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

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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.