Getting Past the Dissonance of Behavior Change
[Editor’s note: the following is a summary of remarks given by Vic Strecher, one of more than 20 presenters at October’s sustainable behavior change conference, Consumer-Centric Health: Models for Change ’11. View a video clip of Strecher’s presentation on Health Innoventions video channel.]

The message from University of Michigan professor and HealthMedia founder, Victor Strecher, Ph.D., M.P.H, was two-fold: tailoring at the individual level in terms of messaging and coaching can be highly effective in eliciting behavior change and utilizing technology to both create and deliver a tailored intervention can lead to very program-effective and cost-effective results.  Strecher began his presentation by illustrating how individualized tailoring is more effective than general messages by highlighting a number of studies.  Upshot: the greater the depth of tailoring, the greater the impact on behavior change. The challenge, however, explained Strecher “is that tailoring deeply is hard, you really have to be thinking carefully and it takes months longer to tailor something more deeply.”  It is very important to tailor from the core of a person’s situation/condition – things like change barriers, motivation to change, self-efficacy – not just the outer rings of demographics and health status or disease.

Strecher also used studies to show that coaches have more impact on change than simply giving someone a pedometer and some educational material, for instance, and asking them to “just do their best.”  Coaches work with an individual to set goals, and push towards stretch goals, among other tactics that move the individual closer to new behavior. But “coaches,” warned Strecher, “can be expensive, on the order of $2,000-$4,000 per year…and not readily available to all.”

The encouraging news, shared Strecher, is that it is possible to use digital health tools to “scale with quality and that’s one of the things that has been hard [in the past] to really do effectively.”  Strecher states that a digital health platform needs the following capabilities in order to be effective: (1) integrated; (2) data-centric; (3) evidence-based; (4) adaptive and (5) longitudinal. It is important to incorporate multiple components because “there is no one perfect single solution for a large population,” cautioned Strecher. Data tracking and analyses can help with predicting the kinds of behaviors likely to be associated with good health.  According to Strecher, “the content of behavioral interventions needs to be built on a basis of theory-informed (vs. theory-driven) research.”   Tailoring tools also need to be adaptive in order to provide just the right help at the right time – “ecological momentary intervention” – based on ongoing gathering of information in the moment – “ecological momentary assessment.” Finally, more profound insights come from looking at progressions, patterns and correlations over long periods of time.

Strecher was quick to point out that these tools are only as effective as a person’s receptivity to hearing what are, often, difficult messages about need for change.  He expressed his perspective that financial incentives ultimately do more harm than good in creating receptivity, and that behavioral strategies, such as Motivational Interviewing, while useful, are not always effective in breaking down the most entrenched of defenses.  He stated that getting people to transcend themselves through a defined and articulated personal mission or value may be a way to counteract the dissonance or threat that people experience when faced with the prospect of behavior change.

Referring to the results of a study that tested the impact of making self-transcending values top of mind before having participants engage in health dialogues, Strecher explained, “when they write down their core values they are much more likely, compared to people who have just written down something else, like their daily routine or the events of the week, or whatever, to become less defensive and accept health messages.”  “We should really be turning this paradigm around,” advocated Strecher, “and [have people] think about energy to achieve a purpose in life, a mission in life, things that relate to your core values.”  Reframing in this way, Strecher stated, gets the person to see disease in a different light, as an obstacle standing in the way of achieving her personal mission.

View Strecher’s talk at Models for Change ’11: Towards Scalability & Sustainability in Behavior Change Programs

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