Using Momentary Assessment to Measure Insulin Habit Automaticity and Factors Associated with Insulin Adherence

Abstract

This dissertation explores the role of habit formation and automaticity in improving insulin adherence among people with Type 1 diabetes (T1D). Manuscript 1 (Chapter 2) reviews habit formation research and theory in relation to diabetes self-management, highlighting the potential of automaticity to reduce cognitive burden and improve adherence. While habit studies show positive associations between habit strength and self-management outcomes, intervention results were mixed, suggesting a need for refined approaches to support automaticity in diabetes care. Manuscript 2 (Chapter 3) investigates the relationship between insulin habit automaticity and mealtime insulin adherence in real-life settings. Findings indicated a positive correlation between insulin automaticity and adherence, with greater automaticity linked to higher adherence rates and less variability. This suggests that promoting automaticity may improve mealtime insulin adherence in T1D. Manuscript 3 (Chapter 4) examines the impact of physical, social, and emotional contexts and context stability on insulin habit automaticity and adherence, revealing that negative emotional contexts like stress and fatigue decrease adherence, while stable emotional environments support higher automaticity and adherence. Together, these studies highlight the importance of habit formation, emotional stability, and contextual factors in insulin adherence for T1D. Future research should focus on enhancing habit-based interventions and incorporating context stability to support sustained insulin adherence, ultimately reducing the self-management burden and improving health outcomes in diabetes.