How to Scale Behavioral Change at the Last Mile in Public Health

Imagine it’s just one of those days. The boss is breathing down your neck. The car is out of gas, and the kids threw a TV remote through the television. Hearing the phrase “at least you have your health” is often the last thing you want to hear, but it raises a pretty good point — how much do we take our health for granted?

Most people simply assume they will remain healthy throughout the rest of their lives, despite the reality that, no matter who you are, some health issues will eventually creep in at some point.

Part of the reason for this belief in a full life of good health is that, until recently, life expectancy rates in the United States were at an all-time high.?Statistics now show that life expectancy in the U.S peaked in 2014?but has been on a slow decline ever since. And even in the face of this data, optimism in public health remains as high as ever.

It’s so high, you may argue, that the public’s response to a health crisis has become optimistically misguided. As the deadliest pandemic since 1918 burned through the country, we still saw large social gatherings, poor mask etiquette, and a general relaxation of personal responsibility.

Even vaccinations are being met with resistance and distrust, and everywhere you look, there seems to be a “last mile” of resistant, distrustful, and avoidant individuals who are inadvertently slowing down efforts to public health initiatives.

In this haze, what happens to our ability to reach these people during a worldwide calamity like a pandemic? How does our hyper-connected world react to the public health crisis of a century, at a time when health is taken for granted?

At the ‘last mile of public health’, you’ll find a dangerous mixture of truth, accidental misinformation, hyper-targeted deliberate disinformation by bad actors, and an under-education of the general population. Public health officials and communicators are tasked with threading the needle of truth into this information-overloaded arena consisting of multiple special interest groups, diverse populations, multiple languages, and communication norms.

At first glance, it may seem like an overwhelming and ultimately fruitless endeavor. But for behavioral scientists like Dr. Alfred McAlister at the University of Texas School of Public Health, it starts with understanding why people believe in alternative or outside sources of information?

Why People Believe False Information

According to the?research from MIT,?we engage with disinformation because its novelty piques our interest more than “boring” real stories. In other words, we like to ascend the doldrums of daily life, and disinformation is ripe for triggering an emotion. Fear, disgust, anger. You name it. These are all powerful emotions triggering social media algorithms to manufacture further engagement with the platform, channel, or source.

According to MIT, the intensity of a person’s emotional response is a primary factor that determines how much a piece of content gets shared. On social media,?people can express emotions such as fear or distrust with much more intensity than joy or sadness, for instance.

When you combine this human desire for an emotional story with the game-like mechanics of social media platforms (with armies of news opinionists playing a global game of “gotcha”), the daily “element of surprise” becomes an addiction that keeps us coming back for more.

We’re also susceptible to the phenomenon of “selective exposure”, which means that we get our online news from a very limited number of pages. Recently,?a report published on Business Insider?uncovered that all the anti-vax misinformation spread across Facebook came from only 111 accounts. With such a high level of artificial and exaggerated reinforcement, we’re robbed of the ability to reach outside sources on the platform, and we only end up reinforcing our existing positions, beliefs, and values. This is known as a ‘filter bubble,’ and it effectively mutes the desire to reach out.

People turn to these sources because they are comforting, yet elusive.

According to Dr. Alfred McAlister, Behavior Scientist, disinformation sources are filling a hole where, in an ideal world, a person would learn about the advancements and efficacy of healthcare options. Instead, these sources comfort the public by wrongfully assigning control to a seemingly out-of-control situation; through misinformation and deliberate disinformation, they use fear to strike at a very deep, human need: the need to know that someone is in control, for better or worse.

The “alternative fact” becomes much more comforting for these individuals, and by knowing the mechanics behind it all, maybe it’s also easier for us to empathize with those who prefer disinformation over the darker reality of an out-of-control virus that’s spreading and mutating among us.

How Misinformation Spreads

The “last mile” of human connection, and how we experience community, has suffered drastically in recent years. Traditional communities, neighborly gatherings, and acts of fellowship have taken a backseat to digital and virtual communities, which are often distorted by algorithms, filter bubbles, and hyper-curated experiences. This has resulted in what we now refer to as the “echo chamber” of life on the internet.

As false information spreads, “echo chambers” are having a detrimental effect on public health measures, increasing friction against the flow of truthful information while simultaneously amplifying and spreading misinformation and disinformation. Furthermore, online echo chambers are beginning to infiltrate our lives offline, something reflected in local and national news.

Increasingly, public health measures are hampered by the disinformation spread via word of mouth, social channels, and online micro-communities. Conspiracy theories float across YouTube, Instagram, and TikTok from people who are?just like us, and therefore perceived as trustworthy (more so than qualified experts). Along with the re-branding of blogs as “alternative news media,” the spread of disinformation is ramping up, and at alarming rates.

A single checkmark on a social media platform has become our all-encompassing symbol of trust, even though that trust is being migrated behind the scenes. It’s the private interest of third parties who are “verifying”, rather than qualified experts and authentic community leaders.

As large groups of people further legitimize these outlets, the bad actors who spread disinformation find themselves with more than enough material, and with the popular channels all around us, they can exasperate us into submission.

