“Why is changing health-related behaviour so difficult?”

Michael Kelly and Mary Barker from the University of Cambridge and the University of Southampton have just published a fantastic article in the Journal of Public Health – “Why is changing health-related behaviour so difficult?” – that conceptualizes in a very accessible way why changing health-related behaviour is so difficult and what we do wrong in no acknowledging it.

This article – is compulsory reading for all those who for years have been researching effective health strategies to prevent the rise in obesity, tobacco o alcohol consumption or promote physical exercise. It is worth reading for all those outside the public health field who are trying to design new change strategies for instance against climate change or for the introduction of new technologies in the classroom.

We are all convinced that changing behaviours is essential to respond to the health epidemics (type 2 diabetes, cardiovascular disease…) affecting hundreds of millions and also puzzled by the fact that we are having a hard way achieving it (and bringing evidence)

The authors draw attention to six errors policy makers (and often we as education specialists) apply to health-related behaviour change in non-communicable disease prevention;

error 1. It is just common sense

“It is obvious what needs to be done, so let us just get on and do it”.

If changing behaviour was simply about making common sense simple changes and good choices then we would all be able to make whatever changes we wanted to whenever we wanted, but we do not.

Just because something appears to be obvious and simple does not mean that we should not bother to study it

error 2. It is about getting the message across

“If we could only get the message out there in some form which people could understand and identify with, then they would change in response”.

The investment in social marketing campaigns which borrow heavily from the commercial analogy and their lack of tangible success suggests that the commercial analogy is flawed if applied simplistically to public health matters. Campaigns can have an important role and can be effective, but they are but one part of a total strategy and behaviour change is not just about simple messaging.

error 3. Knowledge and information drive behaviour

“If we tell people the negative consequences of eating too much or exercising too little, they will change their behaviour accordingly.”

This is clearly not true and every front-line clinician and practitioner knows it is not true.

error 4. People act rationally

“If you tell people what is good for them and what they need to do to protect their health, they will do it”.

Most diets fail, not because people do not know what is supposedly good for them, but because knowledge and its rational assessment alone do not drive behaviour.

error 5. People act irrationally

“People have their own reasons for doing things”.

When someone with asthma refuses to stop smoking, we might regard them as very foolish or addicted or both. But what we tend not to see is that this may not be so irrational a decision after all given their lives and experiences.

error 6. It is possible to predict accurately

“We can say with certainty how individual people will behave in any given situation”.

While we can patterns of health inequalities, tobacco and alcohol consumption and trends in these over time and place in great detail, however, none of this has provided sharp-edged tools with which to tackle health inequalities, the obesity epidemic or the rising tide of alcohol consumption.

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As a conclusion, the authors advocate to rethink the way health professionals work with the public. They insist on the need to steer away from information giving and towards empowering and motivating individuals to generate their own solutions to their problems.

At P.A.U. Education with the Avall project, jointly with Bjarne Bruun Jensen from the Steno Health Promotion Research (Denmark) and Esteve Llargues – the project’s designer and coordinator – from the Granollers General Hospital (Spain), we designed an educational intervention during childhood viewing children and schools as catalysts for health-promotion actions at community level and that could provide a key prevention strategy, with education on dietary habits and physical activity for children and their families being considered the foundation for healthy lifestyles in adulthood. Two years after the study completed, the intervention group showed a lower increase in BMI and the trend consolidated after 6 years.

Mark Hanson’s recent research from the University of Southampton has revealed the importance of healthy lifestyle in parents in the period before they conceive a child. This time in the life course offers a window of opportunity to reduce the risk of later NCDs as well as childhood obesity in two or more generations simultaneously – in parents and in their future children and possibly their grandchildren.

These examples help envision new effective intervention strategies that can only work with the active support and conviction of policymakers…


One Response to “ ““Why is changing health-related behaviour so difficult?””

  1. Mireille Maladry says:

    Bravo!! Avez vous cette recherche traduite en français.Merci

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