Almost all efforts to drive participation in wellness programs focus on motivation. Initiatives like inspiring messages, rewards and incentives, attempts to "make it fun," readiness-to-change surveys and activity tracking often try to address what common sense tells us is missing: People simply lack the motivation to change.
Therefore, if we can "up the stakes," threaten, bribe or convince people that they should change, we will help them over this motivation barrier and new habits will emerge. If you think a lack of motivation is the main problem, think again!
Most people with poor health habits say that they want to be healthier. In other words, they are already motivated. When people fail to change their habits, we naturally assume that they simply didn't have enough motivation. Popular culture and wishful-thinking books like "The Secret" may harmfully lead people to believe that wanting something enough or thinking about it enough will make it a reality - as if there is some sort of yet undiscovered form of magnetism that transforms desires into outcomes.
I am the first to agree that motivation is important. However, the significant element that is missing from wellness and engagement programs today is the most important ingredient required for successful habit change: ability.
Personal ability is sometimes described as self-efficacy: confidence or a belief in one's ability to change. Even when motivation is high, if self-efficacy is low or nonexistent, change doesn't happen.
One of the reasons many people lack confidence in their ability to change is related to their view of the locus of control over health habits and health outcomes.
Some people's worldview is that control over their lives lies outside of their power. They believe things happen to them and that other forces, such as fate or luck, are in control. People with this view naturally have little confidence that their actions directly affect their lives and their health.
In health care, the marketing and pharmaceutical campaigns, and the "doctor knows best" mindset of the medical profession, are pernicious forces that have led many people to believe that when it comes to their own health, control is in the hands of others.
For example, almost all diabetics are led to believe that diabetes is irreversible, although research from the Physicians Committee for Responsible Medicine has shown that up to two-thirds of newly diagnosed diabetics can fully reverse the condition within a few months by changing diet and exercise.
Misperception about role of genes
Similarly, countless people have been told that their high blood pressure, high cholesterol, cancer risk or other diseases are genetic (and therefore out of their control), leaving drug therapy as the only treatment option. I would argue that the misperception about the role of genes in health status is one of the biggest enemies to global improvements in health and one of the biggest friends to drug manufacturers and the sick-care sector in general.
Studies like the long-running Framingham Heart Health Study have shown that high cholesterol, high blood pressure, heart disease risk and other risk factors run in families. Certainly, standard medical practice now includes taking a family history because for hundreds of diseases, a family history is one of the main risk factors for your likelihood of developing a disease.
Yet, in apparent conflict, the Centers for Disease Control and Prevention, the Institute for the Future and others suggest that genes only control 20% of health outcomes, and that health habits and the environment control or predict 50% and 20%, respectively. This apparent conflict can be resolved by thinking more deeply about how we inherit disease from our parents.
The medical community often makes the profound error of confusing correlation with cause. High cholesterol may indeed run in families, but it is not necessarily true that high cholesterol is caused by genetic inheritance. It might be true that we suffer some of the same health outcomes as our parents, but it is often because we practice the same habits and not solely because we share their genes.
So, next time a physician says, "It's probably genetic, here's a script to help you control your [insert condition here]," think twice and consider changes in habits as a first step. When people realize they have more control over their health outcomes than previously realized, wellness programs and change initiatives become attractive, empowering vehicles to regaining health.
Thus, while motivation is important, all the motivation in the world counts for nothing if people believe that they simply have no power to change things or to affect their own health. Wellness programs must think about both motivation and ability if they hope to really drive high and sustained levels of engagement.
Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care and wellness. He can be reached at
