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Ten Tips for Changing Health Behaviors (and Saving Lives)

Ten Tips for Changing Health Behaviors (and Saving Lives)

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I'd call the tenth-patient-of-the-day challenge?

Here's what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient's blood sugar is running high again, she didn't show at the smoking cessation class you recommended, she gained four pounds since her last visit two months ago, and her blood pressure is no longer borderline. It's now high.

And this patient is pretty much like your previous nine patients.

Your urge is to just groan. Or maybe start looking for another job.

The fact is that most Americans know what's killing us. Is there anyone left on Earth who thinks smoking is good for you? Stop smoking, eat better, exercise, and wear your seatbelt. Just those four simple steps, alone, could save more lives than any newsworthy, groundbreaking research ever announced.

We're talking vast numbers, hundreds of thousands of preventable deaths each year. The magnitude of behavior-related health problems is actually quite mind-blowing. But the ways to avoid them is not.  Prevention for four of the five top causes of death can be reduced to two words: "Stop Smoking." And preventing the fifth could be reduced to "Wear Your Seatbelt," and maybe "Lock Up Your Gun (or Better Yet, Don't Own One."

These are not rocket-science, epigenetic-based, hard-to-get-your-mind-around complex instructions. You don't need to get the graphics department involved just to communicate all the moving parts.

Whether you're a reporter or a doctor,  the bottom line is that if you're not talking about the obvious, you're leaving most of your readers and/or patients at high risk of premature death. You're failing at the most basic mandate of your job. So how do you say the same thing over and over again and keep it fresh and compelling?

Heck, should you even be saying the same thing over and over again? Whether you're picking up a chart, or sitting down to write a story about the health of your community, it sure looks like the challenge we face is no longer communicating knowledge, but figuring out how to help people put it to use.

Here are some tips from the Exam Room B trenches for how to move your writing out of the realm of knowledge transfer and into the exciting world of behavior change.

1) Make it personal. There's an old saying in nonprofit fund-raising: Don't tell the story of a whole group of children, no matter how horrible or widespread the devastation. It doesn't matter whether you're trying to help an entire school or a village or a country hit by drought or famine. Instead, tell the story of one child. You'll get more donations that way. When it comes to getting people to act on a problem, an abstract approach doesn't work.

If you want someone to care about making sustained behavior change, you have to get really personal. Sharing your own personal story can feel scary, but can be incredibly powerful. If you don't want to tell your own story, find someone else who's willing to talk about the very personal factors that motivate him or her to make a behavior change. When you're covering an issue, how far down can you drill into your data? How many faces can you put to a problem? Who is your "one child?"

The more personal you can make the link between a desired outcome and the behavior change needed to achieve it, the greater your chances of success.

2) Ditch the shame/blame game. We're wired to need, and want, a narrative. But not just any narrative. For behavior change, we need a narrative that moves us along a path. Shame or blame will yank a person right out of participating in change. If you're writing about food deserts or lack of public spaces, you may already know someone to interview to put a face on your story. But be aware of how that person is being portrayed, or what categories of blame and/or shame might be attached.

For example, telling a patient that many of your other patients are women who don't feel safe walking in their neighborhoods is an approach that can elicit an amazing amount of information about the challenges of affordable exercise in an urban environment. Shared information means shared problem solving can begin. You can mention how others have addressed this issue, such as stair walking in an apartment building or getting off a bus and walking in a "nice" neighborhood before heading home.  

3) As realtors know, it's location, location, location. For health topics, it's details, details, details. Set the stage with details that a person can relate to. For example, you could tell a patient he should stop smoking. Or, you could ask how much he spends on a pack a day, then calculate how much that adds up to in a month, a year, or a decade. How old was he when he started? How much has he spent so far? What else could he buy with that money?

You can see a lot of these types of illustrations in the info-graphics that often accompany good stories. What's nice about social media is that you can create a calculator for many health issues that would let your readers personalize their own experience. For example, what about a calculator to show distances of the walking paths in your community and the calories you'd burn if you walked one each day?

4) Dig into reality. The farther the distance between a behavior and the abstract threat of it, the harder it can be to change. The closer the link between the behavior and the threat to health, the easier it can be to change. For example, a person who realizes that the yellow clotty fat inside fried chicken looks exactly the same as the plaque in a human heart will be more likely to avoid the fried chicken. Pain is a great motivator. Patients who can link their chronic pain to behaviors that need to change are often powerfully motivated to change.

5) Use motivational interviewing techniques. Ask, and ye shall receive. Ask people why they don't change. You can start by giving them permission to be honest by framing the question in a way that avoids the blame/shame game. "Smoking can't be all bad, or you wouldn't still be doing it. What do you get out of it?" When people are asked to look at the reasons why they do something they want to change, a person can often get closer to finding ways to change. If smoking is the one thing that keeps a 48-year-old still feeling hip, encourage him to get a tattoo instead.

