pasha, b RB, Haskard- Zclnienek, & B, & Di matics pM-R. (WWI). Healthy kabower 7 Erdence sock Change aca Aneckment adhenenct te Gua fer mngrevixy, ealthGte Odera 2 Odforel Camere fnew Persuading and Motivating Positive Health Behaviors How soo “not new” Becomes “never.” Martin other, Protestant Reformer Goal Setting In Chapter 1 we outlined several important theoretical models that underpin our knowledge of behavioral change toward the goal of health, These models lead us to some practical questions about what factors persaade aa individual to adopt parti- cular ealth-telated goals and what factors keep the individual motivated to pursue these goal. Sometimes people target certain health objectives because oftheir emotions and feelings: other times they are driven by social comparisons, logical reason, even some kind of direct pressure. An individual might suddenly fs! compelled to undertake a challenge, such as treining to ran a 10-Kilometer (K) race, ater spending the afternoon watching the teack and field events of the summer Olympics. inspiration from watching the athletes may propel the indvidual to plan 8 workout schedule to achteve the level of cardiovascular taess and stamina, that 2 10k race would regulte, Sometimes, though, people adopt goals that are tooled in social comperisons, such as whea a parent observes other parents swim sming with thet children and then decides to Jom infor both exercise and fan, Sometimes health goals are undertaken after a wellreasoned decision-making process has been completed, such as when one decides to change several behaviors atthe same time to achieve greater cardiovascular health, The available informe tion and data are likely to support the goal, and clearly scem to outweigh any sugumenis against thei adoption. Take the example of Gone, He has cecently been diagnosed with worryingly high LDL ("bad") cholesterol and. hypertension. Together these conditions place him at high risk for cardiovascular disease. He needs to make some sweeping dietary changes and increase his level of daily cxercise. In addition, his physician has reeommended that he begin taking two 4 Persuading ana Motivating Positive Health Behaviors 25 ‘medications that will help lower hs cholestrol and contro hs high bloodpressure. Gene has accepted this avies and has set soverel health-related goals for himsel. He has the long-term goals of lowering blood presse and cholesterol ad the short term goals of consistently taking his medications. walking each evening after work, and replacing some ofthe fattening foods in is dit with move fresh traits and vegetables, Gene believes that each ofthese goals is achievable, despite the posit lity of unpleasant side effects associated with one af his prescribe’ medications. in steighing the potential risks and henefis. Gene Judges the argoments in favor of taking medication tobe stronger than the argoments agaist Oiten, health goals ere aiopied i responce to some form of persuasion. Iti common for people tobe influenced by media campaigns orby popula press articles thatreport research findings fom scientific articles. Fr example, a journalist might ‘write about the copious research evidence supporting sleep as eruclal for health and longevity. Eric Nagourney, for example, has presented compelling evidence in the New York Times that disrupted sleep patterns are associated with problems rega- tating blood sugar and might be linked fo cabetes. He cites empirical data published in the Proceedings of the National Academy of Sciences,’ and presents evidence that is compelling enough to motivate an individual fo change behavior and pursue the goal of healthy sleen. Many of oar own sudens, after eading the New York Timss article, were convineed of the importance of sleep and ead that they would make @ concerted effort to get enough oft! Ofcourse we've aleo talked with students who ae commitied to other, somesthat more dublous behavior changes 2s a eesult of compelling news articles or television exposés. These inclade using herbal suppe- rents thet claim to be “fat-bustr,” and adhering to methods of exercise that are ‘supposed to make a person look like an Olympic athlete in only five minutes a day! Having adequate health information availabe to make good decisions and to setreasonable health goals important the avaiabity of god heath information helps people to be more “health literate.”? Studies show that accurate information about the risks and benefits of particular hesth behaviors actully does influence peopk's cheoes about thei om bchaviors. We discus thie ome in more til ltar Jn this chapter and in Chapter 5, sshere awe consider how indvidvals weigh Information about the risks and benefits of health action, Here, we note that having good health information is esenta. although ts only pero the equation ‘many peopl alto set orefetvely purse good health-related goals despite thee ‘Knowledge.’ Information is the crucial first step because people need to know what to dom order to make changes in the right drection Goals are formed and driven by a combination of reason and emotion. Yet sometimes even convincing evidence and a strong emotionsl appeal are not enongh. A person likely also nveds to lest confident that ix posnbe for hime oF her to achieve the identified goal. We encountered this concept, referred to as self- effeacy in Chapter 1, and it plays @ central role in determining both the goels that people st for themselves and the actions they ae willing t take to achiore those goals26 Health Behavior Change and Treatment Adherence In the fist part of this chapter. then, we examine the complexity of knowledge, ‘emotion, and confidence, among other factors that contribute to making, a goal ‘worth pursuing. We consider the factors that compel us to embrace some challenges and to avoid others, Later in the chapter, we discuss what motivates people to take ‘action in pursuit ofa worthy health goal once that goal has been adopted. Social Comparisons Since paychologist Leon Pestinger first described his theory of social comparison processes in 1954, researchers have been interested in how various Huds of social ‘comparisons influence people's emotions and behaviors.* Every person engages in social comparisons: and the effects those comparisons have on health (and other outcomes) can be positive or negative depending on the circumstances. Researchers hhave paid particolar attention to how dillerent aspects of emotion, goal-setting, and ‘motivation are associated with upward and downward comparisons. Upward com- parisons are those in which a person compares him. or herself with someone else (either real or hypothetical) who .s, "better off” than they are on a particular ‘dimension or set of dimensions. For example, one might compare oneself with ished at a particular sport, Is more physically ft, or is more successful at sticking to a healthy eating plan. Alternatively, downward comparisons are those in which the person looks to a reference group or person who is “worse off than they are, For example, one might compare oneself to those who never exercise, are quite obese, or are more severely il with the same disease. ward comparisons have sometimes been linked to more positive emo- tional states” because they fend to make us feel better about ourselves. Our own difficulties can be put into perspective and the things we are thankful for can be highlighted. But downward comparisons tend not to serve as potent motivators because they focus attention on obstacles or goals that have already beon sur- ‘mounted or achteved."