A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions

Robinson, Louisa; Arden, Madelynne A; Dawson, Sophie; Walters, Stephen J; Wildman, Martin J; Stevenson, M

doi:10.1080/17437199.2022.2034516

Cited by 12 publications

(5 citation statements)

References 75 publications

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“…The formation of cue-behaviour associations, as is essential to habit formation, has the potential to lead to sustained behaviour change. Habit based interventions have been successful in improving adherence in other long-term conditions [96][97][98]. Based on published guidance, we selected six behaviour change techniques (BCTs) related to habit theory that were feasible to target [94,[99][100][101] (Table 4).…”

Section: Forgetfulnessmentioning

confidence: 99%

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Green

French²,

Graham³

et al. 2022

BMC Health Serv Res

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Background Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). Methods Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. Results The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components. Conclusions We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.

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Section: Forgetfulnessmentioning

confidence: 99%

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Green

French²,

Graham³

et al. 2022

BMC Health Serv Res

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“…Furthermore, mindfulness and habit formation are often seen as opposites, with a habit defined as mindless behavior (Langer, 1989) and mindfulness as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (Kabat-Zinn, 1994, p. 4). It is proposed in the literature that habit formation needs an expanded view that requires the mindfulness aspect in order to be better applied to the treatment of complex issues (Gardner, 2012;Harvey et al, 2022;Lally et al, 2011;Lally & Gardener, 2013;Robinson et al, 2022;Rothman et al, 2009). A comprehensive review of this literature across different disciplines shows that mindfulness involves deliberate and intentional focused reflection (Casey et al, 2022;Liu et al, 2021;Mitchell et al, 2021;Wong et al, 2022), which are elements that need to be incorporated into intervention that has the effective use of habit formation and automaticity (Ariyasinghe & Arachchige, 2020; Lewis et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…There is a consensus in the literature that including the science of habit formation and automaticity in the design and delivery of evidence-based therapies (EBT) for mental health challenges would appear to enhance their effectiveness (Fiorella, 2020;Harvey et al, 2022;Kazdin, 2018;Lally et al, 2011;Lally & Gardener, 2013;Robinson et al, 2022;Rothman et al, 2009). In patient care settings, the potential benefits of automating complex healthy habits are often overlooked due to the immediate effects of brief advice.…”

Section: Introductionmentioning

confidence: 99%

Habit Formation and Automaticity: Psychoneurobiological Correlates of Gamma Activity

Leaf,

Wasserman,

Leaf

et al. 2024

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Within current mental healthcare practices, a reliable mechanism is needed for transitioning therapeutic interventions into long-term habit formation. While a sizeable body of literature on habit formation and automaticity looking at simple behaviors such as overall activity level and diet exists, few studies have investigated the complex behavior formation needed to instill new beneficial mental health habits. Additionally, limited research has looked at the neurophysiological or biological correlates of these mental processes and changes. Madhavan et al. (2015) proposed that, during active learning or recall, individuals exert more cognitive energy compared to information maintenance, resulting in heightened gamma activity. This new data demonstrates that gamma increases as learning is taking place then decreases once the behavior is learned (habituated), providing evidence of habit formation and automaticity and its nonlinear nature. The current pilot study seeks to contribute to the field's developing knowledge of habit formation and automaticity as something that can be deliberately and mindfully learned, through a planned and guided approach over a specified time frame, to empower individuals to achieve lasting improvements in mental health challenges. Our research contributes practical strategies to improve interventions and achieve sustainable outcomes for the public health emergency in mental health.

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“…In a meta-analysis including 771 interventions supporting medication adherence in a variety of clinical contexts, larger effect sizes were observed for habit-based interventions than for those using simple prompts or educational materials alone [ 38 , 39 ]. However, a recent review highlighted that many medication adherence interventions described as “habit based” are not theoretically informed and do not promote the process of context-consistent repetition, which is fundamental to habit formation [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analyses of SMS text messaging interventions in other long-term conditions have reported positive effects on adherence (odds ratios 1.39-2.11) [ 42 , 43 ]. However, to date, no habit-based interventions to support medication adherence have exclusively used SMS text messages [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach

Green¹,

French²,

Hall³

et al. 2023

J Med Internet Res

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Background Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability. Objective This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs). Methods According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice. Results In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended. Conclusions We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence.

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A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions

Cited by 12 publications

References 75 publications

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Habit Formation and Automaticity: Psychoneurobiological Correlates of Gamma Activity

Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach

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