国際医療協力専攻　マルコム教授のメッセージを掲載しました

Communication and Behaviour

The link between certain cancers and smoking cigarettes is well established, as is the association between diet and exercise and the risk of Type 2 diabetes. Yet, we continue to see behaviour (smoking, eating foods high in sugars and certain fats, high alcohol consumption) that is obviously contrary to sound advice and reason. We could simply attribute these to examples of “group think”, a phenomenon more likely to occur in societies and organisations that are closed and have a vertical social structure - a claim with some credence if we focus on Japan. We could also suggest that educational and socioeconomic levels influence the behaviour; however, Japan has high levels of education and relative wealth for most of the people but the behaviour is not uncommon.

Understanding cognitive determinants of behaviour in any setting may prove beneficial to facilitating behaviour change. To borrow from Fishbein et al (2008) there are eight variables that could account for variance in behaviour (although they limit it to deliberate behaviour, I feel it can also be applied to most behaviour). They firstly identified variables that were necessary and sufficient determinants: strong intention, available skills, experience in the absence of environmental constraints. They then identified the variables that were seen to influence intention. For example, a strong intention to change a behaviour would occur when the advantages and benefits of performing x behaviour over y behaviour outweigh the perceived disadvantages. These would include the social or normative pressure on following through on the behaviour is perceived to be greater to perform than not to perform (or vice versa); there is a belief that the behaviour is consistent with a personally held self-image (or desired image within the social context); there is some anticipation that positive emotional rewards (and not negative punishment) will be forthcoming by engaging in the behaviour; and individuals have high levels of self-efficacy (influenced by context and experiences).

Added to these cognitive variables we also need to recognise the environmental constraints that seek to discourage ‘other’ behaviour. For most, these constraints control behaviour, both desirable and undesirable (for the context and/or for the individual). There are, however, cases of positive deviance: successes in contexts where the norm is to falter. Positive Deviance is becoming an acceptable approach to solving difficulties and has been applied over a range of different contexts. Another approach to understanding and developing sustainable organisations is Capability Building, which starts by aligning contexts, integrating people and resources, creating a learning culture, providing learning options, managing choices with all stakeholders and supporting the opportunities to advance. In addition, as with any useful model, pathways for evaluation and feedback are necessary.

Evaluation loops can simply be recognised as reconsider-redo-recycle. To effectively implement evaluation loops requires communication. Communication is the lynch pin that holds all the models together. Whether we are seeking to get individuals to adopt positive health behaviour (stop smoking) or to get organisational cultures to be more dynamic (more horizontal) communication is at the center. Communication is not a one-direction dissemination of (impersonal and sterile) information: it is an interactive (personal and animate) ebb and flow of building understanding by which contexts that encourage positive behaviour become the norm.