Why don’t scare tactics in public health campaigns like the anti-obesity ads work? The reason is rooted in psychology

You might have several individuals with the same risks, taking part in the same negative behaviours, but the assistance they need will differ widely from person to person

Telling an adult what to do “for their own good” is likely to go down like a Theresa May Brexit deal. So, for those of us involved in healthcare, we need to find ways to understand not only an individual’s health risks, but also what makes them tick.

Think about it, if you tell a child to tidy their toys “just because”, you’re unlikely to achieve the desired effect. How many parents, feeling exhausted by the mountain of Lego and toy cars on the kitchen floor might resort to “tidy your games away and you can have a biscuit”?

It’s the same with us adults and our health. As human beings, we make our own choices based on knowledge and motivation. But what motivates us isn’t the same for everyone. Some people do like rewards. But for others, a motivating factor might be the pride we take in looking after our health, or the fear of becoming seriously unwell.

Take a stroll back through the history of public health marketing and you’ll spot trends from different eras. It wasn’t just the calls to action that changed (back in the early days of health marketing, smoking was, clearly, actively encouraged) it was also the persuasion tactics.

As many will remember, campaigns in the 80s were driven by a culture of fear. Think about the terrifying campaigns about AIDS where imagery was dark and sinister, and messages were designed to scare people into changing their behaviours. If you go back further still, to the 60s and 70s, campaigns seemed to be geared towards attracting the opposite sex by quitting smoking or losing weight. Thankfully, for the most part, we’ve moved on.

The one thing these campaigns had in common was that they communicated blanket messages to a mass market via traditional media channels. This mode of delivery is something that we are no longer constrained by thanks to data and digital developments.

But as health professionals, we can only communicate these messages effectively if we embrace digital innovation and technical expertise. We can’t do it alone.

Today, we can target messages about smoking, or obesity, for example, to individuals who may be at a higher risk of developing cancer. So we’re filtering out the health messages that may not be as relevant, but it doesn’t stop there. If we can understand not only the potential health risks but also the motivations driving the behaviours, we can target messages more accurately.

This is where multi-disciplinary working comes into play. Thanks to legacy funding from the Great Exhibition of the North and its ERDF-funded GX project, small and medium enterprises (SMEs) are teaming up with north-east universities to collaborate on innovative projects.

By facilitating these opportunities, Great Exhibition lead delivery partner, NewcastleGateshead Initiative, has brokered partnerships that cross the more obvious boundaries.

For example, at the University of Sunderland we have teamed up with local SME, Medintu, which provides a digital platform to track an individual’s personalised wellbeing journey. As intelligent as the system is, Medintu’s founders have bigger ambitions. They want to develop a targeted approach to health behaviours based on both health risk factors and user motivations.

In psychology, when we think about motivational factors, there are several theories and models that underpin our work. And we know from previous research that a lack of motivation is one of the main causes of people continuing to use negative health behaviours.

So, you might have several individuals with the same cancer risks, taking part in the same negative behaviours (e.g. smoking) but they may have different levels of understanding of those risks and different motivating factors.

Therefore, different people require different approaches to behaviour change. If you think about it as a scale – from pre-contemplation, where you might not even realise the impact that smoking is having on you, to contemplation and then action and maintenance, we can understand that individuals have the ability to move along that scale – and many do.

Digital advancements have provided a firm foundation to more easily connect behavioural and motivational theory with health data. In Medintu’s system, for example, which is targeted at employers wishing to offer more proactive health and wellbeing packages, we can consider whether an individual, on identifying the health risk, engages with, for example a smoking cessation counsellor. If they don’t, we can try to determine why this may be and help to provide an evidence-based approach to behaviour change.

Digital technology has the capacity to transform public health campaigns because of this ability to provide a tailored approach. We can see this from the various health and wellbeing apps that have grown in popularity, but these often focus on one specific area of health and wellbeing – whether that be sleep, diet, physical activity, hormonal cycles or mood. However, what we are currently looking at is bringing these aspects into one place.

It’s a huge challenge to pinpoint specific, targeted messages within a vast holistic picture, but it’s one that has the potential to significantly improve health outcomes. But we can only rise to this challenge if we look beyond our own sector and embrace expertise from a broad range of backgrounds.

Nicola Davinson, senior lecturer in psychology at the University of Sunderland, is working on the GX Collaborate project alongside Medintu and University of Sunderland colleagues, Dr Kate MacFarlane (computer science) and Dr Catherine Kenny (psychology)