Go Beyond the Limits of Scientific Evidence:
Generate Personal Evidence about Behavior Change
Evidence-based guidelines (EBGs) do not help you work with the majority of patients who resist behavior change. So what do you do when the proven interventions are ineffective? Do you give up and perpetuate a self-fulfilling prophecy of clinical nihilism?
We need to move beyond static, one-up scientific approaches (such as the 5 A's model for behavior change) to a dynamic process of testing interventions that put the patient in the one-up position of discovering what is effective and ineffective for them. We need to go beyond the limits of:
- Practitioners using scientific evidence (surface change approaches) on patients to
- Patients generating their own personal evidence about behavior change
Heisenberg's Uncertainty Principle About
Research and Practice
Within the scientific control approach, researchers produce high-quality evidence about what works in Ivory Towers, but poor results in the messy, real world. Outside of the Ivory Towers in the open economy, marketers (such as tobacco and high-density food corporations) produce spectacular results in the messy real world, but poor evidence about what really works in particular. Granted, marketers have an easier task than behavioral researchers, because initiating behavior change is much easy than changing established behaviors. However, a tension remains between
- Generating high-quality evidence in the Ivory Towers vs.
- Producing spectacular results in the messy, real world
This healthcare dilemma between research and practice is the equivalent of the Heisenberg's Uncertainty Principle.
- The more focused that we become on generating evidence about linear causality about behavior change, the less able we become in producing results
- The more focused that we become on producing results about behavior change in the real world, the less able we become in generating evidence about linear causality
Beyond the Uncertainty Dilemma
We need to change our scientific paradigm from an outside-in to inside-out approach: in other words, from objective science to practical wisdom. Use the MHH learning process to create learning opportunities that empower individuals to become the principal investigator of their own behavior change. Engage patients in reflective experiences using a blend of learning methods that help them to make deep change by exploring their-
- Perceptions about risk, benefits and harms
- Resistance and motivation based on what they think and how they feel
- Energy level and competing priorities
- Confidence and ability to change
- Motives and values
This learning process can help individuals discover what work for them, in particular in how to change their unhealthy habits.
The chapters (below) explore this issue in greater depth how our restricted view of scientific evidence handicaps our capacity to mount effective behavior change programs in real world practice.
The Challenge of Implementing Comprehensive Behavior Change Programs
A. Exploring How World Views Affect Our
Approaches to Health
B. Exploring Different Kinds of Evidence