Bad Habits

Paraguayan skyWhy is the knowledge that something is bad for you not enough to make you stop doing it?

I’ve been thinking about this question a lot recently. When I tell Paraguayans that I’m in Paraguay to teach about health they jump right in and tell me how bad the Paraguayan diet is. Paraguayans tell me their food “has a lot of fat” or that the food “is heavy.” They tell me that there are a lot of people who are overweight, have diabetes, or have high blood pressure.

Next, Paraguayans ask if I like their traditional foods like sopa paraguaya, tortillas, and mandioca. They tell me they want to lose weight, but then put three tablespoons of sugar in the milk they are going to drink with bread. They ask, already knowing the answer, if they should eat fewer carbohydrates if they want to lose weight. They explain how they don’t exercise or eat vegetables.

I don’t know if the people I talk to know that different foods have different nutrients or that balancing calorie intake and calorie burn is the center to weight control, but it’s clear they know what they are consuming isn’t the healthiest option.

If they know it’s bad for them, why aren’t they trying to change it?

  • Is it habit?
  • Is it that they don’t know how to cook different foods?
  • Is it taste preference?
  • Is it cost?
  • Is it cultural heritage?
  • Is it a lack of information or understanding about what makes food healthy or unhealthy?
  • Is it something I’m not seeing?

In the past, I wrote about developing public health programs that encourage change by focusing on the out-of-box-experience. But, as I work in Paraguay, it’s daunting. Clearly, a lack of knowledge isn’t the only thing at work here. But what can I do other than provide information?

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Carrying Health Messages Beyond Behavior Change

In October, I attended a George Washington University Communication & Marketing symposium titled “Frontiers of the New Social Marketing” presented by Dr. Craig Lefebvre a professor at the University of South Florida. Lefebvre discussed the complexity of public health problems, and how solutions to those problems are equally complex. He summarized the evolution of theories of change from the “Stages of Change” model to the “Social Networks” model. He argued that the social networks model should be the main framework for social marketing—and that social marketing is behind corporate marketing (by a lot).

What struck me most was what Lefebvre called the “OOBE” or the “out-of-box experience.” The OOBE is the experience you have after you’ve taken the desired action a marketing campaign (social or otherwise) was designed to convince you to take.

Lefebvre provided a simple example, the iPhone. When you buy a iPhone you take it home. The packaging is neat and when you open it the charger and directions are nicely place by the phone. In a matter of minutes, you are well on your way to setting up your phone. You are happy and you tell your friends about your great new phone. You use your phone a lot and love it. Compare that to an unnamed other phone. You buy an unnamed phone and bring it home. When you open the package you can’t find the instructions, and there isn’t a charger. An hour later, your phone still isn’t set up and you’re annoyed. You tell your friends how annoying it was to set up your phone. You use the phone and  maybe you like it, but you might buy a different phone next time.

In this example, the iPhone won the OOBE. Both companies got you to buy their phone, but by winning the OOBE Apple won not only a new customer, but also a loyal one who believes in their product. Why is this so important? There are two reasons.

  1. People don’t talk about the research they did to find the right phone or where they bought their phone. People talk about their experience with and enjoyment (or hate) of their phone.
  2. Creating a great OOBE helps sustain the action your original marketing campaign was trying to produce. You bought the iPhone and you love it. Next time you need a phone, or maybe another electronic device, you’ll look first at Apple products.

Right now, public health campaigns leave out the OOBE. Campaigns tell you to stop smoking, eat less, exercise more, avoid this, do that…but what happens if you actually do take the action the campaign asks you to take? Nothing. There are no rewards and no one says, “Great job, keep it up.” Those who take the desired action are checked off, forgotten.

You might say the reward for listening to a public health campaign is better health. That’s true, better health is an amazing thing. But, quitting smoking or eating less or exercising more doesn’t provide instant, tangible results and in most cases comes at a price. It’s hard to quit smoking because it’s addictive, and maybe your life is centered on the social aspect of smoking. It’s hard to eat less; food is so good and there are so many options. It’s hard to exercise, everyone’s busy and sometimes you just don’t want to get sweaty. Summary: Even after you make a healthy change there is a chance that you will revert to your old ways. You’re not necessarily sold on the new “product.”

So the question is, how can public health professionals create an OOBE experience? How can they sustain behavior change after initial action is taken?

Let me offer one example of a health program I think does create an OOBE: Alcoholics Anonymous (AA). I know some people find the AA philosophy controversial, but here I am not interested in the philosophy or method but more the structural model. AA is life-long. You are welcome at AA meetings when you are trying to stop drinking; when you are struggling to avoid relapse; and when you’ve been sober for one month, five years, or two decades. You are always welcome. People at the meetings are at varying stages of recovery and sobriety. The community is always there. There are coins that mark that you’ve made it to certain stages or lengths of time. You have a mentor. The OOBE is the sustained support and the opportunity to use your success to help others achieve the same thing.

Social marketing has a lot to do to catch up with marketing. But most important, especially with the rise of chronic diseases, is finding and creating the OOBE to help those who do take action, maintain their healthier choices.