Disruption of the 'Usual' -
Rethinking Behavior Change
and Communication in Nutrition
Education
R. Craig Lefebvre, PhD
chi...
Theory: The Frames We Use to
Understand and Solve Problems
The Power of Theory
• Explains how or why things are related
• Guides us to identify what’s important
• Suggests what ques...
Changing Scales of
Reality
• The Frame Problem – It is
impossible to know all the potentially
relevant facts and determina...
Micro-Macro Gap
X 85 bn ≠
Sources of Program
Failure
• Insufficient intervention resources
• Nonsupportive social and political
environment
• Measur...
Where Theory Can Make a
Difference
• What problem to
tackle - and how
• What the program
objectives should be
• Which prio...
Theories of Change
Stages of
Change
Health Belief
Model
Social-
Cognitive
Theory
Diffusion of
Innovations
Social
Networks
...
The Rational Person
The New Model
The New Model
Rational
Deliberate
Forward looking
Gets loss in
analysisEmotional
Instinctive
Immediate needs
Lazy
Behavioral Economics
The study of the allocation of psychological
(mental) resources to decision-making and
behavioral cho...
Personal Biases
• Loss Aversion - People are more averse to losing things than they are
inclined to gaining things.
• Stat...
Scarcity is the fundamental
economic problem of having
seemingly unlimited human
wants and needs in a world of
limited res...
Scarcity
Bandwidth
Limited Resources
• Scarcity of cognitive capacity –
• Cognitive resources available to people at any
moment are limited a...
Limited Resources
• Scarcity of self-control –
• Think of self-control as a psychic “commodity” of
which we have a limited...
Scarcity
Tunneling
Limited Resources
• Scarcity of attention –
• Think of attention as another precious commodity –
people do not have unlimi...
Scarcity
Multi-Tasking
Limited Resources
• Scarcity of understanding –
• People’s mental models of how the world works (or
what makes a food ‘hea...
Scarcity & Bandwidth
Framing Effects, Social
Comparisons, Norms
• Link reminders to a specific goal they have set.
• People are more responsive...
Behavioral Economics:
So What?
Stop berating people for not being responsible and start
to think of ways instead of provid...
Diffusion on New Ideas and
Behaviors
Characteristics of Segments
Innovators Early
Adopters
Early Majority Late Majority Laggards
Venturesome Respect Deliberate...
Attributes of Innovations
• How is this better than what I currently
do?
• How is it relevant to the way I go about
my eve...
The Innovation Chasm
Source: Moore, G.A. Crossing The Chasm. Capstone Publishing, 1998.
Creating Webs for Change
Social Networks Frame the Opportunities
and Constraints for Change
Social
Networks
Opinion
leaders
Groups
Adding or
removing
members
Bridging
groups
Rewiring
groups
Network
weaving
Social Networks and Obesity
Adolescent Obesity and
Social Networks
• Intervene with the family
system, rather than with
the individual.
• Tailor famil...
New Technologies Expand The
Scope and Capacity for Learning
Social Marketing
Designing products, services and
behaviors that fit people’s reality
Eating Well on $4.30 a Day
Our columnist lives for si...
Positioning Behavior Change
What relevant behavior can
we ask people to engage in
rather than the one they are
currently d...
Brett’s Tricks
• I didn't eat out.
• I didn't eat any packaged or
processed foods.
• I didn't try to live on energy
bars.
...
Costs of Change
• Financial
• Energy
• Geographical distance
• Opportunity
• Social
• Psychological
• Physical
• Structural
Brett’s Costs
• Peanuts and peanut butter
(which cost around $2.50 a
pound).
• Eggs (20 cents each).
• Pulses or legumes, ...
Creating equitable opportunities
and access
Where can we locate a service,
distribute a product, or create
opportunities f...
Where Did Brett Go?
• I took the subway to
the bigger
supermarkets.
• And I hunted
aggressively for
deals.
• What's on sal...
Communicating change in linguistically,
culturally relevant and ubiquitous ways
How Effective are Health
Communication Campaigns?
5%
5%
5%
5%
Brett’s Message
My experience has changed how I eat. I am amazed at how cheaply one can
eat well—and mortified at how much...
