It’s not about the nail

Why do people avoid mandatory self-isolation during the COVID-19 pandemic? The simple answer is because they don’t want to change. “The facts are important, but so are emotions,” says researcher Dr Holly Seale in this article in the Conversation.

A theme that often comes up in conversations with my patients is behavioural change. I discovered a long time ago – mostly through trial and error – that telling people to change, adopt a certain lifestyle etc, has a low chance of creating the desired outcome. There are other, strong factors that influence our willingness and ability to change.

Working against us is the ‘optimism bias’. As a result of unrealistic optimism, we tend to underestimate the probability that we are exposed to negative events, despite clear evidence to the contrary.

Dr Seal and her team found that quarantine compliance is often hampered by a lack of engagement and low levels of ownership within the community, complicated by information gaps, fear of social isolation and concerns about loss of income, job security and sick leave.

Supporting the adoption of desired behaviour appears to be a key element.

It seems to me that people should be invited to learn more about the risks, explore barriers and consider the benefits of taking a certain action. It is essential to help build confidence and develop a positive attitude towards change (the same principles used in motivational interviewing).

The pitfall is to jump straight to the solution. This point is well made in the classic video ‘It’s not about the nail‘.

I recently attended a workshop about behavioural change, where the video was used to demonstrate the ‘righting reflex’ – our strong but not very effective desire to make things right immediately.

The video illustrates the different needs people have when faced with a problem. In this case, the different approach of a woman and a man to the same issue (a nail). If you haven’t seen it, it’s worth having a look.

One thought on “It’s not about the nail

  • So true, it’s a real art that health workers only acquire with practice. There is a great course on how to build patients with addictions up towards change on GP learning from RACGP. It’s called Alcohol and Other Drugs – Essential Skills. And it illustrates clearly the skills required.

    Liked by 1 person

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