* Downward comparisons can cause us fo become compla- cent about our own health behaviors, We might be doing, better than some other people, but stil not doing very well! Inproviding apicture of what “cou waed comparisons, incontrast, can foster a sense of discouragement if ent state and the comparison point. This is specially recognize their owa personal progcess toward the bigh hhave already achieved.!°* ‘We cannot accurately predict how any one individual will react to upward and ‘The ikely results ofupwrard and downward comparisons in the presence of diferent levels of perceived conteol ate ilastrated in Figure 2.1. if Ards, during her group meeting, believed that she couldn't exert any control over her exercise regimen and instead felt that she, herself, was on a track toward morbid obesity, she would have been much less likely to experience an improvement in her mood, Instead of being, uplifting, the recognition of her situation as les dire than others might have been, discouraging: she may have seen only her own imagined future in her morbidly obese pees. ‘Another member of Ards’ group. Pat. also about 70 pounds overweight. but she makes an upward comparison, focusing on.a groap member who. aftera year In the program, is now only 20 pounds away Irom hee deal weight, Pat feels that she does have control aver her outcomes, and she is motivated to achieve a similar goal. ‘Tre upward comparison isa very invigorating and motivating experience for her. If Pat ha low perceived control over her own vieight related outcomes, however, this, upward comparison would likely have been overwhelming and disheartening rather than inspiring. Research on social comparison underscores for us the fact thet a person's characteristics must be. well understood before sneiic tyoes of comparisons can ‘beencouraged to prompt the adoption of health-related goals, We must fist ax question, does this person currently have high self-esteem? Does the individual perceive that they have control dver thelr behaviors? Do they see the comparison ‘person or group as similar to themselves? Are they optimistic? Ensily discouraged?28 Health Behavior Change and Treatment Adherence |ARDIS-Downward Compa ig fetaed ont ingroves i ond bart mosey 2 ety Tile nt sothaag sede +[tarupens Compan Teh Toe set ecard Con oot Desricnoad (Ghose od ‘acres Pigue 2.1 Upnard and donwardcomparions inthe presen of wo ih pri behavioral control. : ss : Intrinsically motivated? The answers to these questions are essential f healtheare professionals are to encourage comparisons that will be most helpful to a specific person, Suggesting that someone strive to achieve what another has accomplished may or may not be felpful, depending upon many factors, For example, th relevance and influence of social comparisons depends to some degree on perceived similarity of others, Comparisons with those who seem very different are less useful because there is ttle reason to believe thal one’s own trajectory or Persuading and Moivating Positive Health Behaviors 29 cutzome would be sinter epardessoflbehavee Thus social comparisons operate fgeinst the backlrop of an Individuals already present tendencies, perceptions, strengths, and weaknesses and within the context ofthe person's lie, Socal eoma- patloai do not operate in a vacwurn, ‘comparisoris are also not “tl soapshts.” People usually receive feed- back overtime about where Uney stand relate to others as they work to achieve their various goals. There ae two categoriesofbese possibilities for what are called “selhather performatice patterns” ai thei asncated comparisons. These cate- goes are “static” and “dynamic. fn te staiccomparison category, an individual ‘ould condistently perform in one of thre ways compared With peets: (1) bettee t {G) the same a peers’ In the dymiamic. comparison ategory, an indludual could experience (1) progressive decline in pelormance relative to peors oa perion could demonstrate (2) growing mastery 2s compared to peers. The feedback tht one receives about her or his porformance relative to others ies. what one's tol by one's doctor about heath markers or how one "measures tap" daring monthly weigh-ins ata weight4oss group) is important, Suck feedback contributes to subsequent goal-setting and seFelicacy. For example, someone ‘might be told they are quite physically fifo their age. or conversely that most people their age are getting more exercise than they are. Not surprisingly, feztback indicating that o: tends tobe associated with higher sellficacy and cleat thinking. and with setting higher subsequent goal-On th oer band, feedback that suggests one slosing ground or Hot mecting expectations can accelerate a downward sical becaie it ower the individual's sense of seleficacy and leads to deteriorating performance, ‘This concep isilstrated in ‘Table 2.1 with Ards, Pat, and another member of thete group. Although Ards’ performance isinaly atthe same level as the est of the group (tnatching the average), overtime her trend is towerd less weight loss Even though she is stil losing weight. she i at lasing as much as her peers over time. This likely to undermine her sense ofseleficacy and to result in continued tundesperformance andl a tendency to st less ambitious goals inthe future, Pat's texperience is the opposite. Her first weigh-in also places her right at the group average, but she demonstrates a consistent pattem of achievement that fosters her sease of seecacy, encourages her tose higher goals inthe future, and increases her chances offre successes. Emory's caseispethaps the mos illustrative ofthe importance of feedback regarding Impcoveneat. His weight loss is consistently teow the group average yt his performance pattern demonstrates regular pro gress at each woigh-n. This lkely to increases selF-eficacy as well as is future goal-setting and periormance even though he never outperforms the group. ‘lthough these efeets will probably not be as dramatic as they ate for Pat. So, what can be dane to help Aris? Does her downward performance pattern door her to ultimate allure? Not necessary An astute group leader might take a litle extea time with Ars to help redirect her comparisons. Instead of pointing out hhow Ards is doing elatve to her group's average, she might instead compare her