This is why scholars have long emphasized the role of self-control in making healthy choices. When we don’t take good care of our health, they argue, a lack of willpower may be to blame.
New research from Hetana Ahar, assistant professor of marketing at the Kellogg School, suggests there’s more to the story. “This may be true for certain types of preventive health behaviors. But for other types of behaviors, the barrier to acting in a healthy way is not only self-control, but that the health behavior itself is intimidating,” she says.
In a recent study, she and her colleagues identify the role that fear may play in reducing participation in disease-detection behaviors, such as mammograms or diagnostic tests, that may reveal a serious illness. At the same time, they find that disease-prevention behaviors, such as diet and exercise, aimed at preventing a future condition are less fearful.
Crucially for health workers and policy makers, it also finds that detection and prevention messages are more effective under different circumstances.
If you want people to participate in detection, it’s more effective to focus on the process (how to schedule an appointment) than the outcome (a potentially scary diagnosis). But if the goal is to encourage prevention, it’s more persuasive to emphasize the “why” (maintaining good health) than the “how” (washing your hands). This is because thinking about the outcome rather than the process of prevention activates our sense of self-efficacy—our belief in our own ability to achieve goals. And that reduces nagging questions about whether we can really trust ourselves to follow through on behaviors.
Indeed, as the world battles a pandemic, it’s perhaps more comforting to think about washing your hands than the prospect of getting tested for the coronavirus.
“Someone who is being tested for a serious infectious disease would probably be more fearful than someone who intends to prevent it,” says Achar. The researchers’ findings suggest that the fear of being diagnosed with a potentially fatal disease is likely to be less felt if people focus on the screening process. Instead, people are likely to take preventive measures, such as hand washing or social distancing, when they focus on the reasons or “why” to do so.
Understanding the differences in detection and prevention
Achar and her colleagues—Nidhi Agrawal at the University of Washington and Meng-Hua Hsieh of Kent State University—wanted to understand how people would react when they were encouraged to take preventive and screening health measures. So, to start, they showed nearly 400 college students a general ad about depression and its symptoms.
The researchers then randomly assigned each participant to one of four groups and asked them to complete a writing exercise in which they described either: 1) how they would detect depression, 2) how they would prevent depression, 3) why they would detect depression depression , or 4) because they will prevent depression.
Participants were then asked to rate how likely they were to seek help for depression, how scared it made them feel, and how confident they were in their abilities. “The beauty of this experiment is that everyone sees the same health ad and is then randomly assigned to a different condition,” explains Achar. “Any difference in people’s intentions to seek help [as measured by these survey responses] is really only driven by differences in detection/prevention or how/why’.
When “why” is motivating—and when it’s scary
Overall, among participants who wrote about detection, those who focused on the “how” were more likely to seek help—and were significantly less fearful—than participants who focused on the “why.” These two detection groups did not differ in their feelings of self-efficacy. Among participants who wrote about prevention, the pattern was reversed. The “how” and “why” prevention groups reported similar levels of fear, but those who focused on the “why” reported higher levels of self-efficacy.
So what did all this tell the researchers?
“When considering prevention behaviors, the ‘why’ is appealing because the outcome of disease prevention is pleasurable and desirable. With detection, the ‘why’ is scary,” says Achar. This makes sense, he adds, because it’s much more enjoyable to focus on staying healthy than thinking about being diagnosed with a disease.
Want to help nervous Nellies join the crawl? Don’t focus on the “Why”.
In these first two studies, researchers measured participants’ self-reported experience of fear or self-efficacy. In a third study, the researchers decided to measure the participants’ underlying levels of fear and self-efficacy, to see if these inherent qualities, rather than the experimental manipulations, explained the difference in the participants’ behaviors.
Their reasoning was that if fear is what blocks people from probing behaviors, then this block should occur more often with people who are likely to fear things in general. People who are not generally anxious should behave as if they are in the “how” state—more willing to seek help in identifying the illness. Likewise, if self-efficacy is indeed what drives prevention behaviors, then individuals with generally low self-efficacy should be more susceptible to the pitfalls of “how” thinking. High-efficacy individuals, in contrast, should feel confident and generally be more likely to engage in prevention behaviors.
So, to test this idea, the researchers recruited a large group of online participants, who completed a fictitious “consumer opinion survey”—a task actually designed to measure their personal levels of fear and self-efficacy without states health detection or prevention.
They called these same participants back ten days later to complete a second task, this time on health behaviors. The setup was similar to the first experiment, except that it was about skin cancer prevention or detection instead of depression.
When the researchers crunched the numbers, they found exactly what they expected: the more generally fearful participants were, the more discouraged they were in the “why” condition from seeking care—a pattern not seen in the “how” condition. But the least fearful people, the analysis showed, did not significantly change their willingness to seek care, regardless of their situation.
Meanwhile, the lower a participant’s self-efficacy, the more discouraged they were from seeking care in the “how” condition. Participants with higher self-efficacy, on the other hand, showed similar willingness to seek care in both the why and how conditions.
When detection is framed as prevention
Finally, the researchers wanted to see what would happen if they addressed the innate link between detection and fear. They also wanted to know whether people actually sought medical advice or treatment — and not just measure what they said they would.
They recruited more than 400 women online to read about a free tool, the National Cancer Institute’s Online Breast Cancer Risk Assessment Tool (BCRAT), which detects breast cancer risk. For some women, BCRAT was framed in this light, as a way of detection, while for other women it was framed as a detection tool that helped prevent breast cancer. After reading about BCRAT, participants wrote about how or why they would use it. Finally, participants were given the opportunity to actually use the BCRAT.
When the researchers analyzed the number of fear-related words used in participants’ how- or why-writing exercises, they determined that “when detection is framed as prevention, the amount of fear expressed by participants it’s much smaller,” Achar said. says.
And in the detection condition, the “why” versus “how” prompt mattered.
Participants who wrote why they would use the tool were less likely to actually use the BCRAT. But when the detection tool was framed by more proactive light, everyone used the tool at a higher rate.
In other words, when you make a detection action look more like a prevention action, you can also make it seem a lot less scary.
The Detection and Prevention Courses
How can these findings help promote good health habits?
Achar says it’s important to understand that behaviors grouped under the umbrella term of “healthy” behaviors can present very different barriers to consumers: some are difficult to adhere to. some cause fear. He suggests that the medical community may want to treat disease detection as a “starting point” on a longer – and less frightening – path to well-being.
“Failure to act in a healthy way is not always a failure of self-control. Sometimes acting healthy is scary,” says Achar.