Sara Johnson, Ph.D. , as Co-president and CEO, leads the Business Development and Strategy Initiatives for Pro-Change Behavior Systems. Sara brings to her role over twenty years of experience in developing behavior change solutions in a variety of domains, including weight management, smoking cessation, medication adherence, and medical education. She has been the principal investigator on over $6 million dollars of research in National Institute of Health grants to examine the effectiveness of trans-theoretical model-based interventions. She is currently leading new research initiative to integrate individual and culture-level interventions to enhance well-being, increase engagement with evidence-based mobile apps that promote behavior change, and to develop interventions for pain self-management, sleep, and financial well-being.
Interview with Sara Johnson
Mari Ryan: Welcome to the Workplace Well-being Essentials Series. I'm Mari Ryan, I'm the CEO and founder of Advancing Wellness. It's my pleasure to welcome you today to this expert interview, where we explore topics that impact employee well-being. My guest today is Sara Johnson. Sara, as Co-president and CEO, leads the Business Development and Strategy Initiatives for Pro-Change Behavior Systems. Sara brings to her role over twenty years of experience in developing behavior change solutions in a variety of domains, including weight management, smoking cessation, medication adherence, and medical education. She has been the principal investigator on over $6 million dollars of research in National Institute of Health grants to examine the effectiveness of trans-theoretical model-based interventions. She is currently leading new research initiative to integrate individual and culture-level interventions to enhance well-being, increase engagement with evidence-based mobile apps that promote behavior change, and to develop interventions for pain self-management, sleep, and financial well-being. Dr. Johnson also serves as the co-editor of The Art of Health Promotion in the American Journal of Health Promotion. She received her PhD in Clinical Psychology from the University of Rhode Island, and is currently an adjunct faculty member to the Psychology Department. She has nearly forty publications, including refereed research publications, book chapters, and published reports. Sara, I’m so excited to have you here as my guest today.
Sara Johnson: Well, it’s a pleasure to be here; thanks so much for the invitation.
Mari Ryan: Today we’re going to explore elements of behavior change, clearly something you are very familiar with and done a lot of research on. Behavior change programs are so common as part of workplace well-being programs, and yet many folks who are designing these programs struggle with them to make them effective and create long-term and effective behavior change. So, let’s explore a little bit about why is behavior change so hard?
Sara Johnson: That’s an excellent question, Mari, and I think we’ve both had that experience, both personally and professionally, that behavior change can be super-challenging. I think that’s in part because we’re often so hard on ourselves and on our participants with the expectation that everyone is prepared to change, and that a one-size-fits-all intervention will be equally effective for everyone, when in fact we now know that people vary tremendously in their willingness to make a change and that in fact tailored health behavior change interventions are much more effective.
Mari Ryan: Excellent, so what is the science behind behavior change then?
Sara Johnson: I think there’s no shortage of science behind behavior change. We draw heavily from the trans-theoretical model of behavior change, which is, of course, one really robust and leading model of behavior change, but we also have a number of other models and theoretical frameworks that in form the evidence that we use. For example, we rely heavily on principals of motivational interviewing and self-determination theory, as well as other communication models and frameworks, such as principals of persuasion and [indecipherable - 0:03:59.5] more recent work on principals of “pre-suasion.” [sic] If you haven’t read that book, I highly recommend that one. Then we add to that really well-established models about employee engagement and all those things together provide a robust foundation and a nice series of best practices that can truly inform the development of effective behavior change interventions.
Mari Ryan: With all those different elements of science, it certainly helps us understand why behavior change is so complicated.
Sara Johnson: Exactly!
Mari Ryan: So many different dimensions from which it can be examined.
Sara Johnson: Absolutely, so many different frameworks from which we can draw.
Mari Ryan: I can remember when I first came to the field of worksite health promotion, which was over a decade ago, I first learned about the trans-theoretical model of behavior change, and it just made such good sense to me, that everybody isn’t ready at exactly the same time, but taking that and translating that into programs that can help address the different stages of readiness is whole different approach. It’s something that is very different, and for some folks, difficult to do.
Sara Johnson: Absolutely, and I think that’s an excellent point. First of all, a lot of people are familiar with what is intuitive about the model, and this concept of readiness to change, but there is so much more happening under the surface because stage is just one of fifteen variables that’s incorporated into the model, that draws from so many theories and models of behavior change. So, it’s the intricacies of the interrelationships between stage of change and those other behavior change variables that helps create that individually tailored behavior change guidance that is so successful. That’s a really important point about the complexity of the application, and you have to add to that, too, you need large data sets from previous program participants to do the statistical analyses to determine which behavior change principals are in fact, most important at a particular moment in time, and to what extent they need to be used so that we can develop artificial intelligence operating on the back end to provide the exact right message at the right moment for participants. In fact, often what we see is people, unfortunately, unintentionally misusing the model. Rather than developing it to be all-inclusive and develop population-based interventions, we’ve seen some folks use it to screen people out of interventions. While I can see the appeal to that, we would really encourage people to use the model to be inclusive and to think about we can tailor messages, rather than exclude people from the programs that they so desperately need.
Mari Ryan: Let’s talk about that; is there a different approach for people at the different stages of change, and can you give some examples of what those might be?
Sara Johnson: For example, early on when individuals are in pre-contemplation, they may be using defenses like denial, or they may be demoralized about their past failed change attempts – I’ve tried quitting smoking a hundred times and I’ve tried every diet and I’m unable to lose weight. Or, they may be completely unaware of the problem; think of behavior, like sleep for example where so many Americans are completely unaware of what a huge health issue that is for them. There could be any number of reasons people are in that “not yet ready” stage, and some of the most important principals there would be things like raising the awareness of the important benefits of changing a particular health behavior, or providing information, or sharing stories that activate emotional arousal, stories of inspiration of people who were once where this participant now is, and who have been able to successfully adapt or change a health behavior. Whereas once individuals are further along that stage continuum … think about the actions [indecipherable - 0:07:54.6] for example, we are heavily relying on behavioral processes of change. We’re thinking of setting up a support system, modifying your environment and using substitutes – all of which are really common behavior change strategies that are much more appropriate for someone in the leader stage.
Mari Ryan: Excellent – really good description there, thank you for that. What role can employers play in helping employees change behavior for the long term? We hear a lot about the effectiveness of some programs for short-term behavior change, but it doesn’t stick. What’s the secret to the long-term change?
Sara Johnson: I think one secret is to think critically about the individual health behavior change programs that are being offered. Look for high-quality, evidence-based, theoretically-grounded behavior change programs that really incorporate best practices of behavior change. Then, surround those with a culture of well-being that is very intentional and very supportive so that, for example, if there is some sort of health behavior change program available, there isn’t someone looking sideways at employees for participating in it, that there’s a supportive culture that promotes work-life balance, promotes social connection, that promotes well-being, using vacation time, being off – all those sorts of things. Really, those two things need to work together and be offered in concert with one another, I think, to achieve maximum success.
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