Bringing about changes in modifiable behavioural risk factors is very difficult.
From a behavioural science perspective one reason why health messages are not making an impact is the habitual nature of human behaviour. A significant barrier to changing behavior is people’s pre-existing personal and lifestyle habits that render them resistant to change. Although a minority of people will heed health advice and change their behaviour because it is good for them, others will have the intention to change, and understand the need to change but will nonetheless persist with their pre-existing behaviours. There are at least three reasons for this:
- The neural substrates of human cognition and brain are designed to automatise all manner of choices and decisions rapidly, without conscious awareness.
- People’s habit associations are cued by their everyday environment. Context cueing, involving sensory activation, expectation and reward in the brain, is extraordinarily potent.
- The disconnect between knowledge and behaviour, or the knowing-doing gap. The human brain registers an action several seconds before the thought of acting enters consciousness.
Given these powerful brain mechanisms and the ability of context to trigger habitual responding, how can medical and other health interventions succeed to change modifiable behavioural risks? It will take more than a ‘nudge’ to reconfigure someones conditioned brain. Health warnings will barely impact the daily automatism of habits. Professor Ben (C) Fletchers’ research shows that a behavioural intervention needs to interrupt the sequence of conditioning; to change the small lifestyle behaviours that trigger the unhealthy habit chain and to try to instigate a new chain of events.
Based on this theory we have created our ToDo program.
 Wood, W. & Neal, D.T. A New Look at Habits and the Habit-Goal Interface. Psychological Review, 2007; 114, 4: 843-863
 Pfeffer, J. & Sutton, R. The Knowing-Doing Gap. 2000. Boston: Harvard Business School Press.
 Siong Soon, C., Brass, M., Heinze, H., Unconscious determinants of free decisions in the human brain. Nature Neuroscience 2008: 11, 543 – 545 (2008); Matthias Schultze-Krafta,Daniel Birmana, Marco Rusconia,, Carsten Allefelda,, Kai Görgena,d Sven Dähnee,