Most of our knowledge about changing behaviors comes from carefully designed and controlled studies that seek to, as much as possible, emulate the laboratory conditions and the scientific method enshrined in the physical sciences. These approaches prided themselves on the objective scientist who carefully controlled all possible sources of variance and then systematically manipulated the level of one to detect its effect on an outcome (or dependent variable) of interest. What makes it science, and not delusion, is that the method can be replicated by other investigators and similar results are observed.
This reductionist model of science has been the bedrock of public health science and social marketing for far too long. As the physical sciences challenged and moved on from conceptions of the world in which the whole is equal to the sum of its parts to one of complex systems, public health has also slowly embraced a guiding philosophy where the whole is greater than the sum of its parts - the social ecological model being one attempt to become holistic. Yet, what fascinates me is what happens when meeting with experts who can spend hours mapping out all the elements, or co-determinants, of how and why children are not physically active and consume excessive amounts of calories. Then, gazing at a wall full of charts and figures showing these relationships, I ask the question: which one do we focus on to change? The answers that come back reflect the reductionist framework - which variables cause changes in another, the lack of data to support the primacy on one over another - and we invariably have more choices than resources to tackle them. The trees have obscured the forest.
A missing link in developing BIG change programs is not that we don't realize that change occurs in the context of larger systems, it is that we do not how to influence systems very well - we have been acculturated to think about "A causes B that leads to C." Or, Sources (or other characteristics) influence Messages sent through various Channels that lead to changes in Behavior among specific Audiences. One of the unsettling notions of the Web 2.0 world for reductionists is that Audiences become active agents in this process and the communication process becomes a system of inputs and feedback loops, not a simple progression of steps (that, if followed correctly, lead to 5% solutions at best). These linear models of communication may be useful in thinking about some types of interpersonal (say patient-physician interactions) and mass communications (political campaigns). In our social marketing and social change work we must step up and acknowledge that most of the behaviors we work with, and the circumstances in which we work with people, happen in a context of dynamic social networks and systems - both theirs and ours. Understanding this context for influencing social change leads us to follow our colleagues in the physical sciences to consider chaos theory and complex adaptive systems as core ideas in our new approach.
Ken Resnicow & Scott Page have explored some of the implications of this new thinking about chaos theory and complex adaptive systems for public health interventions. Key principles they draw from these models are that:
Behavior change is often a quantum event, rather than a linear and predictable one. They cite as evidence to support this contention that almost half of all smokers who successfully quit report that it was the result of an unplanned attempt rather than a deliberate or progressive movement through stages of change. Likewise, drinkers who were non-problem drinkers at long-term follow-up were more likely to state that their decision to quit was the result of a transformational experience rather than a weighing of pros and cons or the encouragement of others to quit.
Behavior change can resemble a chaotic process in that it can be quite susceptible to initial conditions such as motivation or emotion, highly variable, and difficult to predict. The authors echo principles of health communication that call for reaching people when and where they are in the right frame-of-mind to be the most open and receptive to the message.
Change often occurs within a complex adaptive system that involves multiple parts that interact in nonlinear ways and whose results are greater than their sum (e.g., cost, availability, legal restrictions).
As a result, public health interventions should place greater emphasis of the periodicity or frequency of interventions rather than their intensity. That is, as providing opportunities for individuals to hit a motivational lever - not just more opportunities to engage in desired behaviors. One empirical study supporting this view showed that student exposure to multiple channels of a nutrition education program over a semester was the significant predictor of changes in nutrition knowledge and behavior, not individual components of the program.
The practical implications of taking a more systems-oriented view for social marketers is that we have to rise above individual level determinants of individual behaviors. We have to understand how behaviors work in the ecology of the social and physical realities of our audiences - how are the current ones adaptive? What changes in the social ecosystem are necessary for new behaviors to be learned and practiced? How do we find the best combination of product, prices, places and promotions that work at multiple levels - individual, family and social networks, community, and the physical, economic and legal environments - to integrate into programs to improve individual and social welfare (for instance, how do we mix smoking cessation services with increased tobacco taxes, smoke-free workplaces and communication activities to achieve change, rather than argue over the merits of one approach over the other as reductionists are prone to do)? And how do we develop sustainable programs in which frequency of exposure over time becomes the process measure of choice for our programs, not reach?
I am not suggesting here that you throw away all the old ways of thinking about the problems you tackle in your work - but examining them may help you get reach some new insight or inspire a new program idea. Thinking about systems and your interventions can complement the way you construct social change.