COVID-19 Prevention via the Science of Habit Formation

The coronavirus disease 2019 (COVID-19) continues to claim lives worldwide and a vaccine has yet to be developed. Behavioral interventions are the only currently known treatments that have the potential to massively reduce the devastating levels of morbidity and mortality associated with COVID-19. Yet behavioral interventions to support the adoption of these guidelines are not being prioritized. We argue that developing, testing, and providing a habit formation intervention, particularly to high-risk groups, has the potential to be lifesaving. COVID-19 prevention behaviors involve a complex chain of steps. Data from the H1N1 pandemic suggests that adherence to these behaviors is likely to be low. The science of habit formation offers strategies to increase adherence to COVID-19 prevention behaviors. Habit formation is defined as the process by which repeating a behavior, in the context of a stable contextual cue, eventually becomes automated such that we engage in the habit with minimal effort. The repetition of behaviors necessary for habit formation are strengthened by reinforcement. Eight elements of habit formation are highlighted: setting goals, devising an action plan, addressing incorrect beliefs, establishing contextual cues, engaging in repetition, adding reinforcement, aiming for automaticity and recognizing that change is difficult. A behavioral intervention, derived from habit formation principles and known effective behavior change techniques, is proposed as a basis for further development and empirical testing. This narrative review highlights the importance of the science of habit formation for increasing adherence to COVID-19 prevention behaviors. With the COVID-19 pandemic still raging, there is currently an urgent opportunity to leap knowledge on habit formation processes and interventions forward.
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