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COMMUNICATION IN PUBLIC HEALTH:
FACTORS INFLUENCING HOW PUBLIC
HEALTH MESSAGES ARE ACTED ON
Aymery Constant, PhD
Health Psychology Lecturer
EHESP
WHY IS CURRENT HEALTH
COMMUNICATION A HUGE PILE OF CRAP ?
(…from a psychologist’s point of view)
PART 1
So, why?
Please, answer a few questions…
1. Do YOU consider drinking, smoking or unhealthy dietary habits
in a similar way to a wild beast running in your direction?
2. Are YOU identical to your siblings, your parents, your friends… ?
3. Do YOU know ANY smoker who thinks smoking is healthy ?
4. Motivation, habits, desires, imitation, etc… Rings a bell ?
If you answered 1) NO, 2) NO, 3) NO and 4)YES, then you
should easily understand why psychologists consider
current health communication as a pile of crap
Decision makers
Scientists, health providers
Communication specialists
Health practioners
Emitters
General population
Or
Specific groups
Receivers
Classical model of health
information/education/promotion/whatever
Message
Mass media
Flyers
Internet
Face to face
Etc.
SMOKING
= CANCER
Classical model of health
information/education/promotion/whatever
SMOKING
= CANCER
Providing information
« OMG! Smoking is dangerous ! » Increasing
Knowledge/Awarness
«I quit smoking» Behaviour change
ULTIMATE
GOAL
Comparative psychology: fishes
Fishes
• They behave exactly the same way when they
shares common characteristics
• Faced with a danger in a group, they react
similarly
• When knowing the danger, they do not take
risk and go away
For instance…
Comparative psychology: humans
Humans
• They do not behave exactly the same way,
even when they share common characteristics
• Faced with a danger, they react differently
• Some can take risk, even knowing the danger
For instance…
Why such differences ?
BECAUSE HUMANS ARE NOT FISHES
Why is this gentleman still in the water ?
• Not enough signs, we need more warning signs on the beaches
• Sign is not visible, we need bigger warning signs
• Message not clear enough, we need better wording/picture
• He cannot read, so we need reading education programs for
surfers
• He does not know sharks well, so we need more information
mass media campaigns about sharks attacks injuries and
fatalities
• Yes, these explanations are silly
• They would produce expensive preventive
interventions… deterring only those who are already
afraid of sharks
• They rely entirely on the “fight or flight” paradigm
• Make the treat visible (obvious) to trigger avoidance
Captain Obvious returns
“Fight or Flight” Still underlies most health education campaigns !
Research suggest that human behaviour is still influenced by
the primal “fight or flight” reaction, when we face immediate
danger (e.g. shark, lion, jealous husband..)
…but others psychological/social factors are now involved,
making human decision-making somewhat more complex
than 300,000 years ago (go figure !).
Another drawback
“Most of these (health) programs have been based on the premise
that the transfer of knowledge alone could change health
behaviour. Fortunately for Human nature, this proposal is
erroneous, and the decision to act is in fact based on various
personal dimensions”.
Gaston Godin (translation from La psychologie sociale au service de la santé publique et de
l'environnement) In : Environnement et santé publique - Fondements et pratiques, pp. 277-288. Gérin
M, Gosselin P, Cordier S, Viau C, Quénel P, Dewailly É, rédacteurs. Edisem / Tec & Doc, Acton Vale
/ Paris
So, why is current health communication such a huge pile of
crap ? (….according to psychologists)
• Because it relies upon the « fight or flight » paradigm
Do YOU consider drinking or smoking as a predator running in
your direction?
• Because it considers human population or even specific
populations as homogenous ensembles
Are YOU identical to your siblings, your parents, your friends… ?
• Because it considers people stupid
Do YOU know ANY smoker who thinks smoking is healthy ?
• Because it ignores a set of pivotal variables driving behaviour
change
• Motivation, habits, desires, imitation, etc… Rings a bell ?
