Interviews with Dolores Albarracin, PhD, and Caroline Apovian, MD
Communicating health messages to patients to inspire them to change behavior—whether diet, exercise or other habits—is a daily occurrence for endocrinologists and other healthcare providers. However, thinking first about how many messages to give a patient at one time can assure better outcomes in improving health behaviors.1 This was a focus of a study published in Clinical Psychological Science.
“Giving patients a message about medications should be handled very differently, for instance, then one inspiring them to make lifestyle changes,” said Dolores Albarracin, PhD, senior author and a professor of psychology, business, and medicine at the University of Illinois at Urbana-Champaign.
Dr. Albarracin's team conducted two experiments. The first explored the effect of the number of basic health recommendations presented to men and women and on how well they recalled them later.1
A total of 193 men and women, average age 34, participated in the study. Each participant viewed a screen that displayed different sets of health recommendations, ranging in number from 2 to 20.1 The recommendations were presented on a single screen, separated by a black line to make it obvious when one message ended and the next began.
The health recommendations covered a range of topics including frequency of hand washing, getting regular exercise, eating more fruits and vegetables, and positive thinking. Each recommendation included the potential benefit gained by adopting each new behavior. All study participants were allowed to view the recommendations as long as needed. Thereafter, they were asked to recall as many messages as possible. The number of presented recommendations predicted the number of messages recalled (R2=0.299).1 However, the number of recommendations correlated negatively with the recall percentage. (R2=0.93).
The team conducted a second experiment, similar to the first, to replicate the findings. They gave health recommendations to 266 men and women whose average age was 36 years old. The number of recommendations that were delivered ranged from two to 12 in increments of two at a time.
As in the first experiment, the sheer number of recalled recommendations was positively associated with the number of presented recommendations (R2=.197). 1However, the researchers found that the proportion of recalled recommendations was negatively correlated with the number of presented recommendations (R2=.271). This suggested to them that a higher number of messages likely would lead to more problems retaining the information under ''headers'' that effectively helped organize the messages.1
''The best number of behavior changes to recommend depended on the goal of the offered intervention," according to the authors.
"If you want patients to recall a complete set of recommendations give them a low number. If you want them to remember some and don't care which, go with a higher number of alternates," Dr. Albarracin told EndocrineWeb.
For instance, “a physician trying to get his type 2 diabetes patient to exercise and improve blood glucose control might list 20 possible activities as recommended behaviors. All on the list would be acceptable for the goal of inspiring patients to move more,” Dr. Albarracin said.
“However, if you are talking about medications and trying to get a patient to take it regularly as prescribed, you probably need a different strategy,” she said, “For instance, if you want two medications taken together, go with those two recommendations only, because you need recall of the complete set [of recommendations]."
Another key tip:
"Provide actionable messages," Dr. Albarracin said, and avoid vague statements (eg, eat less, move more). To enhance the possibility that patients will respond favorably, make suggestions that are relatable and doable given their current lifestyle.
Caroline Apovian, MD, FACP, FACN, professor of medicine and pediatrics at the Boston University School of Medicine in Massachusetts, who was not involved in the study reviewed the study findings. She agreed that the research produced conflicting findings, with some suggesting one message at a time is the best way.
"The findings may have more relevance on a broad public health scale than for the busy practicing endocrinologist,” Dr. Apovian told EndocrineWeb.
Acknowledging that clear and effective communication was critical to move patients toward establishing healthier outcomes Dr. Apovian said, “Be sure the patient is ready for change. If the patient isn't clearly ready to follow through with even one behavior change message, then it is best to hold off until the patient demonstrates a desire to make the changes required to reach the stated health goal."
To do this, gather information from your patient before presenting the messages, she said. Some may feel overwhelmed by multiple messages so make sure to ask the patient what seems possible and let them select the suggestion or suggested messages they feel they can handle, said Dr. Apovian
In conclusion, Dr. Apovian said, "in a busy endocrinology office, where we may have 10 minutes with each patient, it is of utmost importance to individualize your approach and to offer very focused messages that engender a favorable response from the patient.”
McDonald J, McDonald P, Hughes C, Albarracin D. Recalling and intending to enact health recommendations: Optimal number of prescribed behaviors in multibehavior messages. Clin Psychol Sci. 2017;5(5)858-865.