Thursday, July 10, 2014

Tuning rather than "Behaviour Change": the Make Better Normal Quest

Have you heard about behaviour change (we have standards in the UK about even this)? If you have a "bad" habit, it's a behaviour that you need to persuaded or nudged to be different, because we don't know what's good for us, and wouldn't do it if we were told to.

hmm - proximity of grocery stores to low income areas. Right
and YOUR behaviour is what needs to change?
Ever felt you needed "behaviour change" - maybe you'd like to stop reflexively reaching for that cookie, so you need to change that behaviour? Ya, ok. that's one way of seeing the situation, but what if it were one of the worst ways to address that particular foible? Behaviour change says a lot of stuff that frames YOU as the problem - it's as if we carry these diseases - that are our fault for catching in the first place - and we need to be cured - either

This paradigm of finding ways to change behaviours is becoming an increasingly dominant trope - i see it in research grant funding calls under the Health umbrella: how can we support technology to support Behaviour Change? There's the guidance mentioned above.  There is a Center of Behaviour Change

Indeed, Behaviour Change is a very "health as a medical condition" model - it comes out of clinical psychology - which comes out of working with troubled people. I'd also like to suggest that "Behaviour Change" as a big C concept that one needs like one need any medical intervention may be distinct from Theories of Behaviour Change - which is more about - why do our behaviours change? That's more exploratory than application. Nope, i'm talking about the assertion that the right way to go about a problem with health or wellbeing is, right off the bat "behaviour change" as in, from the above guidelines "train staff to help people change their behaviour." Right.

What if we postulate that Behaviour Change as this concept, might not be the best model for non-clinical people? for every day interactions and wellbeing? What if health weren't a medical condition?

 I'd like to share a few thoughts on why i think "behaviour change" as a paradigm for wellbeing for the rest of us is often (not always but way way too often) a systemic, political cop out, and propose something else that may be more meaningful and actionable in the every day: tuning.

Why bother with language change? As Debra Cameron pointed out in the 80s - she wasn't alone - and a host of dead white guys before her - language frames/creates culture, and culture is what becomes the status quo. And if the status quo is mainly expressed as a language of blame the individual for their oppression, we are caving in to crap rather than addressing the context of our servitude.

The following is a set of idea sketches around tuning. Your thoughts appreciated.

 put the load right on me - or not

Where is this angst with a term coming from? When i hear change, i hear that as an expression of significant transformation: change from one state to another - almost two different things. When i hear about behaviour change, and setting scenes from clockwork orange aside, there seems to be an assumption that i'm doing something wrong, and that must change. Again, that's my vibe, but if we look at the literature around this phrasing, you'll likely recognise this.

Now, there's an app for that
Colleagues of mine argue yeah but sometimes a person really DOES need to change in that transformational way. Indeed, but isn't that the rare case rather than the norm? The extreme end perhaps of tuning?

What's Tuning vs Change

Which brings us to the tuning concept: it's a range of values. Let's look at eating for instance, and why change breaks down as a paradigm. As a colleague at microsoft research, Natasa Millic-Frayling puts it "we all eat. do we need to change that?"

Exactly. We all eat. If we "change" eating to not eating, we have about 40 days, give or take,and then death ensues. If we include drinking in that - so no fluids, esp water, it goes to three days. Really simple. Eat or die (cake or death?)

Depending on our aspirations, we may find that we can eat better to support those desires. IF we want to be more creative and alert at work, we might dial up the whole foods like dark greens and dark berries, and dial back the nutrient poor calorie dense foods like cookies in the afternoon. We might dial back overall amount of food for awhile too to find our sweet spot.

Skills, Knowledge, Practice, Context: choice?

These ideas may sound very simple, but there's actually a hell of a lot going on in there. How would someone even begin to know to pick those combinations to spark the brain? to beat a slump? How would they figure out which bits are working or not? How would they sustain that practice if all their buddies are still serving up the Krispy Kremes?