THE PSYHOLOGICAL APPROACH :
MODELS OF HEALTH BEHAVIORS
PRESENTATION AND CRITISCISMS
PART 2
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
The leading model from the 50s (“top down”)
Information
« There is a lion in front of me »
Expected
Consequences
Subjective
Probabilities
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
The leading model from the 50s (“top down”)
Information
« The lion will attack me »
High
Expected
Consequences
Subjective
Probabilities
Cognitive
Evaluation
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
The leading model from the 50s (“top down”)
Information
This is a bad
situation
I might die
Expected
Consequences
Subjective
Probabilities
Cognitive
Evaluation
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
Emotion
The leading model from the 50s (“top down”)
Information
I have a bad feeling about this™
Expected
Consequences
Subjective
Probabilities
Cognitive
Evaluation
Decision
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
Emotion
The leading model from the 50s (“top down”)
Information
Run away or
use the force
(Jedi only)
Expected
Consequences
Subjective
Probabilities
Cognitive
Evaluation
Decision
Consequences
Source: Loewenstein et al, 2001, Psychological Bulletin 127(2)
Emotion
The leading model from the 50s (“top down”)
Information
Safety
Models of health-related behaviors
Some major models in health behavior research:
 The Basic Risk Perception Model
 The Health Belief Model (HBM)
 The Theory of Planned Behavior (TPB)
The Basic Risk Perception model
The basic risk perception model focus on only two
dimensions of health hazard:
 the likelihood of harm if no action is taken
 the severity of harm if no action is taken
The basic risk perception model
This model is an adaptation of the expected-utility
theory to decision in health behaviors.
Two characteristics:
 Likelihood is one’s probability of being harmed by a hazard under
certain behavior conditions. Example: “What is the likelihood that
you will get the flu this year?”
 Susceptibility (or vulnerability) emphasize an individual’s
vulnerability to a hazard. Example: “Are you more likely to get the
flu than other people?”
1) the likelihood of harm:
The basic risk perception model
can be defined as the extent of harm a hazard would cause.
Examples of questions:
 “How serious a disease is the flu?”
 “Can Influenza cause death?”
 “If you had influenza, would you be able to manage daily
activities?”
2) the severity of harm:
The basic risk perception model
CONCLUSION
The basic risk perception model
Higher levels of severity and likelihood are associated with
higher motivation
It included thirty-four studies (N = 15,988). Risk likelihood,
susceptibility, and severity were significantly correlated:
 Risk likelihood: pooled r = .26
 Risk susceptibility : pooled r = .24
 Risk severity: pooled r = .16
Risk perceptions are involved in predicting preventive
behavior, but correlations are quite small
A meta-analysis of the relationship between risk perception and
adult vaccination has been conducted (Brewer et al, 2007):
The basic risk perception model
• Since first appeared in the South East of
France in 2004, Asian tiger mosquitos have
spread from there and caused serious
infections such as Dengue and Chikungunya
fever, notably during the summer of 2010
Mosquito-borne diseases
Knowledge about tiger mosquito-borne diseases in South
East France between 2012 and 2014
0
10
20
30
40
50
60
70
80
90
100
Diseases (unspecified) Chikungunya Dengue fever Malaria
2012
2013
2014
Year
percentages
Question: What are the potential consequences of tiger mosquito bites ?
Reports by the same respondents
0
10
20
30
40
50
60
70
80
90
100
Have seen tiger mosquitos in immediate
environement
Bitten by mosquitos Avoidance measures
2012
2013
2014
Year
percentages
• Preventive behaviour was not related to knowledge about mosquito-
borne diseases, or even tiger mosquito presence…
• …. because infections were perceived as severe, but rare events (high
severity; moderate vulnerability; low likelihood )
• Avoidance measures were mostly related to mosquito nuisance,
including from European Mosquito
• Not a « big deal » in terms of public health, but huge when it
comes to personal comfort and quality of life
Mosquito-borne diseases
The Health Belief Model (HBM)
 The health belief model was initially developed in the 1950s by a
group of social psychologists in the U.S. Public Health Service
 Research was initiated to explain failure of large number of
eligible adults to participate in tuberculosis screening programs
provided at no charge in a mobile X-ray units conveniently located
in various neighborhoods.
