The role of information in a health context is likely to expand even further over the next few years, with the recent Health White Paper referring to an “information revolution”. The Coalition Government clearly sees transparency as a key element to improve individual quality of care and support the emerging market in the NHS and also a key driver for innovation and reform, driving up quality and productivity and achieving value for money.
Information is also vital for any form of co-production where patients may be asked to increasingly self-care with the support of professionals. The receipt and absorption of information can enable people to act so they can better look after themselves.
Within the NHS itself quality and standards of information are therefore seen as very important. The Information Standards Board for Health and Social Care in England (ISB) is tasked with the independent assurance and approval of information standards for adoption by the NHS and social care. This ensures consistency in a situation where inaccurate information could have very serious consequences.
However despite the provision of better quality and timely information, it is clear that some people:
- Don’t read or understand health information that is meant to be relevant to them
- Don’t take their medication or adjust their prescription
- Don’t eat 5 a day
- Continue to smoke
- Miss appointments
Clearly some of this is down to the issue of health literacy. Over 10 million adults in the UK have problems with basic language, literacy and numeracy which can contribute to all of the above. Increasingly, the link between low basic skills, health literacy and health outcomes is being recognised and tackled.
In addition the impact of globalisation has led to a significantly more diverse population within the UK. The NHS and health providers have led the way in terms of inequality and diversity ensuring information is delivered in a range of formats and languages as well as addressing any cultural differences.
So does tackling these issues solve the problem?
Even people without basic language or literacy problems still do not respond to the rational information that is presented to them. Why do people not act rationally, when in receipt of information? Why do they not take action when the information asks them to do so and is backed up by evidence and the authority of a respected institution such as the NHS? Can we make the information more directly salient to them and does this require a more fundamental behavioural approach based on what we understand nowadays about behaviour change?
Information and behaviour change: Motivation
In behaviour change theory, which health social marketing methodology is grounded on, two elements are seen as important to address. You cannot achieve a successful behavioural outcome without addressing both. They are:
- Ability: “Do I have the ability to continue, start, adapt or stop this behaviour”? e.g. skills, tools, finance, time, physical and mental effort, knowledge and access
- Motivation: “What’s in it for me, or for people like me, to start, adapt or stop this behaviour?”? e.g. How does any new or reinforced behaviour fulfil the needs of sensation, anticipation and belonging that are driven by my emotions and values
If one then takes this and applies it to our understanding of the current provision of health information, what do all the following have in common?
- Provision of information
- Information standards
- Health literacy
- Ensuring equalities and diversity
Each of them relates to tackling and supporting the ability of people to utilise the service. This is understandable. Much of the development of public and welfare service in the last century or so, has focused on building infrastructure, to deliver services of which the provision of information is clearly a part.
Motivation has in the past often been secured through rules and sometimes direct incentives. However, many of the challenges we face now are both complex and intractable and more direct forms of motivation could be difficult to apply when dealing with individuals. No wonder the Prime Minster has been reported hiring Nudge author Richard Thaler.
When it comes to providing information the focus has naturally been to make information as accessible as possible. In other words much of the effort has gone on building mechanisms that enable people’s ability to access information without doing enough to understand who are motivated to obtain information and how this varies. Knowing this would be important in communicating messages to various segments.
How then can we motivate people to take action when in receipt of information? Taking account that resources to achieve this may be limited, how can we identify who are more motivated to act on information and, in particular, who are not?
Information and behaviour change: Emotions as well as Rationality
Often information is provided in a factual way that may make perfect sense to the values of the person writing it, but actually may completely convey completely different messages to the people receiving it.
Thus a very-well respected Doctor might appear on the front of a national paper, to say in very rational factual terms that groups in some communities are obese and need to change their lifestyles. Someone who holds similar broadly optimistic values to the Doctor and who was obese might respond to that in rational/factual terms and at least seek information. However someone with a different set of values might well perceive the perfectly reasonable expression of opinion more as a message about them being wrong and/or stupid. Having more fatalistic or pessimistic values, they might choose to ignore it. The message might simply be added to other “telling offs” and slights they had received at other points in their life.
Often a more emotionally resonant message, told in story format may be more consistent with the target group’s values and thus better heeded. In addition the medium of communications is important too. Online communications by its very nature might be seen to support the rational messaging. For it to be expressed in a way that it is actually taken in it may require a personal interaction to reinforce the offline message.
The issue is how do we identify which values set are more likely to heed different types of messaging and which ones might require offline encouragement to motivate them.
Utilising Values Based Segmentation to target interventions
In order to understand levels of motivation and how important emotions are needed for communication one needs to understand people’s values. We have regularly blogged here about that. More details can be accessed here.
Traditional geo-demographic segmentation is not able to measure motivation or the role of emotions. It can tell you what behaviours there are and where behaviours occur, but cannot tell you why behaviours occur.
Values based segmentation focuses on understanding what drives people to behave as they do. Thus it has to understand the level of motivation and how important a role emotions as opposed to rationalism play in any group’s values set.
The danger information provider’s face is that they may hold values that lead them to be well-motivated and to set a high premium on rational information. This means they often solely aim their message to people who in effect who hold similar values and end up missing out people who hold different values
How values based segmentation and communication might help
If we understand levels of motivation and the importance of emotions in delivering messages there are a number of practical ways this can be taken forward:
- Use the British Values Survey database to understand the groups that are most likely to both read the information and be turned off by it. This could be supplemented by qualitative research to explore people’s needs, values, world views, motivation and behaviour and how it relates to accessing and then to what degree acting on information
- Develop ongoing consumer panels that includes sub-groups of all the values groups to regularly test how people respond and act on different types of information that is being provided
- GP consortia in areas identified as having poor health outcomes could identify advocates within target communities who share similar values and are trusted to engage with in appropriate settings to express key messages in a consistent way.
- Audit the full range of information sources and their delivery to see how they appeal in values-terms. Ensure they are designed so that people are more likely to be driven to action utilising stories and other influence mechanisms to draw people with different values to use them
Conclusion: values driven information
There is a danger we can improve the ability of people to access to information in the coming years, but that it will just be received well by a minority. This paper argues that this is because the information is written and communicated to those who hold the same values set, one should not be surprised that only some will effectively act on it.
A values based segmented approach that can ensure that information is expressed as the right messages are communicated in the right way according to the values set of the people receiving it.
For organisations dedicated to providing rational and factual information this might at first seem something that is at variance with their focus. However in the end the whole point of information is to increase understanding that leads to action and if information is made available and does not resonate then it is a resource that is going to waste with the people who almost certainly need it most.
Jonathan Upton is Chairman of the Campaign Company.