Just because we know we should behave in a certain way, and even when we’re aware the behaviour would benefit our health in the long term, simply having health knowledge doesn’t indicate any intention to act on it.
Knowledge is only part of the equation, because what patients know is often at odds with their attitude, which is described as the view people take of a thing or action. We know, for instance, that many of the world’s most dangerous diseases and health conditions are caused by so-called lifestyle behaviours. Smoking tobacco may lead to lung cancer, an unhealthy diet may lead to diabetes and failing to practise safe sex can result in HIV/AIDS.
Is health knowledge important?
Without knowledge concerning health-related issues and the kinds of behaviour that can lead to chronic, incurable conditions, there is no chance of persuading people to change their behaviour. By itself, however, behaviour change won’t happen purely through awareness of potential risks.
Health is something we take largely for granted for as long as we have it. When we feel well, we can’t imagine that changing. It’s only when something happens (and this can be as commonplace as pulling a muscle during exercise), that we realise how fragile good health actually is. In full health, we often see factors that risk ill-health as minimal. Smokers know the dangers but smoke anyway, and inactive people know moving more would result in better overall health and less chance of developing a heart condition, but continue to prefer sitting still most of the time.
Research has shown that even when confronted with the evidence (such as showing the damaged lungs of smokers) the resolve to amend personal behaviour only lasts for a couple of days.
Clearly, health knowledge is not enough to effect behaviour change.
The perception of threat
Most of the behaviours that harm health are, in some ways, the very behaviours that give pleasure. When confronted with the need to change for the sake of health, we tend to weigh up and balance the benefits of giving up something enjoyable against the perceived cost in terms of lifestyle or enjoyment. Having the knowledge that an action is a risk isn’t the same as seeing a threat.
A threat is something that poses immediate danger. It could fall into one or more of several categories:
Perception of threat is determined by attitude, or the context in which the threat exists. For instance, we understand that falling off a cliff could kill us. The threat is immediately obvious, but responses will differ, for example:
- Some people will move away from the cliff edge.
- Others will enjoy the adrenalin rush of being there.
- A few will invest in climbing equipment.
Changing risky behaviour is also easier when the behaviour isn’t part of a regular pattern or habit, or when it’s not especially valued. Responses to threat are also stronger when the perceived threat is imminent rather than likely to manifest at some distant point in the future.
We are also more likely to change behaviour in response to unanticipated events, such as when an apparently healthy person has a heart attack. Hidden threats, such as those posed by unhealthy eating habits, lack of physical activity or smoking are harder for healthy people to act on, despite associated health knowledge.
People are adept at finding ways of dealing with the cognitive dissonance that arises from behaviours contradictory to their health knowledge. Research into how conflicting health beliefs and health rationalisations impact behaviour change decisions may help to improve general population health.