 Researchers were concerned with identifying factors that were
facilitating or inhibiting participation.
The health belief model (HBM)
ORIGINS OF THE HEALTH BELIEF MODEL
The health belief model (HBM)
COMPONENTS OF THE HEALTH BELIEF MODEL
Perceived susceptibility
Perceived severity
Perceived threat Behavior change
Perceived benefits of change
Perceived barriers of change
The health belief model (HBM)
COMPONENTS OF THE HEALTH BELIEF MODEL
 Perceived susceptibility : one’s subjective perception of risk of
contracting an illness.
 Perceived severity : beliefs concerning the seriousness of
consequence of contracting an illness (e.g., death, disability, and
pain). This includes the social consequences (e.g., work, family life,
leisure, etc.).
 Perceived benefits : beliefs regarding the effectiveness and the
efficacy of various available actions in reducing the disease threat,
but also the non-health-related benefits (save money, relative
approval, etc.).
The health belief model (HBM)
COMPONENTS OF THE HEALTH BELIEF MODEL
 Perceived barriers : spontaneous cost analysis which occurs
when the individual evaluate preventive actions that may be
expensive, dangerous, unpleasant, inconvenient, time-consuming,
and so forth.
 Self-efficacy : this concept introduced in 1977 by Bandura refers
to the conviction that “one can successfully execute the behavior
required to produced the outcomes”
 Cues to action: events, people, or things that move people to
change their behavior (e.g. illness of a family member, media
reports, advice from others, reminder postcards from a health
care provider, or health warning labels on a product.
.
Flu shot
Action is taken if perceived benefits outweight the perceived costs/barriers
HIV test
Lose weight
The health belief model (HBM)
Reviews of HBM studies (Janz & Becker, 1984)
 Perceived barriers were found to be the powerful single
predictor of the HBM dimensions across all studies and health
threat
 Perceived susceptibility and perceived benefits were both
important, while PS seem to be a stronger predictor of preventive
behavior than PB.
 Perceived severity was the least powerful predictor.
So much for the “Fight or Flight” Approach !
The Theory of Planned Behaviour
 Created by Azjen in 1991, from a previous 1985 model
 Designed to predict any type of voluntary behavior, not only
health behavior (economy; etc.)
 One of the most popular models used to predict a wide
range of behavior
 There is no health behaviour, there are social behaviours. And some of
them influence health (Gaston Godin)
Theory of planned behaviour
Model of the TPB
Affective attitudes
Extension of social norms
Extension: speed driving
Influence of TPB variables
High influence on intention
low influence on actua
behaviour
Main criticisms
 Study design: Cross-sectional vs. longitudinal; university
students; self-reported behaviors; correlations between
repeated measures
 Structural flaws: Assumptions based on common sense
that cannot be refuted; Gap between intention and action not
taken into account; not a dynamic model
 Poor predictive validity: Some pivotal variables are not
assessed in the model, not useful to predict behavior or
implementing behavior change
The underlying mechanism of decision-making
Source : Kahneman, D. (2002), Maps of Bounded Rationality : A Perspective on Intuitive
Judgments and Choices, Nobel Prize Lecture 2002.
Huge Influence on behaviours Psychological models
IMPROVING HEALTH BEHAVIOURS AND
LIFESTYE
TIME FOR GAME CHANGERS
PART 3
Changing the future
= requires new approaches
Determinants (beliefs; attitudes; norms..)
New
Behaviour
Current
Behaviour
How the TPB (and most others models) work :
Explaining the past
= how behavior occured
Models: One way relationship…
Attitudes in favor of smoking
• Enjoyable
• Looks cool
• Nice with a coffee
• Help to get relaxed
• Help to focus
• Etc..
Peer pressure
Controlability
…suggesting that we should target attitudes,
information, norms, control etc..
