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Influencing health-related
behavior, habits and lifestyle
using digital health tools
Health & Technology, March 2021; by Herman de Vries, MSc

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Contents
1. Defining behavior, habits and lifestyle
2. Theories on behavior change
3. Technology for behavior change
4. Behavior change techniques
5. Take away messages
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1.1 What is behavior?
“Behavior is an umbrella term that
describes the aggregate of
responses to internal and external
stimuli and the specific observable
conduct of an individual” 1
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1.2 What are habits?
“Habits are context–behaviour
associations in memory that
develop as people repeatedly
experience rewards for a given
action in a given context” 2
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1.3 What is a lifestyle?
“A lifestyle is a set of habits that are
directed by the same main goal” 3
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1.4 A taxonomy 1
Behaviors are building
blocks of habits
Habits are building
blocks of a lifestyle
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2.1 Nature versus nurture
Do we behave the way we do
because we were built that way
(nature)
... or because of what we have
experienced and learned during
our lives (nurture)?
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2.2 Fixed and growth mindsets 4
Adopting a growth mindset is
generally more productive
Be aware: not everything can be
influenced or changed – absence
of change ≠ culpable failure (!)
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2.3 Theory of Planned Behavior 5
• Behavior can be
(sub)consciously influenced
• TPB-based interventions often
target attitude, subjective norm
& perceived behavioral control
The big question: How to sustain a
certain behavior so that long-term
beneficial habits are formed?
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2.4 Nudging
Source: Behaviour Change By Design – YouTube
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3.1 Potential of technology
• Submersed in personal context
• Available 24/7
• Unobtrusive monitoring
• Historical data
• Personalized feedback, triggers
and interventions
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3.2 Lessons from Silicon Valley 6
• It is difficult to change or
replace established habits
• Habit change requires repetition
• Products need to motivate and
enable users to keep using it
• Variable rewards can help to
engage users
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3.3 Persuasive systems design
• Persuasive systems: "Interactive
information technology designed for
changing users’ attitudes or behavior“ 7
• Fogg Behavior Model: Behavior =
motivation x ability x prompt 8
• Potential of health technology: provide
the right prompt at the right time
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4.1 Behaviour Change Techniques
• A taxonomy of 93 BCTs was
formed to optimise the reporting
and scientific study of behavior
change interventions 9
• Some examples (paraphrased):
– Provide information
– Goal setting
– Action planning
– Prompt review of goals or rewards
– Self-monitoring
– Social comparison
– Social support
– Fear arousal
– Motivational interviewing
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4.2 BCT effectiveness
• Goal setting & self-monitoring
help overweight & obese adults
improve physical activity &
healthy eating 10
• … but are associated with lower
self-efficacy & physical activity
in older adults 11
BCT effectiveness can differ per
outcome, per demographic – and
even per individual
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4.3 BCT’s in wearables
• Mercer et al. (2016) assessed 7
activity trackers 12
• Average: 16.3 BCT’s per tracker
• Most BCT’s centered around
self-monitoring & self-regulation
• BCT’s related to planning &
instructions were scarce
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4.4 BCT’s in apps
• Dunn et al. (2018) assessed 40
smartphone apps targeting
sedentary behavior 13
• Just 10 BCT’s (out of a 93-item
taxonomy) were used
• On average 2.42 BCTs / app
• Most focussed on prompts,
information and self-monitoring
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4.5 BCT examples 14
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5 Take away messages
• Behavior < habits < lifestyle
• Using digital health tools
tomonitor and nudge via well
timed, personalized prompts
can complement traditional
approaches
• Choose a tool with the right
properties & BCT’s for the
targeted individual or group
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Questions or comments?
Contact:
• E-mail: h.j.de.vries@pl.hanze.nl
• Twitter: @HermanDeVriesNL
• LinkedIn: hermandevries
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References:
1. Salvador-Carulla, L., Alonso, F., Gomez, R., Walsh, C. O., Almenara, J., Ruiz, M., & Abellán, M. J. (2013). Basic concepts in the taxonomy of health-related behaviors, habits
and lifestyle. International Journal of Environmental Research and Public Health, 10(5), 1963–1976. https://doi.org/10.3390/ijerph10051963
2. Mazar, A., & Wood, W. (2018). Defining habit in psychology. In B. Verplanken (Ed.), The Psychology of Habit: Theory, Mechanisms, Change, and Contexts (pp. 13–29).
Springer International Publishing. https://doi.org/10.1007/978-3-319-97529-0_2
3. Jensen, M. (2009). Lifestyle: Suggesting mechanisms and a definition from a cognitive science perspective. Environment, Development and Sustainability, 11(1), 215–228.
https://doi.org/10.1007/s10668-007-9105-4
4. Dweck, C. (2017). Mindset: Changing the way you think to fulfil your potential. In Constable & Robinson. Hachette UK.
5. Icek, A. (1991). The Theory of Planned Behavior Organizational Behavior and Human Decision Processes. Organizational Behavior and Human Decision Processes, 50(2),
179–211.
6. Eyal, N. (2014). Hooked: How to build habit-forming products. Penguin.
7. Fogg, B. J. (2003). Persuasive Technology: Using Computers to Change What We Think and Do. Persuasive Technology: Using Computers to Change What We Think and Do,
2002(December), 1–282. https://doi.org/10.1016/B978-1-55860-643-2.X5000-8
8. Fogg, B. (2009). A behavior model for persuasive design. ACM International Conference Proceeding Series, 350, 1–7. https://doi.org/10.1145/1541948.1541999
9. Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., Eccles, M. P., Cane, J., & Wood, C. E. (2013). The behavior change technique taxonomy
(v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81–
95. https://doi.org/10.1007/s12160-013-9486-6
10. Samdal, G. B., Eide, G. E., Barth, T., Williams, G., & Meland, E. (2017). Effective behaviour change techniques for physical activity and healthy eating in overweight and obese
adults; systematic review and meta-regression analyses. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 42. https://doi.org/10.1186/s12966-017-0494-y
11. French, D. P., Olander, E. K., Chisholm, A., & Mc Sharry, J. (2014). Which Behaviour Change Techniques Are Most Effective at Increasing Older Adults’ Self-Efficacy and
Physical Activity Behaviour? A Systematic Review. Annals of Behavioral Medicine, 48(2), 225–234. https://doi.org/10.1007/s12160-014-9593-z
12. Mercer, K., Li, M., Giangregorio, L., Burns, C., & Grindrod, K. (2016). Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis. JMIR MHealth
and UHealth, 4(2), e40. https://doi.org/10.2196/mhealth.4461
13. Dunn, E. E., Gainforth, H. L., & Robertson-Wilson, J. E. (2018). Behavior change techniques in mobile applications for sedentary behavior. Digital Health, 4, 205520761878579.
https://doi.org/10.1177/2055207618785798
14. Bondaronek, P., Alkhaldi, G., Slee, A., Hamilton, F. L., & Murray, E. (2018). Quality of publicly available physical activity apps: Review and content analysis. JMIR MHealth and
UHealth, 6(3), e53. https://doi.org/10.2196/mhealth.9069
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