Online Conversations and Interventions for Long-Term Health Behavior Change

Michelle Garrison, PhD from the Child Health Institute, reported on the challenges of creating a system that helps patient effect behavior change. The institute is running a number of such projects. The current ones target asthmas information for parents and media choices for parents. Garrison presented two influential theories on the design of these persuasive systems, walked us through the system, and discussed some of the challenges.

The two theories that influenced the design of this system are “stages of change” and “social cognitive theory”.

“Stages of change” breakdowns the stages of behavior that a person going through to enact behavioral change in their lifestyle. These stages are:
- Pre-Contemplation
- Contemplation
- Preparation
- Action
- Maintenance
Once a person is in a stage of maintenance, they may relapse to one of the first three stages.

Drawing on this theory, the system designers recognized that they needed to be sensitive to the stage of the participant. Using survey questions, they sought to determine their current stage and to shape their health advice accordingly. For example, it would be unproductive to give action recommendations for someone who is still pre-contemplative, having not thought of the issue of asthma before.

“Social cognitive theory”

Social cognitive theory is a model of how people think about behaving. Given knowledge, external barriers, and external support as a milieu, an actor weighs their expectations for the outcomes and their personal efficacy to make goals. These lead to behavior and then to outcomes.

Here, the system designers used the model to identify barriers to behavior change. They combatted this by correcting false beliefs (knowledge barriers), teaching about outcome expectations, giving accessible baby-steps as goals for people with low self-efficacy. An example of a false belief is the association that parents made between steroids in asthma medication and harmful steroid-use in the public media. Correcting this misconception is intended to help clear the knowledge that would inform the outcome expectations.

Overall, the study appears to be still in progress. Additional challenges include health literacy of the participants, facilitating communication between the health service providers and the patients, and finding new mode to reach the populace (e.g. text messaging).