Emerging evidence : a bi-directional
relationship …
Attitudes in favor of smoking
• Enjoyable
• Looks cool
• Nice with a coffee
• Help to get relaxed
• Help to focus
• Etc..
• Peer pressure
• Controlability
…suggesting that we could also target behaviour
directly
Game Changers
 Future directions according to Marteau
 Altering environment to constrain behavior
 Architecture of choice
 Offer healthy alternatives
 Nudging
 Targeting automatic associative processes
 Change automatic reactions to external cues
 Change associations
Best behavioral intervention ever !
Promoting hygiene and safety
Alter environment
Alter environment
The term “nudge” was first used in a book of the
same title to describe “any aspect of the choice
architecture that alters people’s behaviour in a
predictable way without forbidding any options or
significantly changing their economic incentives
Marteau (2011).Judging nudging. BMJ
Create new associations in mind (healthy=fun)
Provide alternative healthy choices
Change the default choice
Change the default choice
plat du jour: a grilled steack
in restaurant 1 in restaurant 2
In restaurant 1: most people will eat vegetables
In restaurant 2: most people will eat french fries
What about motivation ?
75
Understanding motivation
Brain processes that energise and direct
behaviour
Not limited to choice and goal pursuit
Needs to include
drive
habit
desire
instinct
self-regulation
etc.
77
COM-B system for analysing
behaviour in context
1. Capability, motivation and opportunity all
need to be present for a behaviour to occur
2. They all interact as part of a system
3. Motivation must be stronger for the target
behaviour than competing behaviours
78
Common terms for methods for inducing behaviour
change
Capability
Train
Help
Motivation
Expose to
Inform
Discuss
Suggest
Encourage
Incentivise
Ask
Order
Plead
Coerce
Force
Opportunity
Provide
Prompt
Constrain
 Most behavioral models are based on perceptions (attitudes,
norms, beliefs) that might be relevant
 But they ignore some of the most pivotal variables shaping
behaviors (habits; contexts; environment; desires; needs…)
 They correlate poorly with actual behavior and are not very
useful for designing behavior change interventions
 Behavior change technique should include motivation
 New approaches targeting environment, motivation and
habits are warranted to promote healthy behavior
Time for Game Changers !!!!
Conclusions
Communication in Public Health

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Communication in Public Health

  • 1. COMMUNICATION IN PUBLIC HEALTH: FACTORS INFLUENCING HOW PUBLIC HEALTH MESSAGES ARE ACTED ON Aymery Constant, PhD Health Psychology Lecturer EHESP
  • 2. WHY IS CURRENT HEALTH COMMUNICATION A HUGE PILE OF CRAP ? (…from a psychologist’s point of view) PART 1
  • 3. So, why? Please, answer a few questions… 1. Do YOU consider drinking, smoking or unhealthy dietary habits in a similar way to a wild beast running in your direction? 2. Are YOU identical to your siblings, your parents, your friends… ? 3. Do YOU know ANY smoker who thinks smoking is healthy ? 4. Motivation, habits, desires, imitation, etc… Rings a bell ? If you answered 1) NO, 2) NO, 3) NO and 4)YES, then you should easily understand why psychologists consider current health communication as a pile of crap
  • 4. Decision makers Scientists, health providers Communication specialists Health practioners Emitters General population Or Specific groups Receivers Classical model of health information/education/promotion/whatever Message Mass media Flyers Internet Face to face Etc. SMOKING = CANCER
  • 5. Classical model of health information/education/promotion/whatever SMOKING = CANCER Providing information « OMG! Smoking is dangerous ! » Increasing Knowledge/Awarness «I quit smoking» Behaviour change ULTIMATE GOAL
  • 7. Fishes • They behave exactly the same way when they shares common characteristics • Faced with a danger in a group, they react similarly • When knowing the danger, they do not take risk and go away
  • 10. Humans • They do not behave exactly the same way, even when they share common characteristics • Faced with a danger, they react differently • Some can take risk, even knowing the danger
  • 12. Why such differences ? BECAUSE HUMANS ARE NOT FISHES
  • 13. Why is this gentleman still in the water ? • Not enough signs, we need more warning signs on the beaches • Sign is not visible, we need bigger warning signs • Message not clear enough, we need better wording/picture • He cannot read, so we need reading education programs for surfers • He does not know sharks well, so we need more information mass media campaigns about sharks attacks injuries and fatalities
  • 14. • Yes, these explanations are silly • They would produce expensive preventive interventions… deterring only those who are already afraid of sharks • They rely entirely on the “fight or flight” paradigm • Make the treat visible (obvious) to trigger avoidance Captain Obvious returns
  • 15. “Fight or Flight” Still underlies most health education campaigns !
