What is the future of digital interventions for health behaviour change?

Turning Heads – Utilising Psychology

The digital environment (e.g. Internet, mobile phones, smart phones) that is now an integral part of our daily lives is becoming an increasingly important means of sustaining the health of people worldwide, whether by providing access to a wealth of information, by linking geographically dispersed communities of peers and professionals, or by supporting self-management of health and illness. The Internet is therefore rapidly becoming both a medium and a focus for health psychology research.

The Internet can be used as a source of naturally occurring observations and data, as in the qualitative study by Rodham, McCabe, and Blake (2009) of Internet communication between people with Complex Regional Pain Syndrome. It can also be used to give people personalized feedback about their health risks, as in the study of predictors of online diabetes risk test taking by van Koningsbruggen and Das (2009). Perhaps most significantly, it provides a cost-effective means of making automated behavior change interventions widely available, such as the stress and alcohol reduction programmes deployed in two papers in a recent issue of Psychology & Health (Crutzen et al., 2009; Fridici, Lohaus, & Gla

Utilising exposure measures of Internet-delivered interventions

Turning Heads – Utilising Psychology

Evidence from efficacy trials indicates that exposure rates to Internet-delivered interventions are low (De Nooijer, Oenema, Kloek, Brug, De Vries, & De Vries, 2005), and they may be even lower when these interventions are implemented in real life rather than in a research setting (Evers, Cummins, Prochaska, & Prochaska, 2005). Exposure of individuals to the intervention content, through use of the intervention, is necessary since attention is a prerequisite to establish desired behaviour change (McGuire, 1985). Therefore, it remains important to assess exposure to Internet-delivered interventions.

There are several measures to assess exposure to Internet-delivered interventions, such as frequency and duration of visits, but there is no gold standard. Each exposure measure relates to a different aspect of exposure (Danaher, Boles, Akers, Gordon, & Severson, 2006). One can visit an intervention very frequent, for example, but only for a short period of time. Duration of visits, on the other hand, does not necessarily give a clear picture of participants

Language use in persuasive arguments

Turning Heads – Utilising Psychology

Language is a great example of dual information processing. One part of language is explicit and controlled and another part is implicit and automatic. Explicit language processes are consciously manipulated by people such as the choice of words, intended meaning, and intonation, while implicit language processes are largely unconscious and receive little direct attention.

To explain or not to explain?
Looking at the details of language can give us much information about people’s attitudes and inclined behaviours, as people occassionally disclose their attitudes or what they are going to do in a manner of the way they communicate but not in the content. For example, if one expects a Black American male “Darnell” who is a short-distance runner, to be quick on his feet, learning that “Darnell came in sixth place…” may instigate an attempt to explain his disappointing position (“… because he was slightly injured). Attempts to explain behaviour most often occur to make sense of things when there is an incongruity in attitudes or behaviour (American runners are known for being among the best short-distance runners in the world).

However, learning that “Darnell stole an old lady’s purse” is unlikely to be explained. Why? Because the information is congruent. And when information is congruent, it often means that our (stereotypic) expectancies have been confirmed. Thus, just by paying attention to the language, we have come to learn that the fictitious person in our example has a mental representation of Black Americans as both athletic and criminal. But merely having mental representations or articulating these representations in language does not necessarily lead to behavioural consequences.

One example that can lead to behavioural consequences is when subordinates communicate to a female leader that they perceive her as “too soft” or “unprofessional”. Consequently, female leaders sometimes shift their leadership style to a more powerful and masculine style. Language changes to become more directive, task-related, and generally contains few tag questions (e.g. “It could have been better, don’t you think?”), hedges (e.g. “I’m not an expert, but…”), and hesitations (e.g. “…uhm…” or “hmm…”). This sometimes happens when female leaders are put under stereotype threat that they are poor leaders. It is important to note that such reactance is not only reserved for female leaders. It can strike males too, and people in all positions and situations.

Promotion or prevention?
Motivated cognition can definitely translate into behaviour as Spiegel, Grant-Pillow, and Higgins (2004) demonstrated. They assigned participants the goal of writing a report about their leisure time. All participants were given the same set of instructions, except that one half were instructed to focus on taking advantage of appropriate times, places, and methods in writing their reports (i.e. a promotion focus), and the second half were instructed to focus on avoiding bad times, places, and methods in writing reports (i.e. a prevention focus). They were also assessed on regulatory focus prior to the task. Both those who were promotion focused and were given the promotion focused instructions and those who were prevention focused and were given prevention focused instructions were about 50% more likely to mail their reports than those where there was no regulatory fit (i.e. promotion focused/prevention focused instructions and prevention focused/promotion focused instructions). Clearly, paying attention to linguistic details and applying language with intent can dramatically change the “persuasiveness” of arguments.

Implicit use of language can be used beyond the few examples given herein to instigate cognitive, emotional, and behavioural change. It represents a low-budget and low-tech approach to both increasing the persuasiveness of arguments and attitudinal and behavioural measurements. But it also gives us access to information about people that may be inaccessible for different reasons (e.g. because language is largely an unconscious process or because people do not want to disclose sensitive information such as their racial preferences).

Key reading:

Petty, R. E., Fazio, R. H. & Brinol, P. (2009). Attitudes: Insights from the new implicit measures. Psychology Press: New York.


Spiegel, S., Grant-Pillow, H. & Higgins, E. T. (2004). How regulatory fit enhances motivational strength during goal pursuit. European Journal of Social Psychology, 34, 39-54.