Monday, February 1, 2010

Behavior Change

In class, we have been talking about behavior change - specifically, theories or models that purport to explain or describe the processes people go through when changing or when planning behaviors.  The presentation thus far has been along the lines of "look at these theories of behavior change," then "look at how comically inept they are at describing what we see happening in the real world."

There are two main flaws in these theories/models that are lightning rods for criticism in class and in the readings.  First, many of the theories operate on the level of a given individual's behavior, seemingly without the realization that behavior does not happen in a vacuum.  These theories overlook, or include only tokenly, interpersonal influences on behavior, as well as even wider factors such as institutional barriers to access and the like.

The second main flaw is that many of the theories assume that behavior is rational, like I mentioned.  What I mean by rational here is something along the lines of the product of thoughtful analysis.  It is simply not the case that a person thoughtfully analyzes the pros and cons of a given behavior, then proceeds to act in the maximally healthy/efficient/correct/productive/recommended manner.  Really, all the stages of that putative process - starting from the assumption that each action or health behavior has been preceded by a contemplative moment - are vulnerable to influence from the real world.

Sure, maybe you can model that.  Maybe it would look like this?  But then, what do you do with this model? What does it tell you?  How do you use it to create an appropriate intervention?

Two more things:

1.  One of the readings (finally) had some pointers on creating good, working interventions.  I made the following notes:
* Good public health isn't always about a novel product, slogan, or campaign.  Sometimes, it is about facilitating a good match between existing tools and a population.
* Educating or dispensing information isn't sufficient, but it is necessary.  Sometimes (not always) a lack of good information is a barrier.
* The interaction of access issues and self-efficacy.  A resource may be inaccessible or extremely difficult to access.  Or it may be moderately difficult to access and a person may have low self-efficacy on the issue of access.  A robust intervention addresses this issue as well as the health issue at the heart of the intervention.

2.  I have been trying to think of other areas where people are interested in changing other people's behavior.  Here's a list of some that I've thought of:
*Advertising/marketing (obvy)
*Religious organizations (both in exhorting congregations to behave in a certain way, and in proselytizing)
*Motivational speakers
*Rehab centers of many stripes
*Jails (Is this true? Do modern incarceration systems attempt to rehabilitate people? I'm clueless!)

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