Dr Jon Reston of Atlantis Healthcare UK outlines some of the ethical issues associated with interventions aimed at changing behaviour.
“Behaviour change” is something we all engage in all the time. We all intend to change our behaviours sometimes – making a New Year’s resolution to take up a new hobby, starting a diet, deciding to call loved ones more. However, changing behaviour is very difficult – humans are creatures of habit, and many factors determine the success or otherwise of changing a behaviour.
“Behaviour change interventions” can describe anything designed to help people make those changes in behaviour through various types of support – from coaching and counselling, to incentives, apps, and activity trackers… the list is endless.
Many behaviour change interventions can be sorted into one of two types. One type helps people to do something they already want to do. If you want to get fitter, a personal trainer, or an app that lets you track workouts and reminds you when you miss one and provides reinforcement when goals are met, can help you achieve that.
The second type involves getting people to do (or stop doing) something they had no intention of doing. There are many approaches to this, from changing a person’s belief through persuasion, to changing the environment to make behaviours easier or harder to perform. Since the links between smoking and lung cancer have become clear, many interventions of this type have been used, from public “Stop smoking” messaging campaigns, to the banning of smoking in public places, and raising the price of cigarettes through taxation.
The first type of intervention is not, at its basic level, ethically problematic. Helping someone to make changes to their behaviour, in a way they agree to, is usually a positive thing. It is the second type of intervention that can raise the most ethical questions for some. Is it right to apply the science of psychology to altering people’s intentions, even if it is ‘for their own good’?
Beyond this, with the advent of digital interventions and the availability of more and more data on personal beliefs and behaviours, there are new opportunities for more effective behaviour change interventions of both types.
For example; a person has agreed on a cancer treatment plan with their doctor, and they are committed to sticking to it. A digital personal support intervention may ask about their beliefs, and tailor supportive content that aims to keep their motivation to stick to treatment high, even on difficult days – while helping them recognise when they should contact their doctor. If this is happening with the person’s knowledge and consent, the core ethics of the approach are sound.
However, where the information presented to a person is tailored to a specific end without their knowledge it is happening, this becomes problematic. For example, social media sites will frequently use algorithms to choose a subset of information to show people with the aim of influencing attitudes and behaviours – with political views and behaviours having been in the spotlight recently.
Ultimately the key is informed consent – and this should be a central component of all personal behaviour change interventions.
Dr Jon Reston
Atlantis Healthcare UK