaviours. Of note, in Paper 3, the habit for each behaviour that was measured using an avoidance-orientation (i.e., the habit to restrict or avoid) did not produce a significant effect. The non-significant effects could indicate that such habits do not play a role in health behaviour or, alternatively, demonstrate the participants had difficulty understanding and interpreting such questions. Understanding how the general population interprets the meaning of habit is therefore useful; yet, has rarely been explored. Paper 4, in addressing the last aim of the thesis, sought to understand lay representations of habit using qualitative methodology across two studies. The first study used an online, open-ended questionnaire to elicit the most salient features of habit. The second study used interviews and focus groups to explore a more in-depth understanding of lay representations of habit by exploring what lay people identify as the important features of habit and which behaviours they identify as habitual. Paper 4 found that, overall, there were many consistencies with a lay and scientific representation of habit (e.g., automatic, frequently engaged). However, despite being able to identify specific features of habit, lay people, at times, identified habitual behaviours that were inconsistent with their definition. In particular, lay people often used the word habit to mean clustered, repetitive patterns of behaviour, synonymous with routine, or as something that is characteristic or typical of them. This highlights potential problems with how lay people may answer self-reported measures of habit and how they evaluate interventions seeking to modify habits. Furthermore, as researchers continue to explore other automatic and implicit processes (e.g., counter-intentional habits or implicit attitudes and motivations) there must be a coherent and consistent definition to distinguish between them. Overall, the findings of this thesis make an important contribution to the health and behavioural medicine literature by contributing to understanding the role of past behaviour and habit in explaining and predicting health behaviour. The research first corroborated the attenuation effects of past behaviour on future behaviour in an integrated model of health behaviour. It was demonstrated that a significant portion of variance was left unexplained when only reasoned, deliberative processes are used in models of behaviour. The research then demonstrated that the residual variance of past-to-future behaviour was accounted for by automatic constructs (i.e., habit) in three distinct behaviours and populations. This was further expanded by exploring the role of two constructs representing automatic processes, goal-directed and counter-intentional habits, alongside intention. The inconsistent effects across behaviours and samples highlighted that little is known about how lay people represent habits, which likely influences how they interpret measures of habit. Therefore, the final paper qualitatively explored lay representations of habit, demonstrating that while there are some consistencies with a scientific understanding of habit, there remains a number of discrepancies. The findings of this thesis contribute to understanding the effects of past behaviour and habit on health behaviour. These findings highlight that further research is needed in enhancing the scientific conceptualisation of habit and in further understanding the conditions in which constructs representing non-conscious and automatic processes mediate the past-to-future behaviour relationship compared with constructs representing reasoned-action processes.