Keys to increasing healthy
eating using social marketing
Social marketing
benchmark criteria
Keys to increasing healthy ea...
Lessons
• Theories should be tools – not straight jackets
• Theories can inform – and blind (the “frame
problem”)
• The on...
Resources
• Lefebvre, R.C. & Bornkessel, A. (2013).
Digital social networks and health. Circulation;
127:1829-1836.
• Mull...
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Disruption of the 'usual' - rethinking behavior change and communication in nutrition education

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Effective communication is an essential component in the mix of strategies used to effect behavior change in regard to healthy eating. But are nutrition educators using all the behavior change tools? Are we really communicating effectively? Is our communication passionate enough and inspired enough to be heard? How do we increase the likelihood of improving healthy nutrition behaviors? With so many voices and choices out there in so many mediums (i.e. social media, grocery and food packaging advertising, television commercials, radio, etc) we have constant competition. This topic is sure to get nutrition educators thinking about how they currently communicate and to consider new avenues and strategies for their programs.

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  • Source: Carins JE, Rundle-Thiele SR. (2013). Eating for the better: A social marketing review (2000-2012). Public Health Nutrition; 28:1-12.
  • Disruption of the 'usual' - rethinking behavior change and communication in nutrition education

    1. 1. Disruption of the 'Usual' - Rethinking Behavior Change and Communication in Nutrition Education R. Craig Lefebvre, PhD chief maven, socialShift Lead Change Designer, RTI International Research Professor, Florida Prevention Research Center at the University of South Florida College of Public Health
    2. 2. Theory: The Frames We Use to Understand and Solve Problems
    3. 3. The Power of Theory • Explains how or why things are related • Guides us to identify what’s important • Suggests what questions to ask • Creates assumptions about what we should do about the problem • Proposes what objectives to set • Determines how we measure success
    4. 4. Changing Scales of Reality • The Frame Problem – It is impossible to know all the potentially relevant facts and determinants of a puzzle, given the overwhelming number of possibilities and combinations of variables. • The Micro-Macro Problem – Our desire to achieve macro outcomes, ones that involve changes among large numbers of people, or in society as a whole, are driven by the micro actions of individuals; changes at different levels of organization are emergent, not simply an adding up of the components. “Social change programs need to consider more than one scale of reality at a time.”
    5. 5. Micro-Macro Gap X 85 bn ≠
    6. 6. Sources of Program Failure • Insufficient intervention resources • Nonsupportive social and political environment • Measurement and evaluation design • Wrong theory used to understand problem and develop strategies
    7. 7. Where Theory Can Make a Difference • What problem to tackle - and how • What the program objectives should be • Which priority audiences to choose, and how to characterize them • What questions to ask in formative research • Which approaches may be the best to use with specific groups of people • How to best promote behaviors, messages, products, and services
    8. 8. Theories of Change Stages of Change Health Belief Model Social- Cognitive Theory Diffusion of Innovations Social Networks Precontemplation Susceptibility Reciprocal determinism Relative advantage Opinion leaders Contemplation Severity Behavioral capability Compatibility Groups Preparation Threat Expectations Complexity Adding or removing members Action Perceived benefits Self-efficacy Trialability Bridging groups Maintenance Perceived barriers Observational learning Observability Rewiring groups Decision balance Cues to action Reinforcement Network weaving
    9. 9. The Rational Person
    10. 10. The New Model
    11. 11. The New Model Rational Deliberate Forward looking Gets loss in analysisEmotional Instinctive Immediate needs Lazy
    12. 12. Behavioral Economics The study of the allocation of psychological (mental) resources to decision-making and behavioral choices.
    13. 13. Personal Biases • Loss Aversion - People are more averse to losing things than they are inclined to gaining things. • Status Quo Bias - One of the best predictors of our future behavior is our current behavior. This is because inertia is so powerful. • The Dual Self - People have competing preferences, with different preferences dictating different actions at different times. • Attention Constraints - People get distracted. Simply paying attention to one’s goals is often half the battle in reaching them. • Defaults - People make passive choices based on how the choices are presented to them. • Resource Slack - In planning for the future, people realistically assumed that money will be tight, but they expect free time to magically materialize.
