Dual-process models of health-related behaviour and cognition: a review of theory

Objective: The aim of this review was to synthesise a spectrum of theories incorporating dual-process models of health-related behaviour. Study design: Review of theory, adapted loosely from Cochrane-style systematic review methodology. Methods: Inclusion criteria were specified to identify all relevant dual-process models that explain decision-making in the context of decisions made about human health. Data analysis took the form of iterative template analysis (adapted from the conceptual synthesis framework used in other reviews of theory), and in this way theories were synthesised on the basis of shared theoretical constructs and causal pathways. Analysis and synthesis proceeded in turn, instead of moving uni-directionally from analysis of individual theories to synthesis of multiple theories. Namely, the reviewer considered and reconsidered individual theories and theoretical components in generating the narrative synthesis' main findings. Results: Drawing on systematic review methodology, 11 electronic databases were searched for relevant dual-process theories. After de-duplication, 12,198 records remained. Screening of title and abstract led to the exclusion of 12,036 records, after which 162 fulltext records were assessed. Of those, 21 records were included in the review. Moving back and forth between analysis of individual theories and the synthesis of theories grouped on the basis of theme or focus yielded additional insights into the orientation of a theory to an individual. Theories could be grouped in part on their treatment of an individual as an irrational actor, as social actor, as actor in a physical environment or as a self-regulated actor. Conclusions: Synthesising identified theories into a general dual-process model of health-related behaviour indicated that such behaviour is the result of both propositional and unconscious reasoning driven by an individual's response to internal cues (such as heuristics, attitude and affect), physical cues (social and physical environmental stimuli) as well as regulating factors (such as habit) that mediate between them. (C) 2017 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.