Behavior Change

Yesterday we had an excellent lecture on behavioral interventions in our measurement class, specifically focusing on the integrated model of behavior change. I think I may have been the only person in the class who thought so, though.

It turns out that intention to do a particular behavior is the best predictor of whether a person will do it. Intention predicts behavior better than demographics, personality, or culture. Other things like skills or abilities and environmental constraints are also pretty important.

This is not rocket science really. If you intend to do something, you are more likely to do it than if you do not intend to do something regardless of your culture. Regardless of your personality.

So, if you find that people are not doing a behavior, first you measure a) their intention to do it, b) their skills and abilities to do it, and c) any environmental constraints.

Then, if you find that the main reason people do not do a behavior is that they do not intend to do it, you measure things that effect intentions. Like attitudes, norms, and self efficacy.

The doctors in the class got really hung up on this. "What about knowledge?" they wanted to know. "None of this works if patients don't KNOW to do the behavior."

Which explains why 90% of intervention studies doctors do involve teaching patients about disease risk factors.

"Did you know that cervical cancer is caused by HPV?"

"Did you know that smoking causes lung cancer?"

"Did you know that your baby is less likely to die from SIDS if you put them to sleep on their back?"

The problem is, education interventions do nothing to address the other factors that go into forming intention.

For instance, if you don't think YOU PERSONALLY are at risk for cervical cancer, then it won't matter that you know that HPV causes cervical cancer, and you probably won't get the vaccine.

Or if all your friends and family co-sleep with their babies, and you don't feel that you are expected to put your baby to sleep face up, then you might be less likely to do that in your own home.

Or if you feel that you would be unable to quit smoking even if you tried, then you will be unlikely to try.

The thing is, it's not that knowledge is completely UNimportant. It's that it's only a small -- VERY small -- piece of the puzzle, that maybe influences norms or attitudes, but that is less directly tied itself with intention. This means that in order to change behavior, you have to address all of these other issues besides just knowledge.

The talk kind of made me want to do an intervention study. The lecturer made it sound really interesting and cool. I had often shied away from these types of studies in the past because I've often found the people who run them to be kind of..... dogmatic..... and not especially open to discussing competing reasons why patient don't do what they say. I.e. They were not the kinds of people *I'd* want to change *my* behavior for.

But most of them were physicians rather than behaviorists. And in my experience, physicians are often the most likely to wantonly turn a blind eye to the real reasons patients don't comply (and then if you're lucky they'll label the patient difficult to boot!). So maybe that explains some of my issues in the past.