Habit formation of preventive behaviours during the COVID-19 pandemic: a longitudinal study of physical distancing and hand washing

Abstract

Background: Since the outbreak of the COVID-19 pandemic, physical distancing and hand washing have been used as effective means to reduce virus transmission in the Netherlands. However, these measures pose a societal challenge as they require people to change their customary behaviours in various contexts. The science of habit formation is potentially useful for informing policy-making in public health, but the current literature largely overlooked the role of habit in predicting and explaining these preventive behaviours. Our research aimed to describe habit formation processes of physical distancing and hand washing and to estimate the influences of habit strength and intention on behavioural adherence.

Methods: A longitudinal survey was conducted between July and November 2020 on a representative Dutch sample (n = 800). Respondents reported their intentions, habit strengths, and adherence regarding six context-specific preventive behaviours on a weekly basis. Temporal developments of the measured variables were visualized, quantified, and mapped onto five distinct phases of the pandemic. Regression models were used to test the effects of intention, habit strength, and their interaction on behavioural adherence.

Results: Dutch respondents generally had strong intentions to adhere to all preventive measures and their adherence rates were between 70% and 90%. They also self-reported to experience their behaviours as more automatic over time, and this increasing trend in habit strength was more evident for physical-distancing than for hand washing behaviours. For all six behaviours, both intention and habit strength predicted subsequent adherence (all ps < 2e-16). In addition, the predictive power of intention decreased over time and was weaker for respondents with strong habits for physical distancing when visiting supermarkets (B = -0.63, p <.0001) and having guests at home (B = -0.54, p <.0001) in the later phases of the study, but not for hand washing.

Conclusions: People's adaptations to physical-distancing and hand washing measures involve both intentional and habitual processes. For public health management, our findings highlight the importance of using contextual cues to promote habit formation, especially for maintaining physical-distancing practices. For habit theories, our study provides a unique dataset that covers multiple health behaviours in a critical real-world setting.

Keywords: COVID-19; Habit formation; Habit-intention interaction; Longitudinal study; Personal hygiene; Physical distancing; Preventive behavior.

Fig. 1

Timeline of the longitudinal survey in the context of the development of COVID19 pandemic in the Netherlands. The 20 waves of the study were aggregated into five phases that roughly followed critical events of policy changes. The curve in the background indicates the number of daily new cases per 100,000 people

Fig. 2

Aggregated temporal developments of adherence rate, behavioural intention, and behavioural automaticity over the five phases of the study

Fig. 3

Effects of behavioural intention, frequency-based habit index, and their interaction on subsequent behavioural adherence estimated for each context-specific behaviour at each phase of the study (Regression coefficients on the y-axis represents effect sizes. Error bars represent 95% confidence intervals of the estimates)

Fig. 4

Visualization of the effect of behavioural intention on subsequent behavioural adherence for respondents with different levels of habit strength (HS) measured by frequency-based habit index for each context-specific behaviour at each phase of the study

Fig. 5

Effects of behavioural intention, behavioural automaticity, and their interaction on subsequent behavioural adherence estimated for each context-specific behaviour at each phase of the study (Regression coefficients on the y-axis represents effect sizes. Error bars represent 95% confidence intervals of the estimates)

Fig. 6

Visualization of the effect of behavioural intention on subsequent behavioural adherence for respondents with different levels of habit strength (HS) measured by SRBAI for each context-specific behaviour at each phase of the study