    14. 14. Scarcity is the fundamental economic problem of having seemingly unlimited human wants and needs in a world of limited resources.
    15. 15. Scarcity
    16. 16. Bandwidth
    17. 17. Limited Resources • Scarcity of cognitive capacity – • Cognitive resources available to people at any moment are limited and can be depleted by being used for other activities. So increasing the cognitive demands of nutrition programs may in fact be making them less likely to succeed. • Rules-of-thumb; simplify Choices.
    18. 18. Limited Resources • Scarcity of self-control – • Think of self-control as a psychic “commodity” of which we have a limited stock, so that using some up for one task (“continuing to exercise when you want to stop”) depletes the amount available for other tasks (“resisting the extra cookie after your workout”). • Defaults; Time Management skills; explicit Commitments
    19. 19. Scarcity
    20. 20. Tunneling
    21. 21. Limited Resources • Scarcity of attention – • Think of attention as another precious commodity – people do not have unlimited attention and may not pay attention to the ‘right’ things – they are busy paying attention to others. • Prompts and reminders; Incentives.
    22. 22. Scarcity
    23. 23. Multi-Tasking
    24. 24. Limited Resources • Scarcity of understanding – • People’s mental models of how the world works (or what makes a food ‘healthy’) may be incomplete; not all underlying causal relationships are correctly or accurately understood. • Tailoring of messages to existing mental models.
    25. 25. Scarcity & Bandwidth
    26. 26. Framing Effects, Social Comparisons, Norms • Link reminders to a specific goal they have set. • People are more responsive to what they will lose than what they will gain by (not) doing something. • Compare what people do with their peers. • Most individuals make efforts to conform to what they perceive the social norm to be.
    27. 27. Behavioral Economics: So What? Stop berating people for not being responsible and start to think of ways instead of providing the poor with the luxury that we all have, which is that a lot of decisions are taken for us. If we do nothing, we are on the right track. For most of the poor, if they do nothing, they are on the wrong track. – Esther Duflo “ ”
    28. 28. Diffusion on New Ideas and Behaviors
    29. 29. Characteristics of Segments Innovators Early Adopters Early Majority Late Majority Laggards Venturesome Respect Deliberate Skeptical Traditional High tolerance of risk Opinion leaders Very local perspective Sensitive to peer pressure and norms The traditionalists – tried and true Fascinated with novelty Well- connected socially and locally Very engaged in peer networks Cautious Keepers of the wisdom Willingness to travel to learn Resources and risk tolerance to try new things Rely on personal familiarity before adoption Usually scarce resources Near isolates in their social networks Seen as mavericks, not opinion leaders Self-conscious experimenters How does this help me? Minimize uncertainty of outcomes Suspicious of innovation and change agents
    30. 30. Attributes of Innovations • How is this better than what I currently do? • How is it relevant to the way I go about my everyday life? • Is it simple enough for me to do? • Can I try it first? • Can I watch others and see what happens to them when they do it?
    31. 31. The Innovation Chasm Source: Moore, G.A. Crossing The Chasm. Capstone Publishing, 1998.
    32. 32. Creating Webs for Change
    33. 33. Social Networks Frame the Opportunities and Constraints for Change
    34. 34. Social Networks Opinion leaders Groups Adding or removing members Bridging groups Rewiring groups Network weaving
    35. 35. Social Networks and Obesity
    36. 36. Adolescent Obesity and Social Networks • Intervene with the family system, rather than with the individual. • Tailor family-based interventions to the structure of the family. • Design support mechanisms for parents and adult family members on the basis of their social ties within the community. • Use peer networks to encourage increased physical activity. Source: Koehly LM, Loscalzo A. (2009). Adolescent obesity and social networks. Preventing Chronic Disease; 6(3):A99
    37. 37. New Technologies Expand The Scope and Capacity for Learning
    38. 38. Social Marketing
    39. 39. Designing products, services and behaviors that fit people’s reality Eating Well on $4.30 a Day Our columnist lives for six weeks as if he is on the Supplemental Nutrition Assistance Program, and learns something he didn't expect. Brett Arends, The Wall Street Journal 14 December 2013 Eating reasonably well on $4.30 a day turned out to be a bit like a Rubik's Cube puzzle: It seemed impossible until I worked out the trick. Then it became surprisingly manageable, if monotonous.
