In September 2013 I attended the annual conference of the British Psychological Society Division of Health Psychology held in Brighton. In between bracing walks along the seafront and enjoying Brighton’s great restaurant scene there was much food for thought from the speakers and workshops.
Sessions covered a variety of topics from systematic reporting of the content of behaviour change interventions through to the challenges of increasing physical activity participation among older people. However, two of the keynotes struck me particularly as they addressed the great conundrum that will be familiar to anyone who has tried to support behaviour change – the famous intention-behaviour gap.
This is the gap between what people say they intend to do and what they actually do and has perplexed researchers and developers of behaviour change programmes for years. It has been suggested that as many as half of our intentions are not implemented.
Dr Falko Sniehotta from Newcastle University presented an interesting re-framing of this conundrum. He argued that too often we try to understand the relationship between intention and behaviour by looking for direct cause and effect from one to the other, but experimental data have falsified such models. Also, there is an assumption that not acting on our intentions is a bad thing that must be rectified.
However, he proposes that there is no evidence that failure to fulfil intentions is bad for us unless there has been a big investment in the intention, e.g. in terms of self-identity. He proposes a multi-goal perspective as an alternative whereby setting more intentions than you can actually realise can be adaptive. In fact a study of students found a positive correlation between quality of life and the number of failed intentions! Having lots of intentions means that you are more likely to spot and utilise opportunities for action. Rather than a linear relationship between intentions and behaviour Dr Sniehotta described a complex probabilistic process involving intentions, urges, prompts, needs and expectations, all acting together and not necessarily consciously. This means there are lots of competing options which is why some intentions don’t materialise in behaviour.
I like this idea and I think it would help anyone running a health behaviour change programme to breathe a small sigh of relief. It provides an interesting way of reframing patients’ experiences when they might not have met all the goals they set for themselves.
On a complementary note Professor Denise de Ridder from Utrecht University talked about goals and self-regulation. Self-regulation is the capacity to control your impulses and to consciously stop and start doing things. Techniques to support it include goal setting and self-monitoring, key elements of self-management training programmes.
Low self-control is often explained as a deficit. For example, dual process theories of motivation propose that ‘hot’ motivation (impulses) is responsible for lack of self-control while ‘cool’ reasoned and reflective motivation is responsible for success by controlling impulses. So a relative deficit in reflective motivation (for example from alcohol, stress, cognitive load, poor working memory) is responsible for failure. However, Professor de Ridder reframed failure to achieve goals as a conscious choice rather than a deficit. People may have several conflicting goals, not necessarily just one goal at a time. So meeting one goal may mean failing on another and when you have made some progress towards one goal you may then pursue the opposite goal.
I thought both of these talks were encouraging because they provide a positive way of talking to people about their behavioural choices. A conversation with someone about why they have chosen to do one thing rather than another can start a valuable journey of rich discovery even if the original goals have not been achieved and provides new challenges for how we assess the ‘success’ of an intervention.
Frances Early is the Research & Evaluation Lead at the Centre for Self Management Support