Sunday, February 21, 2010

Hope or Fear – What motivates people to change?

Most health communications are fear based. My colleague, Amy, mentioned this to me last week and, after some consideration, I think she’s right.
For me, it’s the reason I don’t smoke. When I was in elementary school, a teacher showed us a video with pictures of cross slices of lungs from people that smoked and those that didn’t. The smokers’ lungs looked like black, moldy, Swiss cheese. Who wants to do that to themselves?
Certainly, fear can be a good deterrent, but is it a good motivator for people to make and sustain major lifestyle changes?
According to Alan Deutschman, author of Change or Die, probably not. He says that the odds are nine to one against an individual being able to change when given this ultimatum. If this is true, and the fear of death only motivates one in ten people to change, maybe fear-based health communications aren’t the best way to deliver the message.
Think about it. You’re overweight. You’ve tried every diet in the book, but you’ve never been able to get to a desirable weight and stay there. Someone gives you a brochure like this – Do You Know the Health Risks of Being Overweight? It alarms you, of course (you knew the risks already), but you don’t believe you can change your lifestyle enough that it will make a difference. Deutschman sums it up perfectly:
“When a person is demoralized and feels a sense of hopelessness and powerlessness about a seemingly impossible situation, then the common responses are depression and defeatism or denial and defense.”
He proposes three keys to change. First you need to form a new, emotional relationship with a community that inspires and sustains hope. Second, use these new relationships to help you to learn, practice, and master the new habits and skills that you need. Third, build on the new relationships to help you learn new ways of thinking about your situation and your life.
How to make this work in real life, then; now THAT is a pretty tall order. Most of us don’t have the resources that they have on the Biggest Loser, this isn’t a residential program, and we don’t have Jillian and Bob. At my association, we are bringing in experts -- nurses, nutritionists, trainers -- but people probably aren’t spending enough time with them individually to build a relationship.
I wonder, will the relationships they form within their teams be enough to inspire them? Are we providing enough opportunities for people to learn and practice the new skills and habits they’ll need to lose weight and sustain that weight loss?
The ultimate goal, of course, is that our particpants transcend the fear and avoidance mindset and embrace a more healthful approach to their wellbeing. Much to do, but I think we are on our way.

4 comments:

Krista Ogburn Francis said...

Thanks for the interesting post. Fear certainly can be a motivator but not one that I would typically chose to use. I'm also thinking that the more abstract the fear, the less likely the change? E.g. the brochure you mentioned talks about general risks which may or may not actually materialize in my life or anyone else's, whereas your doctor might say "Your blood pressure and your blood glucose levels are dangerously high. We need to take immediate action or these conditions could be life-threatening" and that gets your attention.

But life-threatening situations aside, I agree that more positive approaches, including the relationship-building you mention, are much more motivating.

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