In a call to action timing is everything

Nebulizer Baby

I recall with shame that I had failed to protect our little boy when he scalded his hand while I was running his bath. At that moment the advice to keep toddlers out of the bathroom while a hot tap is running was hardly necessary. Similarly the dentist who advised us that dried fruit can cause dental caries rammed home the message when he announced that our five year old needed fillings.

Health professionals frequently impart information as a call to action:

You are drinking too much. You need to stop smoking. You need to take more exercise. You need a holiday. You are damaging your hearing. You are putting yourself at risk of skin cancer. You need to take the test.

The problem is that the advice is rarely followed. A wonderful paper by McBride, Emmons and Lipkus cited 487 times offers a heuristic model for ‘Teachable Moments’. Events such as: clinic visits, notification of abnormal test results, pregnancy, hospitalization and disease diagnosis. In many cases the impact of a health promotion message delivered in this context is substantial, and far better than any other intervention.

  • Clinical visits for health promotion and acute illness

It is more likely that a parent will stop smoking if their child is attending a clinic for a condition that is exacerbated by passive smoking. Similarly dentists are much more likely to promote successful quit attempts when they advise smokers attending with dental problems.

  • Notification of abnormal test results

It is more likely that people with abnormal spirometry results will quit smoking if advised at the time of receiving their results.

  • Pregnancy

Studies have reported that among those smoked prior to pregnancy 39% quit after becoming pregnant, a rate 8 times that reported among smokers in the general population.

  • Hospitalisation and disease diagnosis

The 12-month follow-up quit rates among hospitalised smokers who received no formal intervention ranges from 15-78%. Reason for hospitalisation has been suggested as an important co-factor in cessation rates. Long-term abstinence rates are higher among cardiac patients and those receiving care for cancers.

The evidence from research is that pregnancy and hospitalisation have the greatest potential as a ‘Teachable Moment’. It seems that the triggering effect of a health promotion message is much more effective given the heightened emotional state and the increased perception of risk and benefit from the suggested action. In addition ‘individuals see greater personal relevance in events that threaten or increase their self-esteem, undermine or enhance feelings of personal control and endanger positive expectations of the future‘. In these circumstances people will invest greater emotional and cognitive effort in achieving the necessary outcome.  It’s not just the message that needs to be considered but the ‘Teachable Moment’ and how that message is to be imparted. The most effective health professionals know how to do this without making a bad situation worse.

Picture by Kristy Faith

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