Health Coach? Try the Element of Surprise

The element of surprise in action--I bet you didn't know what Abraham Lincoln and adhesive bandages have in common.
The element of surprise in action–I bet you didn’t know what Abraham Lincoln and adhesive bandages have in common.

“Ugh. I already know what you’re going to tell me. Eat less food and get more exercise, right?”

This is common feedback I’ve heard during user testing for the software products I work on. Our coaching programs address various health and lifestyle concerns, and indeed, much of the advice boils down to eating differently and moving more. After all, that is how you lose weight, improve your heart health, control your blood sugar, etc. There’s no magic pill that will let you avoid dietary and activity changes and still get the same health results.

Unfortunately we can lose our users’ interest when the message we deliver is exactly the one they’re expecting to hear. Worse in the case of health behavior, the message is often one they’ve heard before and that has not helped them. “Eat fewer calories” is a lot easier said than done. Users are bored by the same old advice, and they will tune you out as soon as they perceive that you’re dishing it out.

One of the things we’ve found in our user testing is that wrapping the expected message in an unexpected context can help break down some of the users’ barriers to hearing it. This can take many forms:

  • Forget about health for health’s sake. Most people aren’t interested in changing their health behaviors just because. They have other more personal reasons. A lot of people want to lose weight to look good and feel confident (this drives change even in people who have more serious health concerns, like diabetes). Beneath that there are often deeper reasons as well, such as wanting to enjoy retirement or wanting to get more out of life generally. If you can put healthy behaviors in the context of these goals, instead of making them sound like goals in and of themselves, people are more likely to take note. Getting your cholesterol below 200 because that’s what the guidelines say isn’t very exciting, but getting your cholesterol below 200 so that you’ll be in better shape for your dream vacation in Italy next year is more appealing. Ask why someone really wants to tackle a health change, and listen to their answer.
  • Let people take on changes gradually–even if it means┬ámaintaining a bad habit for now. Research on behavior change shows that people are more successful in the long term if they tackle smaller changes in sequence, instead of trying to dramatically remake their entire life at once. To continue with the weight loss example, it’s ok for someone who’s just starting to lose weight to not begin an exercise routine right away. Making dietary changes might soak up all the person’s willpower at first until it becomes more of a habit. Once the dietary changes feel a bit more comfortable, then you can urge the person to start walking. Similarly, if someone has a lot of health issues, it might be more productive to work with them in an area where they’re more confident about changing rather than trying to fix everything. One doctor I spoke to said that when he sees patients who smoke, he doesn’t even approach the subject because these are people who are aware of the health risks but for whatever reason choose to smoke anyway. He said he only works on smoking cessation when the patient raises the subject. Letting people work on their health in small bits, maintaining some bad habits while creating others that are better, surprises the people on the receiving end of the coaching and again can catch their attention.
  • Ask about things other than health.┬áPeople hate being reduced to their health conditions. Our users tell us that part of what is aversive about taking a health risk assessment or an online coaching program is the relentless focus on their biometrics and health behaviors without any accounting for other parts of their lives. We get a lot of user feedback every month from people who say things like “Yes, I eat too much, but you don’t understand, it’s because I had this stressful thing happen . . .” Asking people about other parts of their life is a great way to immediately catch their attention. It’s different, and it’s pleasant. And all the better if your question does relate to health. We ask people about their personal values in our programs, because it’s a great way to get someone thinking about what really motivates them. It also allows us to craft messaging that supports what really matters to a user, so that the typical information can be delivered in a way that is personally meaningful.

I’m not sure we’ll ever get to a place where people are delighted to hear that they need to make difficult lifestyle changes. But we’ve learned that if we can present the need for those changes in a way that promotes other valued outcomes, doesn’t sap willpower by asking too much at once, and acknowledges the total person, we can do better. And the very first, perhaps most important step, is keeping the user’s attention through that initial interaction by not giving them the same old information.

If you work in health coaching or health communication, how do you keep familiar information fresh? If you work in another area, do you have tactics for making “bad” news more welcome and interesting?