Non-conscious processes in changing health-related behaviour: a conceptual analysis and framework

Abstract

Much of the global burden of non-communicable disease is caused by unhealthy behaviours that individuals enact even when informed of their health-harming consequences. A key insight is that these behaviours are not predominantly driven by deliberative conscious decisions, but occur directly in response to environmental cues and without necessary representation of their consequences. Consequently, interventions that target non-conscious rather than conscious processes to change health behaviour may have significant potential, but this important premise remains largely untested. This is in part due to the lack of a practicable conceptual framework that can be applied to better describe and assess these interventions. We propose a framework for describing or categorising interventions to change health behaviour by the degree to which their effects may be considered non-conscious. Potential practical issues with applying such a framework are discussed, as are the implications for further research to inform the testing and development of interventions. A pragmatic means of conceptualising interventions targeted at non-conscious processes is a necessary prelude to testing the potency of such interventions. This can ultimately inform the development of interventions with the potential to shape healthier behaviours across populations.

Keywords: Health behaviour; automatic; awareness; behaviour change; intervention; non-conscious.

Figure 1.

Conscious and non-conscious processes underlying behavioural activation cued by exposure to an external stimulus. The black path represents behavioural activation that would be regarded as conscious, whereby the actor is aware of a causal link between a stimulus and a behaviour. The grey paths represent a behaviour that would be regarded as non-conscious, whereby the actor is unaware of the causal link between a stimulus and a behaviour. The green–red shading represents the conscious–nonconscious spectrum, whereby awareness of each element is of a degree on a spectrum depending on the level at which awareness is analysed. Note: This figure is intended to provide a simple representation of behaviour activation and so does not include goal activation processes, but the principles apply equally to behaviours for which goals are represented and those for which they are not.

Figure 2.

A framework of conscious and non-conscious activation of behaviour by an intervention. Conscious activation of behaviour (green) is characterised by awareness of both the intervention and the behavioural response. Non-conscious activation of behaviour (red) is characterised by a lack of awareness of the intervention and/or the behavioural response. Moderately conscious activation of behaviour (light green) indicates an assumed spectrum. For the purposes of this figure, we assume that, where there is some awareness of both intervention and behaviour components, an awareness of the causal link between these has also been generated to a varying degree (should this be absent, then the behaviour would inevitably be regarded as non-conscious).