6) Find a narrative with an arc.  Most people writing about a health issue may already have a person in mind to interview. Framing a story with one snapshot in time might hook someone into the story, but it may not help those looking for ways to change their lives. Although it's harder, it's worth the time to dig a little deeper and interview someone who recognized the problem and who's making changes. Get him to explain how he's managing to do it.

7) Ride the surf of community. We change best when we change together. Social media is a great way to allow communities to form around behavior-related health issues. Cheerleading each other is a powerful tool; in fact, many would say it is THE most powerful tool we have when it comes to behavior change. Groups are sometimes spontaneous, and sometimes artificial. Allowing creative, innovative ways for people to connect on shared topics of interest about health is an important tool in improving the health of any community, and online communities can drive change, and traffic, to your work.

8) Stay on message. Throwing up an issue and then walking away is a recipe for disillusionment and stagnation. We doctors need to keep ourselves on track. If it's smoking one visit, then weight the next, then exercise the next, a person is left feeling overwhelmed and hopeless. What is the primary health issue and how can it be a goal that is sustained over time? Who's looking for changes, whether they're changes for the better or worse? What is the plan for recognizing and celebrating good changes?

9) Plan for failure. When it comes to behavior change, relapse is a normal part of the process, but one that often isn't covered in health topics. What's the plan when you backslide? Is there a sidebar to your story with tips for making a relapse plan? Do you tell patients how to be patient with themselves? It is often the toxic mix of shame and dismay that can convert a simple relapse into total stoppage.

10) Remember the power of the positive. Studies show that focusing on the positive, rather than focusing on a threat, is much more potent at encouraging healthy behaviors. That approach is the opposite of the traditional "if-it-bleeds-it-leads" doctrine on the 5 p.m. news. African Americans are much more likely to get life-saving colonoscopies if the benefits are emphasized, rather than the racial disparities in colon cancer death rates. When it comes to healthy behaviors, fatalism can be, well, fatal. The California Kaiser ads, themed around the phrase "Thrive," are a classic real-life depiction of that phenomenon. It's hard to listen to the ads without getting an urge to go do something for your health.

Putting all of these factors together into one story's arc can be quite a challenge. But it can make what you do feel more inspiring, and result in more measurable health change.  

Can you organize a group change for your community? Which of these tips might help you think differently about how to report on the obvious? Share your tips and experiences (or great examples) in the comments section.

Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

Comments

Hi Dr. Jan

Ten brilliant suggestions here - thanks for this. As a heart attack survivor and blogger, I've been shocked to come across other heart patients who continue to live their lives as if they are utterly oblivious of their diagnosis. One man - a year post-MI - recently told me that he'd started smoking again and was no longer taking his cardiac meds.  I felt like smacking him upside the head! "Let me just call an ambulance for you right now, because you're a CABG case waiting to happen!"

That's when I became interested in the phenomenon of DENIAL. This universal tendency seems to override our common sense, despite clear evidence surrounding us.  As you say, we KNOW what's killing us, but merely knowing is apparently not enough to CHANGE. More on this at: "Denial and its Deadly Role In Surviving a Heart Attack".  

Laurence Gonzales, writing in National Geographic’s How To Survive (Almost) Anything: 14 Survival Skills, says:

“It is in our nature to believe that the weather will improve, that we’ll find our way again, that the fire alarm doesn’t really mean ‘fire!’, or that night won’t fall on schedule.”

That's why your #10 pointer is so important.  Warning heart patients that they are idiots for smoking or stopping their cardiac meds (even if this is true!) may indeed promote a fatalistic "What the hell, I'm going to die of something, right?" response. And people who've already survived what they may have always believed was an unsurvivable event may embrace the rosy glow of invincibility as they dodge bullet after bullet.

 

 

Thanks for sharing your experiences! The "art" of medicine is often found in providers (nurses, nurse-practitioners, PA, and docs) who can somehow find a narrative that inspires a patient to engage. Many of us believe we're already engaged - heck, that's why we went to the clinic in the first place, right? But really engaging happens after you leave, when you start tackling an issue that is, by definition, emotional, personal and probably threatening. And then, after engaging, we all get discouraged. It's as predictable, (as you say) as night following day. But true "art" comes with finding a way to help a fellow human, as much as you can, stick with the long, winding road of change. Those narrative, and narrative tricks could help so many people on a broader scale. Thanks again for sharing and huge congratulations on the ways (I know how hard they are!) you're nurturing your health!

[...] physician blogger Dr. Jan Gurley points out that her patients (and all of us) know most of what we need to be doing to take care of ourselves. [...]

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