Vic Strecher Behaviour change: key issues in health communication research within an interdisciplinary context

1. Key Issues in Health
Communication Research Within
an Interdisciplinary Context
Victor J. Strecher, PhD, MPH
Professor and Director for Innovation and Social Entrepreneurship
University of Michigan School of Public Health
strecher@umich.edu

2. My purpose
Vic Strecher, PhD, MPH
Professor and Director for Innovation and Social
Entrepreneurship
University of Michigan School of Public Health
Founder, HealthMedia, Inc. (a Johnson & Johnson Company)

3. 7392048
Shiv B and Fedorikhin A. 1999. Heart and mind in conflict:The interplay of affect and cognition in consumer decision making. Journal of Consumer Research. 26(3):278.
26
or

4. 7392048 26
0%
10%
20%
30%
40%
50%
60%
High Cognitive Load Low Cognitive Load
59%
37%
Shiv B and Fedorikhin A. 1999. Heart and mind in conflict:The interplay of affect and cognition in consumer decision making. Journal of Consumer Research. 26(3):278.

5. Our work at
the University
of Michigan...

7. 7
Our Research Network:
School of Public Health
School of Medicine
School of Information
School of Nursing
School of Dentistry
School of Social Work
School of Art
Department of Psychology
Department of Statistics
Institute for Social Research

8. Tailoring to
specific needs
and interests...

9. “By eliciting and reporting
back information about
factors that influence
patients’ health behaviors,
computer programs can
achieve one of the strengths
of face-to-face patient
counseling: the ability to
tailor the educational
message for the individual
patient.”
1993

10. Engineering
Informatics
Psychology
Medicine
Nursing
Communication
Graphic design
Screenwriting
Nutrition
Statistics

11. Demographics
Perceived Benefits
Perceived Barriers
Tailored Message
Data
red
blue
aqua,
gray
orange
Environment
Motivation

13. 1994

14. Special dietary needs:
diabetic, vegetarian,
vegan, low fat, low
cholesterol, low salt,
weight reduction, lactose
Self-rating vs. scored items (grain, whole grain,
fruit, vegetable, calcium, protein, fluid, drink,
dessert servings; added fats, high-fat foods,
breakfast).
Whole grain, grain, vegetable, fruit, calcium, dessert
servings, high fat foods, added fats, breakfast, eating
out.
Fats, fruits & vegetables, fibers
Fats, fruits & vegetables, fibers
Favorite foods: chocolate, seafood, ice cream, chicken,
pizza, soups, steak, salads/ Chinese, Mexican, Italian
cuisines
Pregnancy, disease history (HA, angina, CHD, CHF, OHD, breast, colorectal, prostate, stroke,
diabetes, HBP, cholesterol, obesity, osteoarthritis) family history (HA, angina, CHD, CHF, OHD,
breast, colorectal, prostate, stroke, diabetes, HBP, cholesterol, obestity, osteoarthritis).
Primary shopper? Eat out? (fast food/ full service)

15. Experimental design
Survey of patients
in family practices
Tailored
message
No
message
Survey patients
at home
Untailored
message

16. Percent of patients who remembered receiving dietary
message (4 months) by receipt of tailored, untailored or
no dietary message.
Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF and Sandler RS. The impact of message tailoring on dietary behavior change for disease prevention in
primary care settings. American Journal of Public Health, 1994.
0%
20%
40%
60%
80%
Tailored Untailored No Message
15%
33%
73%

17. Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF and Sandler RS. The impact of message tailoring on dietary behavior change for disease prevention in
primary care settings. American Journal of Public Health, 1994.
-10.0
-7.5
-5.0
-2.5
0
Tailored Untailored No Message
-1.0-4.0-10.0
Changes in grams of total fat per day (4 months) by
receipt of tailored, untailored or no dietary message.

18. How much tailoring?

19. Demographics
Motives
Barriers
Coping strategies
Social Environment
Data
red, pink,
greens
gray,
maroon
pink, green,
blue
red, gray,
pink
blues,
aqua, reds

22. High depthLow depth
Motives
Self-confidence
Success stories

23. Tailoring depth
+ + + +
Tailoring depth

24. 6-mocessationrate
Number high-depth tailored components
15%
20%
25%
30%
35%
40%
0 1 2 3
39%
34%
26%
28%
Adjusted 6-month smoking cessation rates by cumulated number
of high-depth intervention components received. Per Protocol
analysis (n=944; OR=1.91; CI=1.18-3.11)

26. Relevance through images

28. Matched
Mismatched
Sunset
Tailored Pictures

32. Matched
Mismatched
Sunset
85 participants:
Most convincing testimonial
Most picture/text saccades
Smaller average pupil size

