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Resolving to get healthier is easy; following through is the hard part. Now, researchers at the Ottawa Hospital Research Institute are aiming to test a simple mental tool, or “brain hack,” designed to get people to turn their goals into action – and they believe it could be used on a large scale to help improve the diet, fitness and health of Canadians.

The brain hack is called “implementation intentions," a fancy term for what some also referred to as “if/then” plans or “when/where/how” plans. The idea is that when people mentally hitch their intended behaviours to a very specific situation – for example, “If I’m offered a second helping of Aunt Gloria’s three-cheese macaroni at Sunday dinner, then I will politely decline and reach for the veggies instead” – they can program themselves to carry out their desired behaviour when they encounter that situation.

“It’s not just about thinking about it or planning it. It’s actually about making the link in your brain between the if and the then,” said Justin Presseau, a scientist at the Ottawa Hospital Research Institute.

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“So that when you’re in the situation, you almost automatically go to your then [response] ... instead of sort of being faced with the temptation and have to use your willpower.”

The concept itself is not new. German psychologist Peter Gollwitzer is credited with introducing implementation intentions in the 1990s. But the idea has since made its way beyond the realm of social psychology, and is now increasingly being used as an experimental public-health tool.

Dr. Presseau and his colleagues recently completed a systematic review, yet to be published, that examines studies around the world, in which implementation intentions were used to try to change health behaviours among various groups. These ranged from efforts to encourage heart-attack survivors to follow exercise plans to getting people at increased risk of cancer to participate in cancer screening, to helping smokers quit the habit.

In some cases, participants were asked to create if/then plans during a visit to a clinic. In others, forms for filling in implementation intention plans were sent to participants in mass mail-outs.

The Ottawa researchers found the effects of the brain hack promising enough to try further experiments.

“What’s neat and, I think, exciting about implementation intentions is that compared to some other strategies, there’s actually a huge amount of research around this – and good research,” said Dr. Presseau, who is also an assistant professor in the schools of epidemiology and public health and psychology at the University of Ottawa.

He and his colleagues are now looking to form partnerships with existing health organizations, such as cancer screening or blood-donation agencies, to see if they can introduce and measure the efficacy of implementation interventions on a large-scale in Canada.

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In England, University of Leeds professor Mark Conner has conducted one such large-scale trial published in 2019 that suggested implementation intentions helped prevent adolescents from taking up smoking. That trial involved asking preteens and teens from more than 45 schools to form if/then plans during classroom sessions about how they would respond if they were offered a cigarette.

For younger students, at the ages of 11 and 12, this meant writing down statements such as, “If I’m offered a cigarette, I will say, ‘No cancer sticks for me,’” Dr. Conner said. Older students opted to come up with their own responses.

Dr. Conner said he and his team found about a 10-per-cent reduction in smoking rates among adolescents who formed a plan, compared with those who didn’t.

In a separate study, he and his colleagues mailed out forms to participants, asking them to fill in implementation intentions for completing and sending in bowel cancer screening kits. Recipients of these forms were about 5 per cent more likely to complete and return their kits than controls who weren’t.

Although implementation intentions seem to have only a small to medium effect on getting people to adopt healthier behaviours, “that translates to a sort of public-health effect because you’ve changed people not very much, but you’ve changed a lot of them over time,” he said.

He added the tool is simple, cost-effective and easy to roll out to hundreds or thousands of people.

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There are, however, some limitations to its efficacy. For one thing, Dr. Conner said people need to be motivated to make a behavioural change. And even the most motivated individuals may find a brain hack can’t help them overcome socioeconomic barriers to adopting healthy habits.

Michele DeBiasse, a clinical assistant professor of nutrition at Boston University, learned this a few years ago when she tried using implementation intentions in a study to boost the fruit and vegetable intake of women of colour living in Boston public housing. Even though her participants were eager, Dr. DeBiasse said, not enough of them continued in the study for her to adequately measure the effects of the tool.

“They want to improve [their] fruit vegetable intake, but they can’t afford it,” she said, emphasizing there is a fundamental need to make healthy choices affordable and accessible. Without the opportunity to follow through on their goals, she said, “they were really thwarted before they could even get started.”

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