You can see, there's a lot of knowledge happening in there, there's some skills about potentially how to access these foods efficiently and prep them, say, for work; there's a context that plays a role around opportunities to go get these foods. I just saw a story where teaching assistants in the UK are paid less than the minimum wages and have to work on average two extra jobs to get by. What support do they have to get brain foods, or do experiments to tune in what ratios work for them? And if we can't practice something with some regularity, we do not develop skills. we do not reinforce knowledge.

If we don't have knowledge, skills, opportunities to practice, how can we make choices? how can we make informed choices?

Want to learn more about Tuning for Creativity?
try this slide share on in5 for creative excellence

So the concept of TUNING vs Change says, you probably don't need to change around eating - you may need some knowledge about how food choices align with your values and aspirations; you might need some skills about how to execute that knowledge, and you might need some access and social support to build that practice.


Tuning isn't also just about the individual. Tuning can be about how do we better design our environments and infrastructures to support better creativity, better quality of life - better health?
My humble hypothesis is, if we had a better normal, there wouldn't have to be behaviour change.

Why do we need behaviour change? Does Normal Suck?
What is an example of make better normal. If there isn't an elevator, except for parcel delivery and handicap access (sort of like designated parking spaces) people would take the stairs. Why does that little bolus of stair taking matter? Because our sedentary lifestyles, research indicates, are having an effect similar to smoking: they're killing us. More movement more of the time is key physiologically.

What cultural priorities are expressed in these technological marriages?
Another example of making better normal: put sit stand desks in people's workspaces. Again research shows that given the option, people will make use of standing positions 50-60% of the time. More movement: better health, and standing does the trick. (Here's an overview of this sit/stand related research)

Another example of making better normal: stop subsidising corn and feedlot beef - driven by fast food - and why have we elevated fast food to an art form? so more people can eat in the car (1 in 5 meals in the US is consumed in the car) because they are too tired to get up early enough to have breakfast, or too tired to make dinner. Work sucks. Do you eat lunch at your desk? is any of it processed food? See? Now what's going on there?

This cycle that reinforces the status quo is what i'm talking about: normal sucks. Normal in a knowledge worker culture is sedentarism, long hours, poor pay and crap food choices at the grocery store.

And you tell me i have bad behaviours and need to change? That it's my fault i'm overweight/obese?

The Un Status Quo - Design to Make Better Normal; Make Normal Better

What if meal trucks that served healthy foods to time starved workers running three jobs, had it there in the am and prepapred great food to take home for their families? What if that business model were the norm? So many folks out of work - so many folks who can learn and maybe love cooking skills. This idea came out of a great chat with Casey Choosewood of NIOSH/CDC who care about wellbeing at work as a whole person issue.

What if there was technology that coordinated fresh veg that stores were getting rid of (stores have made public how much fresh food gets binned each day) and rather than wasting could be used by this food truck posse at reduced cost? so that rather than using food subsidy coupons to go to a fast food joint, they got tasty delicious meals?

i keep imagining food trucks like those hannah grant has for team support of her Saxo bike team - filled with people over 50 who have been laid off and love to cook, and now they get wages and great meals as a perk to take home and new skills. They work with high tech info systems that coordinate food disbursement. Maybe they go on to open their own businesses. Or run the food trucks, or coordination or...

Behaviour change: mistaking the site of pain for the source of pain

You'll hear a lot of movement specialists say "the site of pain is not the source of pain" - in other words having a sore shoulder doesn't mean the issue is in the shoulder. It could be a visual issue; could be scar tissue triggering something; could be something happening in the liver 

From just the number of folks i've worked with, this lesson comes back over and over again - work with someone with shoulder pain; affect considerable change by looking at visual performance (can you stair at a dot? some people find this really challenging): deal with that, wow, look what happens with range of motion in the shoulder.

