Behavior Change

We talk about behavior change as if its impossible. We get teaching about the transtheoretical model where a person must go through various stages before behavior change happens: precontemplation, contemplation, preparation, action, and maintenance. When we meet a smoker of 50 years, we throw up our hands and give up. But should we? Is change really that tough?

Over a year ago, most of the counties around here started enacting laws that required grocery stores to charge for plastic or paper bags. It was a small thing to encourage behavior change. Consumers grumbled. We'd forget to bring our reusable canvas bag and we'd mumble about paying that extra dime or quarter. We wondered what we'd line our trash cans with. But deep down, we understood the environmental principles beneath this change. Now, whenever I go to the grocery store, I and most other customers I see lug along our reusable bags. It's ingrained in us now, and perhaps this small but universal change will help out our landfills some, reduce the plastic we produce and waste.

Similarly, a year ago, our ICU progress notes changed. The decision from the "higher-ups" was to change our notes from "organ-systems based" to "problems based." The details are unimportant, but this translated into a lot more work for the residents. I used to be able to jot out a note in a couple minutes; now, as I click through our electronic medical record to add problem after problem, the notes become much more time-consuming. There was a lot of resistance at first; we didn't understand why this needed to be. But now, a year later, it's how things are done.

To enact change, we'd like the person to be ready for it. We'd like all our smokers to be reading about alternatives, going to counseling groups, and talking to their families and friends about quitting. But in absence of such an idealistic world, we should not give up. We should continue to push for rules, regulations, incentives, and disincentives to nudge those along who need behavior change. I used to think that increasing the tax on cigarettes would not dissuade smokers, but I've come to question that notion. It's true that everything has pros and cons - and a tax like that might have a biased effect on a certain socioeconomic class - but behavior change is paramount for public health, and we should do everything we can to make it happen.