approaches is that they rely on changing behavior; if an intervention fails to change behavior, it does not produce the desired effects.

Behavioral change depends on two types of motivation. One is motivation to adopt the new behavior and achieve a particular outcome, which Robinson terms outcome motivation. The other is motivation to participate in the intervention itself, which Robinson calls process motivation (Robinson, 2010a). The medical and public health communities tend to focus on outcome motivation. They emphasize the risks of obesity, type 2 diabetes, hyperlipidemia, hypertension, cardiovascular disease, and cancer (Robinson, 2010a). “Those are the things that we try to persuade the public or patients to pay attention to as motivators to change behavior,” Robinson said.

However, research on motivation in children as well as in adults points to an entirely different set of powerful motivating forces. These include fun, choice, control, curiosity, challenge, cooperation, competition, social interaction, sense of accomplishment, peer approval or disapproval, and parental approval or disapproval. These factors, rather than the ultimate outcome of the behavior, are more likely to predict whether a child or an adult will persist at a task or participate in the process of behavioral change (Lepper et al., 2008; Robinson and Borzekowski, 2006). None of these factors is specific to health. Robinson’s question, then, is whether an intervention to change a health-related behavior needs to look, feel, sound, smell, or taste like health education. Does the intervention need to have anything to do with health, given that the things that motivate people to change their behaviors often have little or nothing to do with outcomes?

These questions have led Robinson to examine what he calls “stealth interventions.” Stealth does not imply deception or manipulation, he said. Rather, the intervention has an effect on physical activity or diet but is centered on a different aspect of motivation (Robinson, 2010a). In other words, although the intervention may target changing obesity, the participant is not motivated by an outcome such as losing weight or being more active but instead is focused on other motivating aspects of the process. Nonetheless, physical activity or dietary changes are beneficial side effects of the intervention.

The ideal situation is to target behaviors that are motivating in themselves. For example, Robinson and his colleagues have used ethnic dance to work with pre-adolescent girls (Robinson et al., 2010). “Physical activity and obesity never enter the lexicon,” he said. “It’s about the costumes, it’s about the music, it’s about learning about your cultural heritage, it’s about the importance of doing dances that your parents did when they were growing up in Mexico.” Another example involves overweight children on sports teams. These children tend not to join sports teams, but they may be much more likely to do so if they are joining a league that is just for overweight



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