Making good quality care habitual : an exploration of the concept habit in relation to healthcare professional behaviour

Translating evidence-based guidance into practice involves healthcare professionals (HCPs) adopting new, and changing existing behaviours. Implementation research typically focuses on the reflective process that underlies HCPs’ behaviour, however there is a growing interest in the role that impulsive processes such as habit have on behaviour. Habit can be defined as a learned tendency to perform a behaviour automatically in response to a specific cue. This thesis presents four studies investigating how a habit perspective can contribute to understanding HCPs’ behaviour. Chapter 1 describes how a greater consideration of habit in the implementation literature could contribute to the field. Chapter 2 presents theory-based interviews conducted with HCPs who piloted a new self-management tool for diabetes. The study showed how HCPs formed a new habit of using the tool and how electronic reminders facilitated this process by promoting behavioural repetition. Chapter 3 describes a randomised controlled trial that aimed to test whether a planning intervention (using action- and coping planning) would be effective in supporting HCPs with habit change. While the study did not reach recruitment targets, it provided some first insights regarding the feasibility of using a planning intervention to support HCP behaviour change. Chapter 4 presents a secondary analysis of a large national data set, which found that the relationship between planning (action and coping planning) and six guideline-recommended behaviours operated indirectly on HCP behaviour via habit. Finally, Chapter 5 describes a systematic review and meta-analysis of studies investigating the association between habit and HCPs’ behaviour and showed that habit plays a significant role in predicting clinical behaviours. This thesis supports the consideration of habit when predicting HCPs’ behaviour and suggests that the use of conditional planning interventions may offer a feasible approach to support HCPs with creating and breaking habit.