  • 16. Research suggest that human behaviour is still influenced by the primal “fight or flight” reaction, when we face immediate danger (e.g. shark, lion, jealous husband..) …but others psychological/social factors are now involved, making human decision-making somewhat more complex than 300,000 years ago (go figure !).
  • 17. Another drawback “Most of these (health) programs have been based on the premise that the transfer of knowledge alone could change health behaviour. Fortunately for Human nature, this proposal is erroneous, and the decision to act is in fact based on various personal dimensions”. Gaston Godin (translation from La psychologie sociale au service de la santé publique et de l'environnement) In : Environnement et santé publique - Fondements et pratiques, pp. 277-288. Gérin M, Gosselin P, Cordier S, Viau C, Quénel P, Dewailly É, rédacteurs. Edisem / Tec & Doc, Acton Vale / Paris
  • 18. So, why is current health communication such a huge pile of crap ? (….according to psychologists) • Because it relies upon the « fight or flight » paradigm Do YOU consider drinking or smoking as a predator running in your direction? • Because it considers human population or even specific populations as homogenous ensembles Are YOU identical to your siblings, your parents, your friends… ? • Because it considers people stupid Do YOU know ANY smoker who thinks smoking is healthy ? • Because it ignores a set of pivotal variables driving behaviour change • Motivation, habits, desires, imitation, etc… Rings a bell ?
  • 19. THE PSYHOLOGICAL APPROACH : MODELS OF HEALTH BEHAVIORS PRESENTATION AND CRITISCISMS PART 2
  • 20. Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) The leading model from the 50s (“top down”) Information « There is a lion in front of me »
  • 21. Expected Consequences Subjective Probabilities Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) The leading model from the 50s (“top down”) Information « The lion will attack me » High
  • 22. Expected Consequences Subjective Probabilities Cognitive Evaluation Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) The leading model from the 50s (“top down”) Information This is a bad situation I might die
  • 23. Expected Consequences Subjective Probabilities Cognitive Evaluation Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) Emotion The leading model from the 50s (“top down”) Information I have a bad feeling about this™
  • 24. Expected Consequences Subjective Probabilities Cognitive Evaluation Decision Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) Emotion The leading model from the 50s (“top down”) Information Run away or use the force (Jedi only)
  • 25. Expected Consequences Subjective Probabilities Cognitive Evaluation Decision Consequences Source: Loewenstein et al, 2001, Psychological Bulletin 127(2) Emotion The leading model from the 50s (“top down”) Information Safety
  • 26. Models of health-related behaviors Some major models in health behavior research:  The Basic Risk Perception Model  The Health Belief Model (HBM)  The Theory of Planned Behavior (TPB)
  • 27. The Basic Risk Perception model
  • 28. The basic risk perception model focus on only two dimensions of health hazard:  the likelihood of harm if no action is taken  the severity of harm if no action is taken The basic risk perception model This model is an adaptation of the expected-utility theory to decision in health behaviors.
