OT and habits

Habits for student success

This blog discusses habits, routines, and rituals and makes the case for OTs working with post-secondary students to address habits as they relate to health, well-being, and student success.

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The importance of routines, rituals, and habits for students

Natural transitions in life are times of rapid change.  During the transition from high school to university or from introductory coursework to more demanding major-specific coursework, some students develop bad habits (less exercise, excessive drinking behaviors, not eating well, poor sleep, etc).  These behaviors can influence academic success and retention1 and also lead to health issues and disablement later in life.2,3

So, what do OTs need to know about routines, rituals, and habits?

Routines

Routines are a sequenced set of familiar events that occur on a daily basis.4  Routines allow life to be more orderly and efficient.4 Some people are naturally more routine-driven than others5 and need more routine to feel balanced.   

A lot of routines will change for students as they adjust to university or college.  Student schedules are more variable due to course scheduling and new work, social, and family obligations. In addition, many students will not have as many imposed time restrictions as they did in high school, such as after-school activities or sports, once they transition to post-secondary studies.  Those who have difficulty with establishing new routines may find themselves struggling in post-secondary studies.  Those who desire a higher level of “routinization” may find the transition especially troubling to their psychosocial well being.5

Rituals

When meaningful routines are combined and shared with a group – it is called a ritual.4

In students, rituals that are shared with a group can help fulfill their need for social identity and belonging.  For example, a student might be interested in joining a running group on campus on Saturday mornings, since the group of runners also meets for breakfast after the run.

Habits

Some routines become habits.  Routine behaviors can be habitually initiated, but consciously performed; consciously initiated, but habitually performed; or habitually initiated and habitually performed.6

Because they are automatic behaviors, most habits are not tied to time of day but linked to environmental cues.4 Basically, habits are performed because they are driven by situational/contextual cues rather than by intentions or motivation.7 Dunn’s research on sensory sensitivity adds that people vary in their differential levels of sensory processing and most habits are assumed to maintain homeostasis.8

What OTs need to know

Current evidence on behavior change suggests that context and situational factors are most important for creating changes in behavior.9 Since habits operate under conscious awareness, occupational therapists can help students recognize negative behaviors and enact strategies to improve their health behaviors.  

An OT should:    

  • look at the personal meaning of the habits; how the student’s identity may be shaped by the habits; and how competent and satisfied the student might be with habit change;10
  • understand if the habit is driven by sensory responses to different environments;8
  • help the student reflect upon the time, place, and social contexts for those habits that need to be changed and how they fit into the person’s pattern of daily occupation; 
  • help the student succeed by structuring necessary social supports to support behavior change.11

With the help of the OT, the student must

  • learn new skills, such as self-reflection.  As students try to change behaviors, it will take them more time than usual to plan, prepare, and organize their engagement in daily occupations.12 
  • reflect upon how routines might provide or limit the his/her ability to develop living and academic skills.13  
  • determine his/her willingness to change behaviors. Does she want to change? Is she willing to change behaviors?
  • conceptualize the times when behavior change is and is not possible. It may be difficult for students to figure out ‘closed’ time (time that is unavailable) versus ‘open’ time (time that is available) to work on behavior changes.13 

To create effective change, the following should be used in goal setting and intervention:

  • IMPLEMENTATION INTENTION:  This is an action plan stipulating where, when, and how one will engage in the intended behavior.14  The OT should help the student create “if-then” or “when-when” situations.
    •  For example, a student who wants to increase their physical activity to 3 days/week might write a goal that states “I will increase my exercise to 3 days/week by wearing my workout clothes to psychology class so that I can exercise after class”.  In this goal, a specific situation is set-up to help the student succeed in their physical activity goal (exercising after psychology class) instead of leaving the goal open-ended.9
  • CONTEXT MODIFICATION:  This relies on manipulating environmental cues to modify behavior.  Cues will be dependent upon the resources available to the student (cognitive, emotional, material) and where a cue is available to modification (physical location, preceding action in a sequence, during certain moods, or with certain people).9
    • In the example above, it might be helpful for the student to lay out their workout clothes and shoes on a chair next to their bed or in the bathroom so that they do not have to think about what to wear when they wake up to get ready for their morning psychology class.   

Assessment

Time use:

  • Time use diaries:   Can be helpful at the beginning to understand the impact of routine behaviors on lifestyle balance. Looking at occupational balance will also help understand the impact of behaviors and time use on subjective feelings of balance.  A previous post on time use and balance can be found here. 

