SECOND OPINION:Methods used to 'train' humans nearly always negative, writes JACKY JONES
LIFESTYLE IS behaviour so why does RTÉ behave as if it’s a disease? I tuned into Marian Finucane’s Saturday radio show to hear her interviewing Dr Austin Darragh about long life and health. He gave the usual lifestyle advice with Finucane interjecting from time to time with “my goodness me”, as if she hadn’t heard it all before.
People have been advised about healthy lifestyles for at least 100 years. The question she didn’t ask, and no presenter ever asks, was why do most people ignore the advice? Why don’t presenters interview behavioural scientists, or even dog trainers, who probably understand more about human behaviour than many health professionals?
This may seem farfetched, but dog trainers would not dream of using the methods and techniques employed when persuading humans to develop healthier behaviours. Books on puppy training recommend using positive messages all the time. Praise and encouragement, and keeping things interesting and fun, are important tools. All good dog training rewards desired behaviour and ignores undesired behaviour. Negative messages and criticism make dogs aggressive and disobedient.
The methods often used to “train” humans, or to get people to adopt a healthy lifestyle, are nearly always negative and emphasise disease, risk factors and the terrible things that will happen if people don’t follow the advice. Examples include the “one in every two smokers will die of a tobacco-related disease” campaign; the grisly car crash TV adverts; and the recent short films featuring people dying of smoking-related diseases. Undesirable human behaviours, such as overeating and smoking, are constantly referred to, and desirable behaviour is ignored.
When you think about it, children are toilet trained in much the same way as dogs. They are taken to the lavatory, shown what to do, the parent waits until they do the business, and the child is praised for performance. This kind of training works effectively for the next 80 or 90 years. Something goes drastically wrong when it comes to children learning about exercise and healthy eating. Most dogs are excited when they hear the word “walk” regardless of the weather. They are eager to go for a walk at any time of the day or night. Children, on the other hand, over the age of about eight, show no enthusiasm for a walk or any kind of exercise. In just a few years of life they learn that movement and healthy eating are not pleasurable.
Research carried out in the 1970s showed that some behaviour-change tactics run a high risk of being counterproductive such as advice-giving and negativity. Earlier this year, researchers in the UK confirmed that negative messages do not work. Their study used distressing messages to persuade people to drink less alcohol. People avoided the messages and those most vulnerable to alcohol-related problems ignored them completely. Advertisers are advised to use scary messages sparingly or not at all when devising health education campaigns.
Why do organisations such as RTÉ and the Health Service Executive, and health professionals, persist in using techniques that don’t work? The main reason is that professionals spend years learning about diseases and defects and how to diagnose and alleviate them. They learn how to give effective advice and this is what patients expect. Advice-giving becomes the default position. This over-reliance on a familiar tool is a good example of Maslow’s metaphor: when all you have is a hammer, everything you see is a nail.
Since almost all diseases and conditions have a lifestyle element, giving advice about undesirable behaviours seems the right thing to do. The assumption is that ignorance of health matters is the “nail”, or the reason for the poor lifestyle, and the advice just has to be hammered home. Unfortunately this does not work.
Radio and television presenters are also guilty of Maslow’s mentality when it comes to choosing who to interview on lifestyle matters. They see only nails and look for the biggest hammer available. This is often entertaining but does nothing to promote public health which surely should be one of the goals of the national broadcaster.
We need to hear more interviews with people who understand human behaviour and who can make healthy lifestyles sound like fun.
Dr Jacky Jones is a former regional manager of health promotion with the HSE