  • 29. Two characteristics:  Likelihood is one’s probability of being harmed by a hazard under certain behavior conditions. Example: “What is the likelihood that you will get the flu this year?”  Susceptibility (or vulnerability) emphasize an individual’s vulnerability to a hazard. Example: “Are you more likely to get the flu than other people?” 1) the likelihood of harm: The basic risk perception model
  • 30. can be defined as the extent of harm a hazard would cause. Examples of questions:  “How serious a disease is the flu?”  “Can Influenza cause death?”  “If you had influenza, would you be able to manage daily activities?” 2) the severity of harm: The basic risk perception model
  • 31. CONCLUSION The basic risk perception model Higher levels of severity and likelihood are associated with higher motivation
  • 32. It included thirty-four studies (N = 15,988). Risk likelihood, susceptibility, and severity were significantly correlated:  Risk likelihood: pooled r = .26  Risk susceptibility : pooled r = .24  Risk severity: pooled r = .16 Risk perceptions are involved in predicting preventive behavior, but correlations are quite small A meta-analysis of the relationship between risk perception and adult vaccination has been conducted (Brewer et al, 2007): The basic risk perception model
  • 33. • Since first appeared in the South East of France in 2004, Asian tiger mosquitos have spread from there and caused serious infections such as Dengue and Chikungunya fever, notably during the summer of 2010 Mosquito-borne diseases
  • 34.
  • 35. Knowledge about tiger mosquito-borne diseases in South East France between 2012 and 2014 0 10 20 30 40 50 60 70 80 90 100 Diseases (unspecified) Chikungunya Dengue fever Malaria 2012 2013 2014 Year percentages Question: What are the potential consequences of tiger mosquito bites ?
  • 36. Reports by the same respondents 0 10 20 30 40 50 60 70 80 90 100 Have seen tiger mosquitos in immediate environement Bitten by mosquitos Avoidance measures 2012 2013 2014 Year percentages
  • 37. • Preventive behaviour was not related to knowledge about mosquito- borne diseases, or even tiger mosquito presence… • …. because infections were perceived as severe, but rare events (high severity; moderate vulnerability; low likelihood ) • Avoidance measures were mostly related to mosquito nuisance, including from European Mosquito • Not a « big deal » in terms of public health, but huge when it comes to personal comfort and quality of life Mosquito-borne diseases
  • 38. The Health Belief Model (HBM)
  • 39.  The health belief model was initially developed in the 1950s by a group of social psychologists in the U.S. Public Health Service  Research was initiated to explain failure of large number of eligible adults to participate in tuberculosis screening programs provided at no charge in a mobile X-ray units conveniently located in various neighborhoods.  Researchers were concerned with identifying factors that were facilitating or inhibiting participation. The health belief model (HBM) ORIGINS OF THE HEALTH BELIEF MODEL
  • 40. The health belief model (HBM) COMPONENTS OF THE HEALTH BELIEF MODEL Perceived susceptibility Perceived severity Perceived threat Behavior change Perceived benefits of change Perceived barriers of change
  • 41. The health belief model (HBM) COMPONENTS OF THE HEALTH BELIEF MODEL  Perceived susceptibility : one’s subjective perception of risk of contracting an illness.  Perceived severity : beliefs concerning the seriousness of consequence of contracting an illness (e.g., death, disability, and pain). This includes the social consequences (e.g., work, family life, leisure, etc.).  Perceived benefits : beliefs regarding the effectiveness and the efficacy of various available actions in reducing the disease threat, but also the non-health-related benefits (save money, relative approval, etc.).
  • 42. The health belief model (HBM) COMPONENTS OF THE HEALTH BELIEF MODEL  Perceived barriers : spontaneous cost analysis which occurs when the individual evaluate preventive actions that may be expensive, dangerous, unpleasant, inconvenient, time-consuming, and so forth.  Self-efficacy : this concept introduced in 1977 by Bandura refers to the conviction that “one can successfully execute the behavior required to produced the outcomes”  Cues to action: events, people, or things that move people to change their behavior (e.g. illness of a family member, media reports, advice from others, reminder postcards from a health care provider, or health warning labels on a product. .