TUNING - it's not about the site of pain; it's options; exploration - having the skills/knowledge/context to find what works for you, for now. Tuning the environment to find what supports a better normal

For me, what i'm finding is that behaviour change - perhaps especially in the hands of popular press or even energised researchers who are not subject experts around cognitive behavioural therapy, it's really easy to jump on the behaviour change band wagon: you there, you're overeating. stop that. wait, i have an app that will fix that and persuade you and build new habits. You won't even know you're being manipulated into this new habit. 

Yes that's extreme - maybe - but i'm having a moment. 

Tuning says - i don't actually know exactly what optimal is - i have some heuristics that we can start from to get to alignment - to dial in practice to values and aspiration -

imagine a gifted mechanic working with a car that seems to be making that funny pinging sound - sure sometimes that person might know - or might believe they know - exactly what it is right off - but how often does that happen? what's more likely the case? They work the problem.

We're way cooler than cars. When we work a problem it's not to find THE solution - who knows what THE solution is or even if one exists but AN APPROACH THAT WORKS and adds to our resilience.

Hence, Tuning also says there are multiple paths to an effect. For instance - having trouble burning fat? Maybe some food tuning could happen, but if that feels insurmountable what about looking at sleeps? what about looking at having a coffee with friends? Un huh, as i've written about elsewhere - because we're complex systems we have many ways to tune in better performance, better alignment 

Tuning says: make better normal - how do we tune our environments so that it is effortless to be optimal?
does this mean better quality food in the canteens at work? group support to walk? Better ways to coordinate work for optimal sleep?

Social options to engage in volunteer activities at times you're available? Colleague Ryan Andrews found a garden activity, i think, where he can work in a garden during the week, and the food goes to folks in need. Isn't that cool? That would do so much for us over watching TV at night. Blending movement, socialising, getting tired in the body, recovering in the mind. awesome. Here's an example of this kind of activity.

And again, for some folks trying to get by with multiple jobs, who are "time starved" - they have no time to give - and that's not a behaviour change issue - at least not theirs, right? How do we design systems to support this wellbeing, systemically? back to Food Trucks? Do we pick on ourselves and each other because it's easier than say, taking on fast food or monsanto (more on that point here)?

Yup, what i'm proposing by tuning is to find paths to design against the status quo to make better normal, and evolve the status quo into where better is normal. And while we do that, stop looking at each other as if we're sick rather than the system that produces illness.

We know the story right? 19th C work conditions folks weren't obese as food was not abundant, but all sorts of other diseases associated with work conditions were rife and killing people. These were systemic. In the knowledge economy calorie dense nutrient poor, sedentary LIFESTYLES reinforced status quo - resistance is - well, challenging. Make Better Normal - help tune in better.  Less effort more "better normal." 

Tuning is More Complex than Behaviour Change - Respect the Complex
For me, the idea of tuning and that it's about exploring multiple paths to find those sweet harmonics that make things click, individually, socially, who knows, maybe politically, is that it's not a single factor, big pill solution. "behaviour change' says "you there: you eat too many cookies: stop eating cookies" 
Why? Maybe if we looked at the work place we'd see there's no social interaction or support, and if we looked at improving workplace interaction quality, the cookie thing would fall away - effortlessly. 

Our complexity is a gift - it means we have thousands of ways to make progress over thousands of paths.   Tuning is a gentle dialing in or tweaking of possible paths of things we already do to help them get closer in tune, to push a metaphor, with what we value - for ourselves, our families, our community, our work, our lives together. 

Tuning  asks what in the whole context - not just me - can be tuned better to support a better normal for all of us, all the time. 
How do we design to make better normal/make normal better? IF we do that, doesn't behaviour change largely just go away?

food for thought, anyway.
As said, the above is some sketches - keen to hear your thoughts.
to me, Tuning feels more explorable, testable, safer, and less "your fault" than the medical/clinical model of behaviour change. That reduced threat may also make that change you seek more doable. And being motivated to design better tuned systems may reduce the need for changed anything anyway, eh?

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