Saturday, February 19, 2011

Prevention: Changing Awareness Doesn't Mean Changing Behavior

ScienceDaily brings word of an interesting study that examines the difference between awareness and action, and suggests more effective interventions.

Two things are pretty clear: people "know" exercise is important to maintain and improve health, and sedentary lifestyles and obesity rates are so high that they've become major national issues.

The parallel with child abuse is obvious. Increased awareness is necessary, but not sufficient, for prevention. This policy memo from Prevention Child Abuse America discusses the expanding gap between awareness and action, noting that the public's very high awareness of child abuse is not translating to action. So, PCAA solicited thought from Frameworks Institute on what to do. Link to Frameworks memo Link to Frameworks memo on child abuse and child development strategy

Back to the study.

The University of Missouri researchers found that healthy adults who received interventions focused on behavior-changing strategies significantly increased their physical activity levels. Conversely, interventions based on cognitive approaches, which try to change knowledge and attitudes, did not improve physical activity.
"The focus needs to shift from increasing knowledge about the benefits of exercise to discussing strategies to change behaviors and increase activity levels," said Vicki Conn, associate dean for research and Potter-Brinton professor in the MU Sinclair School of Nursing. "The common approach is to try and change people's attitudes or beliefs about exercise and why it's important, but that information isn't motivating. We can't 'think' ourselves into being more active."

Behavior strategies include feedback, goal setting, self-monitoring, exercise prescription and stimulus or cues. Self-monitoring, any method where participants record and track their activity over time, appears to significantly increase awareness and provide motivation for improvement, Conn said.
[Which reminds me of a story told in 2005...a researcher monitoring at risk parents gave them a cell phone, so she could call them and ask what their child was doing. As the study went on, she realized that the reports were changing because the parents were observing their child more closely, so they would have more interesting stories to tell. Link]
"Health care providers should ask patients about their exercise habits and help them set specific, manageable goals," Conn said. "Ask them to try different strategies, such as tracking their progress, scheduling exercise on their phones or calendars, or placing their pedometers by their clothes. Discuss rewards for accomplishing goals."
The study, featured in the American Journal of Public Health, incorporated data from 358 reports and 99,011 participants. Link to abstract

The study identified behavioral strategies that were most effective in increasing physical activity among healthy adults. Successful interventions were delivered face-to-face instead of mediated (i.e. via telephone, mail, etc.) and targeted individuals instead of communities.

[...which suggests that SBS prevention efforts that rely on brochures and community awareness initiatives may not be very effective. Conversely, what better place than face to face intervention by nurses in the hospital?]

Interventions were similarly effective regardless of gender, age, ethnicity and socioeconomic status.

[Another recent study shows awareness doesn't translate to action: calorie labels on food increased awareness of calories, but did not alter food choices by teens or adults. Link]

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