Catalyst for change

December 1, 2010

Pediatric healthcare practitioners are often faced with patients and their parents who have difficulty accepting or following through with medical advice on issues such as diet and exercise or vaccine administration.

Key Points

Pediatric healthcare practitioners are often faced with patients and their parents who have difficulty accepting or following through with medical advice on issues such as diet and exercise1 or vaccine administration.2 These and other health issues can be difficult to address and manage for patients, parents, and clinicians. Patients may feel overwhelmed by their problem, and parents may be stressed in general by all their responsibilities. Patients and parents may fear the prospect of confronting the problem and failing. Clinicians are challenged by the demands of a busy practice and by parent expectations. Furthermore, clinicians may be unsure or unaware of how to administer advice in such a way that patients will accept it and comply with it.

Many clinicians adhere to a traditional, authoritative "professional as the expert" model of dispensing medical advice and may resort to nonproductive approaches such as coercion and scare tactics to effect patient change. A directive approach may be appropriate for handling specific, acute problems, such as fever or vomiting, but a more collaborative approach is often required when facilitating patient behavior changes. Through the use of motivational interviewing, clinicians can foster a collaborative relationship with patients and their parents and serve as catalysts for promoting behavioral change.3

Factors that influence thinking and behavior

Default to zero

When confronted with opportunities for change, people are often inclined to maintain the status quo and "default to zero" by doing nothing or as little as possible. Status quo bias appears to be a natural phenomenon often exploited by marketers, such as when magazines offer limited-time free subscriptions but require active cancellation to stop the service from continuing.4

Illogical thinking

People often do not think logically, even though clinicians may do their best to present logical and statistically sound arguments for change. For many people, correlation is equivalent to causality so that, in their view, a recently administered inactivated influenza vaccine may have caused their child to get the flu. People may also assign relevance to what may be a coincidence. For example, a parent who becomes aware of several autistic children in the community may conclude that vaccines or an environmental toxin must be the culprit because they were all recently vaccinated or all live in a similar environment.

Other types of illogical thinking include the infallibility bias, which is common among adolescents ("It won't happen to me. Unlike other people, I can handle excessive drinking without consequences"), and the ego bias ("It won't be difficult for me to change. Unlike other people, when I decide to stop overeating, it will be easy for me").

Media, family, and peers

Patients are swayed by celebrities, commercials, and the opinions of family, friends, and members of online social networks. Sociologists refer to these types of influential effects as availability.4

People want to feel connected to, be accepted by, and behave similarly to others in their social network. For example, studies show that the average obese person is more likely to have friends and friends of friends who are also obese. The average nonobese person has a similar network of nonobese friends.5

Social networking literature also refers to the "contagion of ideas" that, like a virus, spreads between people in a specific social network and exerts a strong influence on behavior and in creating social norms. Eating in fast food restaurants with friends may become the social norm for overweight teens. Parents who are reluctant to vaccinate their children may link with friends or online social networks that ascribe to similar thinking that influences their behavior.

Windows of opportunity

Patients who have been refractory to change may suddenly shift their behavior when confronted with a personal crisis. A family member may develop type 2 diabetes mellitus, which precipitates a change in family eating habits, or a parent may know a family whose unvaccinated child has developed pertussis, which leads the mother to rethink her position on vaccination for her own children. These crises may open the window for change, and the clinician should be prepared to assist families when these moments arise.