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Exploring decision biases in healthy behaviour formation among older adults with chronic diseases: A qualitative
Zhenggang Zhu1, Jun Tian2, Xiaoyan Pan3
1School of Nursing, Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, 325200, China.
Background:
Population ageing contributes to a growing burden of chronic diseases. Older adults must make repeated daily health decisions, yet often face intention-action gaps. Bounded rationality offers a lens for understanding the systematic decision biases that affect the formation of healthy behaviours.
Objectives:
To explore decision biases in the formation of healthy behaviours among older adults with chronic diseases from a bounded rationality perspective.
Methods:
A qualitative descriptive study was conducted using semi-structured interviews with 35 community-dwelling older adults (aged ≥65) with chronic conditions in Wenzhou, China. Data were analysed via thematic and framework analysis to identify decision bias dimensions and construct user personas.
Results:
Five decision bias dimensions were identified: information-processing bias, cognitive-judgement bias, emotion-driven bias, behaviour-execution bias, and social-reference bias. Cross-case analysis revealed five interpretive persona profiles: avoidance-oriented individuals, constraint-driven strugglers, habit-locked stabilisers, short-term comfort prioritisers, and goal-oriented adapters, representing heterogeneous configurations of these biases.
Conclusions:
Healthy behaviour formation is shaped by interacting biases under real-world constraints, rather than by knowledge or motivation alone. The persona framework may provide a conceptual basis for developing tailored, context-sensitive intervention approaches for this population. Future research should examine the feasibility and predictive value of the persona framework.