    40. 40. Positioning Behavior Change What relevant behavior can we ask people to engage in rather than the one they are currently doing? How can we make this behavior more compelling, relevant, and potentially more valuable to people when they practice it, in comparison to the alternatives?
    41. 41. Brett’s Tricks • I didn't eat out. • I didn't eat any packaged or processed foods. • I didn't try to live on energy bars. • I avoided cheap carbohydrates, like white bread and noodles. • I abandoned buying coffee out. For my caffeine needs I carried tea bags instead
    42. 42. Costs of Change • Financial • Energy • Geographical distance • Opportunity • Social • Psychological • Physical • Structural
    43. 43. Brett’s Costs • Peanuts and peanut butter (which cost around $2.50 a pound). • Eggs (20 cents each). • Pulses or legumes, like split peas and lentils, which can cost not much more than $1 a pound. • I rarely ate meats or fish. They were too expensive. • Milk is expensive, but I had a cup—about 25 cents—a day. • Healthy carbohydrates: oatmeal, whole-wheat pasta, brown rice, baked potatoes and sweet potatoes, and whole- wheat bread - which I made at home and cost a little more than $1 for a 1½-pound loaf. • I ate plenty of bananas (sometimes just 20 cents each), and I bought frozen peas, corn and other mixed vegetables for around $1.30 a pound. • I took a cheap multivitamin a day.
    44. 44. Creating equitable opportunities and access Where can we locate a service, distribute a product, or create opportunities for members of our priority group to engage in healthier behaviors?
    45. 45. Where Did Brett Go? • I took the subway to the bigger supermarkets. • And I hunted aggressively for deals. • What's on sale is what's on the menu. I found the food aisles at downtown drugstores sometimes had surprisingly good deals.
    46. 46. Communicating change in linguistically, culturally relevant and ubiquitous ways
    47. 47. How Effective are Health Communication Campaigns? 5% 5% 5% 5%
    48. 48. Brett’s Message My experience has changed how I eat. I am amazed at how cheaply one can eat well—and mortified at how much I have spent needlessly over the years. I suspect I am not alone.
    49. 49. Keys to increasing healthy eating using social marketing Social marketing benchmark criteria Keys to increasing healthy eating using social marketing Behavioral objective Evaluate healthy eating using multiple behaviors Tackle single behaviors serially over time Audience segmentation Identify different groups Serve each group with a unique solution Formative research Conduct formative research Research must be consumer oriented Exchange Offer salient benefits – short-term benefits can be more salient than long- term benefits Consider trials, rewards and prizes to stimulate trial and repeated behavior Marketing mix Move beyond communication – interventions must be multifaceted (e.g. more than promotion and communication) Efforts need to be directed at initiating new behavior and encouraging repeat behavior Competition Undertake competitive analysis Know your direct and indirect competition Source: Carins JE, Rundle-Thiele SR. (2013). Eating for the better: A social marketing review (2000-2012). Public Health Nutrition; 28:1-12.
    50. 50. Lessons • Theories should be tools – not straight jackets • Theories can inform – and blind (the “frame problem”) • The one with the biggest toolbox wins • It’s a complex world (the micro-macro gap). • “There’s nothing so practical as a good theory”
    51. 51. Resources • Lefebvre, R.C. & Bornkessel, A. (2013). Digital social networks and health. Circulation; 127:1829-1836. • Mullainathan, S. & Shafir, E. (2013). Scarcity: Why having too little means so much. New York: Times Books. • Snyder, L. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior; 39(Suppl.):S32–S40. • Valente, T.W. (2013). Network interventions. Science;337:49–53. • Wakefield, M. A., Loken, B., & Hornik, R. (2010). Use of mass media campaigns to change health behaviour. Lancet; 376:1261– 1271.
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