Implementation Intention and Action Planning Interventions in Health Psychology: evaluating the state of the art and developing guidelines for best practice and future research

Expert meeting description

There has been a rapid increase in the use of planning techniques in interventions to promote health-related behaviour (Abraham, Kok, Schaalma, & Luszczynska, 2011). The proliferation of interventions using planning has largely been a direct response to the considerable literature which has recognised the limitations of intentions as a predictor of behaviour (Dekker, 2008; Sheeran, 2002; Webb & Sheeran, 2006), the so-called intention-behaviour ‘gap’. Recent theoretical models incorporating both motivational and volitional phases have sought to resolve this issue by examining the role that furnishing intentions with planning exercises plays in improving the link between intentions and behaviour (Gollwitzer & Sheeran, 2006; Schwarzer, 2001; Sheeran, Milne, Webb, & Gollwitzer, 2005). Prominent among these planning interventions are implementation intention and action planning techniques. These techniques aim to bolster or augment intentions with means to promote recall and enactment of the intended behaviour.

These planning techniques are two of the most recognised and frequently-applied components in health behaviour interventions (Adriaanse, Vinkers, De Ridder, Hox, & De Wit, 2011; Bélanger-Gravel, Godin, & Amireault, 2013; Webb, Sniehotta, & Michie, 2010). There are numerous reasons why these techniques have attracted so much attention: (1) they are steeped in established social psychological theory, have been embedded in popular and well-cited theories of social cognition applied in health contexts such as the theory of planned behaviour, and address a commonly-known limitation of these theories (i.e., the intention-behaviour ‘gap’); (2) they have intuitive appeal in their parsimony; (3) they have low response burden making their promulgation through multiple modes of delivery comparatively easy; and (4) they are low-cost. Above all, there is growing support for their effectiveness in engendering behaviour change health-related contexts as stand-alone intervention strategies or as part of more elaborate interventions involving multiple behaviour-change techniques. Implementation intention and action planning interventions have been shown to be effective in changing diverse behaviours such as physical activity (Arbour & Martin Ginis, 2009; Barg et al., 2012; Conner, Sandberg, & Norman, 2010; Gellert, Ziegelmann, Lippke, & Schwarzer, 2012; Luszczynska, 2006; Milne, Orbell, & Sheeran, 2002; Prestwich et al., 2012; Prestwich, Lawton, & Conner, 2003), healthy and unhealthy eating (Adriaanse, de Ridder, & de Wit, 2009; Adriaanse et al., 2010; Armitage, 2007; Chapman, Armitage, & Norman, 2009; Prestwich, Ayres, & Lawton, 2008; Sullivan & Rothman, 2008), smoking (Armitage, 2008; Armitage & Arden, 2008), alcohol consumption (Armitage, 2009; Hagger et al., 2012), breast self-examination (Orbell, Hodgkins, & Sheeran, 1997; Prestwich et al., 2005), rehabilitation from injury (Scholz, Sniehotta, Schuz, & Oeberst, 2007), vitamin consumption (Sheeran & Orbell, 1999), cancer screening behaviours (Browne & Chan, 2012; Rutter, Steadman, & Quine, 2006; Sheeran & Orbell, 2000), workplace health and safety (Sheeran & Silverman, 2003), vaccine uptake (Milkman, Beshears, Choi, Laibson, & Madrian, 2011; Payaprom, Bennett, Alabaster, & Tantipong, 2011), contraception use (de Vet et al., 2011; Martin, Sheeran, Slade, Wright, & Dibble, 2009; Teng & Mak, 2011), and dental health behaviours (Orbell & Verplanken, 2010; Schuz, Wiedemann, Mallach, & Scholz, 2009). In addition, systematic reviews have confirmed the effect of implementation intentions on behaviour in multiple behavioural domains (Gollwitzer & Sheeran, 2006) and in specific health-related behavioural domains such as physical activity (Bélanger-Gravel et al., 2013) and healthy eating (Adriaanse et al., 2011).

However, while there is growing support for these planning interventions in the health-behaviour literature, a number of limitations in the research have been noted. For example, the meta-analytic findings indicate substantial heterogeniety in the effect. In other words, there is a lot of variation in the strength of the effects of planning interventions, implying that their effectiveness varies across studies. This heterogeneity presents considerable challenges when attempting to systematically evaluate the evidence in terms of the effectiveness of planning interventions in health behavioural contexts. Possible reasons for the heterogeniety may be variations in study design and execution. For example, studies differ in their definition and operationalisation of planning procedures and their proposed mechanisms for the effect (e.g., mediation analyses). The heterogeneity in the effect sizes and lack of consensus in the definitions and operationalisation of planning interventions in health contexts present considerable problems to researchers attempting to develop interventions to change health behaviour adopting planning techniques.

