Exploring decision biases in healthy behaviour formation among older adults with chronic diseases: A qualitative study from a bounded rationality perspective.

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.