When I'm 64 (2006) / Chapter Skim
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Part Two Background Papers - Initiatives to Motivate Change: A Review of Theory and Practice and Their Implications for Older Adults
Part Two Background Papers - Initiatives to Motivate Change: A Review of Theory and Practice and Their Implications for Older Adults
Pages 119-144
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PartTwo BackgroundPapers
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From page 121... ...
Moreover, these changes would result in meaningful improvements in quality of life and also increase the potential for dramatic reductions in health care costs. Yet even though the benefits of these behavioral changes are clear, eliciting consistent changes in people's behavior has proven to be a formidable problem (Baumeister, Heatherton, and Tice, 1994; Rothman, 2000)
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. Given the difficulty people have initiating and maintaining changes in their behavior, there is continued demand for intervention strategies that effectively motivate healthy behavior.
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. Given the myriad of factors that determine people's behaviors, investigators have worked to formulate systematic accounts of the factors that regulate people's behavioral decisions with respect to health issues (e.g., health belief model [Rosenstock, Strecher, and Becker, 1988]
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The psychological needs and prior experiences that older adults bring to a decision are likely to have a significant effect on where they are most likely to be in the behavior change process. When younger adults express limited interest in modifying their behavior, it is typically thought to reflect a failure to attend to or think through the behavioral decision.
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Asking for Change: Communication Strategies that Motivate Behavior Change A primary strategy for motivating people to change their behavior has been to provide them with information that will persuade them to alter their behavior (Eagly and Chaiken, 1993) .3 Although in some cases this may involve providing new information about an issue, messages are typically designed to help people recognize or confront issues that are familiar but not seen as important enough to motivate a change in behavior.
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respond to health information must wait until investigators assess a sufficiently broad set of indicators to provide a complete description of people's psychological and behavioral response. Given the challenges associated with providing people with information about their health, are there communication strategies that have been shown to be effective ways to motivate behavior change?
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Message Tailoring Message tailoring is guided by the premise that people will pay more attention to and be more persuaded by information that speaks directly to their own personal concerns.4 For example, a smoker who is concerned about the social stigma of smoking would be sent a message focusing on that topic, whereas a smoker who is concerned about how smoking is harming the health of his wife would be sent a message focusing on that topic. There is a growing body of empirical evidence indicating that tailored health messages are more effective than generic messages that provide all individuals with the same information (Brug, Glanz, van Assema, Kok, and van Breukelen, 1998; Dijkstra, De Vries, and Roijackers, 1998a, 1998b; Kreuter and Strecher, 1996; Kreuter, Oswald, Bull, and Clark, 2000; see Skinner, Campbell, Rimer, Curry, and Prochaska, 1999, for review)
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For instance, is it more important that people's understanding of the determinants of a health problem are well matched so that they readily infer that they either suffer from or are at risk for a health problem, or should the recommended response to the problem be well matched so that people more easily infer that they can perform the new pattern of behavior? Although stage-based models of behavior change could provide a theoretical framework for selecting the dimensions on which to tailor a message, to date investigators have only compared tailored messages to generic messages.
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will be more successful than those who focus on avoidance goals or downward comparison standards for the behavior (e.g., an interest in dieting predicated on a desire not to be fat) , and that tailoring messages to approach goals will be more effective than tailoring them to avoidance goals.
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. Specifying the impact of avoidance goals on health behavior change may be particularly important given the observation that older adults frequently possess health-related images of themselves that they want to avoid (Hooker, 1999)
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In fact, these behaviors are risky only to the extent that one chooses not to engage in them. This distinction in risk perception suggests that loss-framed appeals would be more effective in promoting the use of detection behaviors and gain-framed appeals more effective in promoting the use of prevention behaviors.
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In light of the thesis that how people construe a behavior determines their response to gain- and loss-framed information, any efforts to use message framing to motivate older adults must be grounded in a clear understanding of how they perceive the targeted behavior. As people get older, their perceptions of screening behaviors may very likely change and this may be particularly true of those behaviors that have to be performed repeatedly.
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Research on message framing and treatment decisions has almost always been limited to responses to hypothetical scenarios (Rothman and Salovey, 1997)
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make no direct reference to issues regarding behavioral maintenance other than to define it as a course of action sustained over a specified period of time.6 By comparison, stage models have identified maintenance as a distinct stage in the behavior change process. However, the primary focus of these theoretical approaches has been to delineate the processes through which people become ready to initiate a change in their behavior (Prochaska et al., 1992; Weinstein, 1988)
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What differentiates decisions concerning initiation from those concerning maintenance are the criteria on which the decision is based. Decisions regarding behavioral initiation involve a consideration of whether the potential benefits afforded by a new pattern of behavior compare favorably to one's current situation, and thus the decision to initiate a new behavior depends both on people holding favorable expectations regarding future outcomes and on their ability to obtain those outcomes.
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has on each phase of the behavior change process. To date, claims regarding the determinants of behavioral maintenance have relied on tests of whether a psychological state (e.g., self-efficacy at baseline)
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This would lead to the prediction that older adults would have a particularly difficult time sustaining behaviors for which the initial costs are high and the focal benefits are delayed (e.g., smoking cessation)
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. Initiatives that shape what people expect to experience when engaging in a particular pattern of behavior may have the ability to increase the likelihood that people are satisfied with the actions they have taken and thus enhance the probability of sustained behavior change.
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For instance, the applicability of message framing as a tool to motivate behavior change among older adults is constrained by limitations in our understanding of the processes that underlie its impact. The ability to specify the processes that underlie a particular intervention strategy also provides investigators with a framework within which to compare different types of intervention protocols.
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. Specifying the determinants of behavior change initiation and maintenance: An examination of self-efficacy, satisfaction, and smoking cessation.
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. Do tailored behavior change messages enhance the effectiveness of health risk appraisals?
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. The transtheoretical model of health behavior change.
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. The influence of message framing on intentions to perform health behaviors.
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Health Psychology, 23, 119-125. Taylor, S.E., Kemeny, M.E., Reed, G.M., Bower, J.E., and Gruenewald, T.L.
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