The aim of this Synergy expert meeting is to stimulate discussion and debate of the evidence on planning interventions in health behaviour. The goal will be to develop a consensus on the most effective means to implement and evaluate planning interventions to move the field forward and resolve some of the theoretical, operational and methodological shortcomings of previous research. Specifically, the expert meeting discussion will focus on, but not be limited to: evaluating the research evidence on interventions adopting planning components; identifying the common features and differences of planning interventions in terms of operationalisation, design, measurement, mechanisms, and evaluation of planning components; identifying the salient gaps in the literature; formulating possible guidelines for good practice; and identifying priority areas for future research that will improve understanding of planning interventions in the field of health behaviour.

SET-UP OF THE COLLABORATIVE EXPERT MEETING

We will ask researchers to bring their own experiences of intervention research (including implementation intentions and action planning techniques) to the expert meeting, particularly the scripts and methods they have used in their interventions themselves, and the source material for their interventions. The idea would be to use these as a basis for discussion of variations and consistencies in the current literature and practice of planning interventions. We would also ask participants to report on the success of their manipulations, any failed replications, and feedback and reports from participants on the use of the techniques. This would enable the identification of strengths of current descriptions of these techniques in the literature and the limitations, omissions, lack of clarity, and needs for future research. Each half day of the expert meeting will include a particular theme (outlined below) that will be introduced by the facilitators, an initial exercise where participants will work in small groups on a particular aspect of the theme, and then a collaborative session where each group feeds back to the main group on their findings. The feedback session will be followed by a general discussion of the main issues, with all participants encouraged to contribute. Ideas and points will be recorded for the group using a whiteboard. Each session will be followed by a summary session to finalise the points and ask for additions. The points from each session will be typed up and added to a set of summary notes. At the end of the expert meeting, a final summing-up session using the notes as a stimulus will aim to arrive at a consensus in terms of the definition, contents, appropriate study design (e.g., intervention components, measures, and analyses), and key issues in need of research with respect to planning interventions.

PROGRAM AND THEMES

  • Defining and conceptualising of planning interventions (e.g., distinguishing between types of planning intervention and their role in social-cognitive models), how should they be operationalised, and what are the conceptual differences between types of planning e.g. implementation intentions and action planning.
  • Format and measurement of planning techniques (e.g., mode of delivery, measurement effects, format, use of examples, self- vs. other-defined plans).
  • Mechanisms and processes underpinning planning technqiues (e.g., the role of habit, moderators of planning intervention effects, forming multiple plans, planning interventions for low intenders).
  • Design issues around planning techniques and interventions based on them (e.g., sustainability of behaviour change, intervention fidelity).
  • The way forward: what would a ‘gold’ standard design for a planning intervention study look like?

FACILITATORS

Martin S. Hagger, Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth Australia
Aleks Luszczynska, Trauma, Health, & Hazards Center, University of Colorado at Colorado Springs, USA and Warsaw School of Social Psychology, Wroclaw, Poland

Martin Hagger (Curtin University, Australia) and Aleks Luszczynska (University of Colorado, Colorado Springs) both have considerable experience with the use of implementation intentions and action planning interventions in health behaviour. In addition, they have experience in running expert meetings and roundtables on the subject of planning at two EHPS conferences (Crete, 2011 and Bordeaux, 2013). John De Wit (UNSW, Australia), who also has a wealth of expertise in both the theoretical and application of interventions, including the use of planning techniques, in a number of health behaviour contexts, has also agreed to contribute to the expert meeting as he will be in attendance and could serve as an additional facilitator in the event of a large attendance. We also plan on inviting participants who have experience intervention design and other behaviour-change techniques to offer different and complementary perspectives.

RELEVANCE

An increasing number of studies in many health behavioural contexts are adopting planning interventions, and many of the EHPS members will be affiliated to labs and research groups that are currently using at least one form of planning as part of their interventions. There will also be researchers with links to policymakers and practitioners interested in how planning interventions can be most effectively employed on a practical level in the field to maximize health behavior maintenance. The topic is, therefore, a very pertinent one for many members of the society and this is an opportunity for an in-depth discussion of the issues surrounding planning interventions and their implementation that will not only benefit the participants, but will also provide consensus recommendations for non-attending members interested in using planning interventions in their research.

COSTS

Note that at this moment, the price is not yet known. We can guarantee however, that the price will not exceed € 250,-. We will update the price here as soon as possible, and will of course mail everybody who has already applied at that point. Note that participants from those countries listed under the categories low-income economies, lower-middle-income economies and upper-middle-income economies by the World Bank are qualified for reduced fees, which are half the regular fee. A list of these countries is available here.

GRANTS

A small number of grants are available for attendants of the Synergy expert meeting against expert meeting registration, conference fee, accommodation and travel. See the grants page for further details.

SELECTED REFERENCES (see PDF for full list)

Hagger, M. S., Lonsdale, A., Koka, A., Hein, V., Pasi, H., Lintunen, T., et al. (2012). An intervention to reduce alcohol consumption in undergraduate students using implementation intentions and mental simulations: A cross-national study. International Journal of Behavioral Medicine, 19, 82-96. doi: 10.1007/s12529-011-9163-8
Luszczynska, A. (2006). An implementation intentions intervention, the use of a planning strategy, and physical activity after myocardial infarction. Social Science & Medicine, 62, 900-908. doi: 10.1016/j.socscimed.2005.06.043