Specifically for public health, all this disinformation swirling around is creating widespread apathy, and a lack of trust, and a relaxing of public health measures. As the population continues to grow, failing to course-correct can cause an overall stagnation of public health measures. A once-in-a-lifetime or once-in-a-century public health crisis may become recurring outbreaks, and vaccination and contact tracing efforts may fail repeatedly and become a never-ending concern — all because of apathy and disbelief.

How Messaging Changes Psychology & Affects Behavior

As of 2019, the Stop Mandatory Vaccination Facebook page had about 125,000 followers and 150,000 members in its private group. By 2020, when the group was banned from Facebook, it had amassed?more than 195,000 members.

Although the page and group may not be all that influential in terms of membership size, relatively speaking, its members were accelerating misinformation to all of their friends, families, and colleagues. One group could reach thousands of people, compounding our feelings of complexity, confusion, and frustration, and ultimately causing us to behave in ways that are outside of what we consider our core character.

This is unfortunately the case of the mother?who declined to give her four-year-old son Tamiflu?when he was sick with the flu, in favor of the “natural remedies” recommended by fellow members of the Stop Mandatory Vaccination Facebook group. The boy tragically died.

Communication channels and tactics are evolving, and with it comes a growing “trust gap” between the general public and the institutions that govern the foundations of our society. There is distrust in public health, healthcare institutions, healthcare providers, and healthcare communicators, and people are flocking to groups with similar doubts in the system. The idea that it’s safer to trust one another becomes the glue holding them together. Meanwhile, the content they view continues to be full of misinformation, from dubious sources and bad actors.

And according to Dr. McAlister, this refuge from the distrust that they seek is, ironically, also an illusion.

Social media platforms have emphasized highly personalized, self-fulfilling feedback loops. What’s in-demand doesn’t necessarily have to be real; it only needs to tell us what we want to hear, reinforcing what we already believe. Disinformation lies in wait, ready to fill this addictive demand, and to “enhance” our own experience, we’re incentivized to re-play this game day in and day out.

On social media, we’re rewarded more for pulling the handle of the metaphorical slot machine of maximized engagement, rather than share objective truth.

Several efforts to combat bad information are already underway by multiple digital channels, and some social channels have implemented control measures to prevent the spread of false information. Many advertising platforms prevent entities from running campaigns that take advantage of public health emergencies.

But who watches the watchers?

Another question may be, in the American landscape, can we rely on a private entity to regulate free speech and how public health information is disseminated?

Change Starts at the Individual Level

Behavioral change is based on trust. It begins at the individual level (the trust that we share with one another), and we can build upon that rust by sharing consistent, concise, and timely truths combined with active, empathetic engagement.

“Psychological inoculation” can make people more resilient against the threat of any type of addiction, whether it’s substances like alcohol and smoking, or social media.

This is how individuals can be psychologically inoculated from addictive disinformation.

According to a study by Dr. McAlister, students trained to resist social pressures toward tobacco, alcohol, and drug use began smoking at less than one-half the rate than those who didn’t receive the special training. We can take similar approaches to make people more resilient against the addictiveness of social media and those disinformation dopamine hits.

Trust and inspiration, essential to motivating actual and meaningful behavioral change, intersect when individuals with influence and authority in the real world are able to deliver and amplify these truths. These figures include employers and heads of businesses, local organizational leaders, community influencers, heads of household, and family members.

Unsurprisingly, beating back disinformation means doing more than only engaging with people online. Audiences need to be surrounded by these truths across channels, in public, and in their professional/personal relationships.

These channels, environments, and relationship dynamics are different for every community and audience. The language we use — the tone, syntax, and tempo used in delivering it — it all matters. How we communicate is as important as what we communicate.

Remember, members of the community talk with people while institutions tend to talk?at?people. To achieve inspiration, and therefore behavioral change, we must establish trust by communicating with the public as a member of the community rather than as an institution.

Scaling the Last Mile

At the last mile, we can win the battle for trust at the individual level, but public health officials and communicators must also focus on partnering with heads of networks at every societal level: religious leaders, political leaders, professional associations, employers, social organizations, non-profits, and heads of households.

It is important to not only communicate through these figures but to truly partner with them. This means filling in the gaps by using their channels and networks, and vice versa. Let your partner identify the strengths and weaknesses in your communications and supplement these areas with your partners’ feedback.

We must identify and target intrapersonal networks that exponentially reach more of the public on a deeper level.

To scale, public health officials and communicators must utilize these networks to synergistically disseminate public health truths. These truths, communicated timely and consistently, will motivate people to change their behavior at the individual level and position them as peer models in their community.

And because of how we are connected, these truths are amplified by trusted figures and accelerated by the size and speed of our personal and professional networks and across, multiple generations, and professional networks.

Fighting for better public health, access to care, and education is a battle against resiliency.?To help reach the CDC’s COVID-19 vaccination rate of 80%, our?advertising agency?has kicked off a national campaign to reach resistant, refusing, avoidant or hesitant audiences. You can?download our white paper here, and speak to a subject matter expert to design a resiliency communications campaign of your own.