Readiness to change behaviors:15,16

  • Motivational interviewing – This is a specific open ended interview technique designed to solicit the student’s feelings about changing their behaviors.  There are specific courses that teach motivational interviewing, if you are unfamiliar with this technique.  It is well-supported by evidence. 
  • Process of change questionnaire17 – This questionnaire uses the transtheoretical model’s five-steps to habit change and assesses the level of motivation for change in the respondent. There are 40 items structured as 5-point Likert questions. Primarily used for alcohol, drug use, and smoking behaviors.   

Measuring habitual behaviors: 

Most individuals cannot pick out habitual behavior without assistance since these behaviors are so ingrained.

  • Self-reported Habit Index –  This tool asks the respondent to report the amount of habit involved in a certain behavior.  It is a 12 item rating scale. Self-report behavioral automaticity index (SRBAI) is a more succinct four-item measure that looks at automaticity of habitual behaviors.    

Measuring routine and habit:

  • Creature of Habit Scale (COHS)18 – 28 item questionnaire with five point Likert scales that measure level of routine behavior and automatic responses. If you are finding students who are more routinized that need help with establishing routines for university life, they would do well with more active-coping strategies.5 

References

  1.  Larson, M., Orr, M., & Wayne, D. (2016). Using student health data to understand and promote academic success in higher education settings. College Student Journal, 50, 590-602.
  2. Quan, L., Zhen, R., Yao, B., & Zhou, X. (2014). The effects of loneliness and coping style on academic adjustment among college freshmen. Social Behavior and Personality: An International Journal, 6, 969-977. doi:10.2224/sbp.2014.42.6.969
  3. Rangul, V., Bauman, A., Lingaas Holmen, T., & Midthjell, K. (2012). Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: The HUNT Study, Norway. International Journal of Behavioral Nutrition& Physical Activity, 9, 144-154. doi:10.1186/1479-5868-9-144
  4. Clark, F. A. (2000). The concepts of habit and routine: A preliminary theoretical synthesis. Occupational Therapy Journal of Research, 20, 123S–137S.
  5. Reich, J. W. (2000). Routinization as a factor in the coping and the mental health of women with fibromyalgia. Occupational Therapy Journal of Research, 20(Suppl. 1), 41S -51S.
  6. Gardner, B. (2015). A review and analysis of the use of “habit” in understanding, predicting and influencing health-related behaviour. Health Psychology Review, 9, 277-295. doi:10.1080/17437199.2013.876238
  7. Orbell S, Verplanken B. The automatic component of habit in health behavior: Habit as cue-contingent automaticity. Health Psychol 2010;29:374–83.doi: 10.1037/a0019596.
  8. Dunn, W. (2000). Habit. What’s the brain got to do with it? Occupational Therapy Journal of Research, 20(Suppl. 1), 6S-20S.
  9. Fritz, H. & Cutchin, M. (2016).  Integrating the science of habit: Opportunities for Occupational Therapy.  OTJR:  Occupation, Participation, and Health, 36(2), 92-98.  doi: 10.1177/1539449216643307
  10. Yerxa, E. J. (2002). Habits in context: A synthesis, with implications for research in occupational science. The Occupational Therapy Journal of Research, 22(Suppl.), 104-110
  11. Hilton, C., Ackermann, A.A., & Smith, D.L. (2009).  Healthy habit changes in pre-professional college students: Adherence, supports, and barriers.  OTJR: Occupation, participation, and health, 31(2), 64-72. Doi: 10.3928/15394492-20100325-01
  12. Wallenbert I, Jonsson H. (2005).  Waiting to get better: A dilemma regarding habits in daily occupations after stroke. Am J Occup Ther, 59, 218–24.doi: 10.5014/ajot.59.2.218.
  13. Fritz, H.(2014).  The influence of daily routines on engaging in diabetes self-management. Scandinavian Journal of Occupational Therapy, 21, 232-240. doi: 10.3109/11038128.2013.868033
  14. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493-503. doi:10.1037/0003-066X.54.7.493
  15. Jeon, D-J., Kim, K-J., & Hao, M. (2014).  Factors related to stages of exercise behavior change among university students based on the transtheoretical model. Journal Of Physical Therapy Science, 26, 1929-1932. 
  16. Marcus BH, Rakowski W, Rossi JS: Assessing motivational readiness and decision making for exercise. Health Psychology: official journal of the Division of Health Psychology, American Psychological Association, 1992, 11: 257–261.
  17. Nigg CR, Courneya KS: Transtheoretical Model: Examining adolescent exercise behavior. The Journal of Adolescent Health: official publication of the Society for Adolescent Medicine, 1998, 22: 214–224.
  18. Ersche, K.D., Lim, T-V., Ward, L.H.E., Robbins, T.W., & Stochl, J. (2017).  Creature of Habit:  A self-report measure of habitual routines and automatic tendencies in everyday life.  Personality and Individual Differences, 116, 73-85.  doi:10.1016/j.paid.2017.04.4024

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