Taking back control: dealing with impulsive processes in digital health behaviour change.

我们中的许多人珍视自己的健康，但我们的行为方式仍然会破坏健康。不良饮食、吸烟、饮酒和缺乏锻炼会导致大量疾病，如心血管疾病、2型糖尿病和癌症。成功地改变这些行为可以帮助预防并在某些情况下治疗这种情况(例如，体重减轻可能导致2型糖尿病缓解)，这将对英国和全球经济产生重大影响。然而，我们的行为是复杂的，受到生物、心理、社会和环境因素的影响。为了能够支持行为改变，对行为及其影响的良好理解是至关重要的。传统的行为改变方法侧重于告知不健康行为的负面后果。这是为了增加积极性，通常还包括教育部分，提供关于哪些行为应该执行以及如何执行的指导。但是，即使受到激励，人们仍难以改变自己的行为。人类的许多行为都是由情景提示触发的冲动的、无意识的过程引导的，这意味着在大多数情况下，我们的行为是不加思考的。这有助于我们变得快速高效--我们不必有意识地思考我们一直在做的每一件事。然而，这些过程可能会阻碍成功的行为改变，导致不健康的、但往往在心理上有益的、自动的和习惯性的行为复发并保持下去。有时，我们意识到瞬间引发的(例如，想吃一块蛋糕的欲望)和我们知道我们应该为长期目标(例如，控制体重的欲望)所做的事情之间的斗争或冲突。这种斗争的经历经常被描述为一种诱惑。支持行为改变的更有效方式将有助于人们管理这些冲动的过程。这种方法应在需要时提供支持。在我攻读博士期间，我使用干预地图方法帮助开发了一种基于智能手机应用程序的干预(ImPulsePal)，它以人为中心，由理论和研究证据提供信息。这种数字干预提供了各种策略，包括大脑训练游戏(食物抑制训练)、基于位置的目标提醒、如果-然后计划、基于正念的策略和紧急按钮。在可行性试验中，使用该应用程序的参与者比那些没有使用该应用程序的人减掉了更多的体重。对应用程序用户的采访表明，他们重视获得即时支持。他们也更加意识到这对他们饮食行为的影响，这促使他们采取行动。一些人还提到，他们的渴望随着时间的推移而发生频率和强度的变化，因此使用这些策略的必要性随着时间的推移而减少。我的目标是在学术界内探索这一研究途径。这笔奖学金将在多个方面提高我未来申请研究资金和教师职位的能力。一项研究将帮助我进一步探索访谈中提到的渴望频率和强度的人内变化，并将它们与个体一直使用的策略联系起来。这可能有助于完善ImPulsePal，以便在关键时刻提供适当的支持。这项研究也将帮助我扩展我的研究和分析技能。我将利用这个机会探索ImPulsePal应用程序的全面评估的各种选择，它的推出，以及适应其他临床领域的应用(例如，酒精消费)。我将进一步利用奖学金建立专业网络，更广泛地传播我的工作，增强我的特定学科知识，并获得更多的研究、教学和其他学术技能。其目的是加强作为独立研究人员的能力，以便能够更有效地为这一领域的研究作出贡献。

Many of us value our health, yet we still behave in ways that undermines it. Poor diet, smoking, alcohol consumption, and lack of exercise can cause a large number of diseases such as cardiovascular disease, type 2 diabetes, and cancer. Successfully changing these behaviours can help prevent, and in some cases treat, such conditions (e.g., weight loss can result in Type 2 Diabetes remission) which would have a substantial impact on the UK and global economy. However, our behaviours are complex and influenced by biological, psychological, social and environmental factors. To be able to support behaviour change, a good understanding of the behaviour and the influences on it is crucial.Traditional methods of behaviour change have focused on informing about negative consequences of an unhealthy behaviour. These were meant to increase motivation and often also included educational components that provided instructions on which behaviours to perform and how. But, even when motivated, people still struggle to change their behaviour. Much of human behaviour is guided by impulsive, non-conscious processes that are triggered by situational cues, which means that in most instances we act without thinking. This helps us to be fast and efficient - we do not have to consciously think about every single thing we do all of the time. However, these processes can get in the way of successful behaviour change, leading to the relapse to and maintenance of unhealthy, but often psychologically-rewarding, automatic and habitual behaviours. Sometimes we are aware of the struggle or conflict between what has been triggered in-the-moment (e.g., desire to eat a piece of cake) and what we know we should be doing for our long-term goals (e.g., desire to manage our weight). The experience of such a struggle is often described as a temptation. More effective ways of supporting behaviour change would help people to manage these impulsive processes. Such approaches should provide support as and when required. During my PhD, I used the Intervention Mapping approach to help develop a smartphone app-based intervention (ImpulsePal) that is person-centred and informed by theory and research evidence. This digital intervention offers a variety of strategies including a brain training game (food inhibition training), location-based goal reminders, if-then planning, a mindfulness-based strategy, and an emergency button. Participants using the app in the feasibility trial lost more weight than those who did not use the app. Interviews with app users suggest that they valued having access to in-the-moment support. They also felt more aware of the influences on their eating behaviour, which prompted them to do something about it. Some also mentioned that their cravings changed in frequency and intensity over time and that therefore the need to use these strategies reduced over time.My goal is to pursue this avenue of research within academia. This fellowship would enhance my future applications for research funding and faculty positions in a number of ways. One study would help me to further explore the within-person changes in craving frequency and intensity mentioned in the interviews, and to link them to the strategies the individual had been using. This could help refine ImpulsePal to offer appropriate support at key times. This study would also help me to expand my research and analytical skill set. I would use the opportunity to explore various options for the full-scale evaluation of the ImpulsePal app, it's roll-out, and adaptation for application in other clinical areas (e.g., alcohol consumption). I will further use the Fellowship to build professional networks, disseminate my work more widely, enhance my subject-specific knowledge, and acquire additional research, teaching, and other academic skills. The aim is to strengthen as an independent researcher to be able to contribute more effectively to research in this area.