Association of context type and stability to insulin habit automaticity and adherence in type 1 diabetes

Habit theory incorporates context stability as important for the development of habit automaticity, but its role in insulin habit automaticity and adherence is unknown.

To examine the roles of context and context stability in insulin habit automaticity and adherence in adults with T1D.

Using an intensive observational design, 63 adults with T1D completed a 7-day ecological momentary assessment protocol using a time-contingent prompt schedule corresponding to approximate mealtimes (morning, afternoon, and evening). Physical, social, and emotional contexts were assessed at each timepoint. Generalized linear mixed-effects models tested associations between specific contexts with momentary insulin habit automaticity and insulin adherence. Spearman correlations were used to assess the strength of associations of context stability with baseline reports of insulin habit automaticity and insulin adherence.

Feeling tired, stressed, and sad were associated with lower likelihood of insulin adherence but were not associated with automaticity. Those who reported feeling stressed were 56% less likely to appropriately administer insulin compared to those who reported no stress. As the extent of feeling tired increased, the likelihood of adherence decreased. More stable emotional contexts were associated with higher insulin habit automaticity scores and with greater insulin adherence. Greater stability in emotional context was also associated with less variability in both insulin habit automaticity and insulin adherence. Social context demonstrated a similar pattern of associations to that of emotional context for adherence but not for automaticity.

This study supports the role of emotional and social contexts as important in insulin adherence and insulin habit automaticity in adults living with T1D.