  • 44. Action is taken if perceived benefits outweight the perceived costs/barriers HIV test
  • 46. The health belief model (HBM) Reviews of HBM studies (Janz & Becker, 1984)  Perceived barriers were found to be the powerful single predictor of the HBM dimensions across all studies and health threat  Perceived susceptibility and perceived benefits were both important, while PS seem to be a stronger predictor of preventive behavior than PB.  Perceived severity was the least powerful predictor.
  • 47. So much for the “Fight or Flight” Approach !
  • 48. The Theory of Planned Behaviour
  • 49.  Created by Azjen in 1991, from a previous 1985 model  Designed to predict any type of voluntary behavior, not only health behavior (economy; etc.)  One of the most popular models used to predict a wide range of behavior  There is no health behaviour, there are social behaviours. And some of them influence health (Gaston Godin) Theory of planned behaviour
  • 54. Influence of TPB variables High influence on intention low influence on actua behaviour
  • 55.
  • 56. Main criticisms  Study design: Cross-sectional vs. longitudinal; university students; self-reported behaviors; correlations between repeated measures  Structural flaws: Assumptions based on common sense that cannot be refuted; Gap between intention and action not taken into account; not a dynamic model  Poor predictive validity: Some pivotal variables are not assessed in the model, not useful to predict behavior or implementing behavior change
  • 57.
  • 58. The underlying mechanism of decision-making Source : Kahneman, D. (2002), Maps of Bounded Rationality : A Perspective on Intuitive Judgments and Choices, Nobel Prize Lecture 2002. Huge Influence on behaviours Psychological models
  • 59. IMPROVING HEALTH BEHAVIOURS AND LIFESTYE TIME FOR GAME CHANGERS PART 3
  • 60. Changing the future = requires new approaches Determinants (beliefs; attitudes; norms..) New Behaviour Current Behaviour How the TPB (and most others models) work : Explaining the past = how behavior occured
  • 61. Models: One way relationship… Attitudes in favor of smoking • Enjoyable • Looks cool • Nice with a coffee • Help to get relaxed • Help to focus • Etc.. Peer pressure Controlability …suggesting that we should target attitudes, information, norms, control etc..
  • 62. Emerging evidence : a bi-directional relationship … Attitudes in favor of smoking • Enjoyable • Looks cool • Nice with a coffee • Help to get relaxed • Help to focus • Etc.. • Peer pressure • Controlability …suggesting that we could also target behaviour directly
  • 63. Game Changers  Future directions according to Marteau  Altering environment to constrain behavior  Architecture of choice  Offer healthy alternatives  Nudging  Targeting automatic associative processes  Change automatic reactions to external cues  Change associations
  • 67.
  • 68.
  • 69. Alter environment The term “nudge” was first used in a book of the same title to describe “any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives Marteau (2011).Judging nudging. BMJ
  • 70. Create new associations in mind (healthy=fun)
  • 73. Change the default choice plat du jour: a grilled steack in restaurant 1 in restaurant 2 In restaurant 1: most people will eat vegetables In restaurant 2: most people will eat french fries
  • 75. 75 Understanding motivation Brain processes that energise and direct behaviour Not limited to choice and goal pursuit Needs to include drive habit desire instinct self-regulation etc.
  • 76.
  • 77. 77 COM-B system for analysing behaviour in context 1. Capability, motivation and opportunity all need to be present for a behaviour to occur 2. They all interact as part of a system 3. Motivation must be stronger for the target behaviour than competing behaviours
  • 78. 78 Common terms for methods for inducing behaviour change Capability Train Help Motivation Expose to Inform Discuss Suggest Encourage Incentivise Ask Order Plead Coerce Force Opportunity Provide Prompt Constrain
  • 79.
  • 80.  Most behavioral models are based on perceptions (attitudes, norms, beliefs) that might be relevant  But they ignore some of the most pivotal variables shaping behaviors (habits; contexts; environment; desires; needs…)  They correlate poorly with actual behavior and are not very useful for designing behavior change interventions  Behavior change technique should include motivation  New approaches targeting environment, motivation and habits are warranted to promote healthy behavior Time for Game Changers !!!! Conclusions