Carrot or Stick? Message framing to motivate health behaviour change

Advertisers are experts on human motivation and decision-making, using psychology to get us to buy their products or use their services. Take a look at these two commercials for mouthwash. Aside from any brand loyalty you might have, which of the two would be more likely to motivate you to start using mouthwash, if you didn’t already?

Behavioural economists and health psychologists know that we can be differently motivated to seek the benefits associated with doing something or to avoid the losses associated with not doing it. This  has been shown through research examining the effects of message framing on how people make decisions. Message framing refers to the how the emphasis is placed in a message on either the positive (gain) or negative (loss) consequences of adopting, or failing to adopt, a particular behaviour. Either can be variously persuasive depending on the value we attribute to the risks/benefits, how we rate our “odds”, and our individual motivational style (approach/avoidance).

By depicting an attractive woman who is gradually revealed to have a missing front tooth, the first commercial for Corsodyl is a clear-cut example of emphasising the loss-framed message: “I don’t want to look like a pirate, so I will gargle!”. This commercial is also pretty unusual in a dental campaign in how explicit it makes the risks, or losses, associated with gum disease. Corsodyl have kept up their loss/risk framed campaign in their latest commercial which shows blood dripping from a woman’s eye with the caption “you wouldn’t ignore this”.

Yet most dental campaigns (like the Listerine commercial) focus on positively-framed imagery emphasising the clean, fresh aspect of dental hygiene, even if they do list the problems that the product is designed to fight. The assumption made by these advertisers is, presumably, that people are going to be more motivated by the benefits of a perfectly aligned sparkling smile.

You  might already have identified which commercial most motivates you to start using mouthwash. This kind of effect can apply to our motives for all kinds of lifestyle changes, such as improved diet, increased physical activity, quitting smoking or using sunscreen.

Our decisions are also influenced by several cognitive biases that cause us to take (or not take) action despite the seemingly rational reasons why we should. Two of these biases relate to how we evaluate our chances, or the “odds” of something happening:

• We are more likely to underestimate high probability odds. The “it won’t happen to me” syndrome, e.g., we chose to ignore the evidence smoking causes 90% of lung cancer deaths in men and 83% of lung cancer deaths in women.
• Conversely, we are more likely to overestimate low probability odds. The “someone’s got to win it” syndrome, e.g., a 1 in 14 million chance of winning the Lottery
• Similarly, the optimism bias means that we are more likely to overestimate the likelihood of positive events and underestimate the likelihood of negative events. In fact, we are more likely to view the risks of various behaviours as lower for ourselves than for others engaging in similar behaviours. For instance, studies show that smokers believe that the health risks of smoking are lower for themselves than for other, same-age smokers.

So how can this information be used to help people be more likely to engage in, and stick to, a lifestyle change to increase their physical activity? Here are a few thoughts:

1. Are you not yet convinced that you need to do more physical activity despite perhaps being advised to do so? Review the cognitive biases above and be honest with yourself: are you being over optimistic about the risks to your own health despite the known facts?
2. If you have already decided that you want or need to increase your activity levels, then you probably have some good reasons for making that decision: Are you exercising to avoid health problems (losses) such as diabetes or reduced mobility? Or are you exercising to achieve benefits (gains) such as looking good in a bikini or having more energy to play with your children? Reflect upon whether these are sufficiently motivating for you. Think about the most meaningful things you have to gain by being healthier, and lose by ignoring your health.
3. It might be that right now you are exercising simply to avoid health risks and that this is motivating enough for you. But by exercising you will reduce those risks – how might that affect your long-term motivation? Remember to revisit your reasons and motives for exercising regularly and make sure they are aligned with your current health status.

I am fascinated by how we make decisions, and within my practice these are some of the things I help my clients explore and understand. We need our own personal motivations, not those of others, but, like goals, they are a moveable feast and it is important to review them regularly.