33. MORE RELEVANT
MESSAGES
MORE
ELABORATION
AND MEMORY,
LESS WORK
MORE
BEHAVIOR
CHANGE

34. Understanding
needs and
interests...

35. Gugulethu 2002

36. Psychology
Communication
AnthropologyJournalism

37. Getting the
frog to jump...

38. Psychology
Philosophy Epidemiology

39. Health
message
AHA! Change

45. Motivational Interviewing

46. SO WHAT DO YOU THINK
ABOUT THE RESULTS OF
YOUR HEALTH RISK
ASSESSMENT?

47. OVERALL, I THINK I’M
DOING REALLY WELL!

48. WELL... I GUESS I
WOULDN’T SAY “HAPPY.”
YOUR NUTRITION SCORE IS
A 2 OUT OF 10. WHAT DO
YOU MAKE OF THAT SCORE?

49. I GUESS IT’S NOT GREAT,
BUT ONE THING I WON’T
DO IS GIVE UP MY DONUTS!

50. SO WE MAY HAVE TO FIND A
WAY TO WORK IN THE
OCCASIONAL DONUT.

51. WELL, THEY’RE NOT AS
IMPORTANT AS MY HEALTH.
I REALLY DO NEED TO WORK
ON MY DIET.

52. VIC, ON A SCALE OF
0-10, HOW MOTIVATED
WOULD YOU SAY YOU
ARE TO EAT FEWER
DONUTS.
I WOULD
GIVE IT A
‘7’.

53. HMM... I’M WONDERING WHY
YOU’RE NOT A ‘2’ OR A ‘3’. YOU
SEEM REALLY COMMITTED TO
YOUR DONUTS.

54. TO BE HONEST, I’M A ‘7’
BECAUSE I JUST TURNED 50
AND I DON’T WANT TO GROW
OLD AND FAT.

55. HERE’S A LIST OF THINGS PEOPLE
VALUE. WHICH OF THESE VALUES
ARE MOST IMPORTANT TO YOU?

56. I GUESS MOST OF ALL... I WANT TO BE IN
CONTROL OF MY LIFE. I ALSO VALUE MY FAMILY
AND MY HEALTH.

57. SO VIC, YOU SAID THAT YOU
VALUE BEING IN CONTROL, AND
THAT YOU WANT TO BE THERE
FOR YOUR FAMILY. HOW DOES
EATING TOO MANY DONUTS
RELATE TO THESE VALUES?

58. Values
Behaviors

59. Values
Intrinsic motivation
Behaviors

61. “These studies, in concert
with previous research,
suggest that values
affirmation reduces
defensiveness via self-
transcendence...”

62. COPD
CAD
CHF
Stroke
Cancer
Morbidity
DEATH
MortalityBehavior
Activity
Stress Mgt
Nutrition
Smoking
Sleep
Condition
Hypertension
Cholesterol
Pain
Depression
Back
Diabetes
Obesity

63. COPD
CAD
CHF
Stroke
Cancer
Morbidity
DEATH
MortalityBehavior
Activity
Stress Mgt
Nutrition
Smoking
Sleep
Condition
Hypertension
Cholesterol
Pain
Depression
Back
Diabetes
Obesity
PURPOSE
Life
Energy
Wellness

65. Getting bees
to swarm...

66. Psychology
Biology Sociology

69. One queen bee
~ 10,000 worker bees
3-5% are active scout bees
A Swarm of Bees

70. Angle of waggle run
indicates direction.
Coding location information in waggle dance
Duration of waggle run
indicates distance.

72. One 16-hour “debate”: 11 sites, 149 scouts
Seeley& Buhrman (1999) Behav. Ecol. Sociobiol. 45:19-31.

73. The scout
bees...

75. Starting things...

76. Engineering
Informatics
Psychology
Medicine
Communication
Graphic design
Screenwriting
Poetry
Business

77. strecher@umich.edu
Research Real world

82. ...with EMR

83. ...with biometrics

84. ...with coaches

85. Engineering
Informatics
Psychology
Medicine
Communication Graphic design
Screenwriting
Poetry
BusinessPhilosophy
SociologyMedicine Nursing
NutritionBiology
EpidemiologyJournalism
Screenwriting Anthropology
Statistics

86. The best way
to predict the
future is to
create it...

87. Thank you,
Anne Moorhead!

88. Thank you!
Victor J. Strecher, PhD, MPH
Professor and Director for Innovation and Social Entrepreneurship
University of Michigan School of Public Health
strecher@umich.edu