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Center for Health Literacy Promotion Blog

The Role of Motivation in Health Literacy Promotion

Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.
Nutbeam, D. (1998). Health promotion glossary. Health Promotion International, 13(4), 349-364

Health literacy involves skills, motivation and action.  Research has focused on skills used to gain knowledge, mostly reading, less often numeracy (math).  The presumption is that these basic literacy skills leads to understanding which leads to knowledge, which leads to appropriate health decisions which lead to right action. But experience teaches that knowing what to do is far from deciding to do it and deciding is a long leap from action.
Motivation is the impetus that moves a parent or a patient from understanding to action.  It’s what takes health literacy out of the purely cognitive realm. Finding the motivation is the first step a health literacy promoter takes to empower a person to take action for health.
Ask before telling
Telling a mother she needs to loose weight to reduce risk of developing heart disease decades from now is not likely to motivate her to change habits that bring her comfort and joy every day. Nor is it likely to encourage her to give up the protection her size may afford her.  It is more likely to motivate her to shut her ears and wait for you to stop talking.
Key Question #1: What do you want and how will you know you go it?
Finding her motivation requires asking a reflective question, rather than telling her what to do. A reflective question makes her think about facts and feelings and link to her experience.  Gail is a new mother having trouble shedding extra weight gained during pregnancy. I asked her  “What would be different if you were at your ideal weight?”
As you might anticipate, Gail’s immediate answer was “I dunno?” She’s not thinking yet. To help her imagine in detail I asked, “What would you see that you don’t see now?”  I could see her thinking turn on as she replied,  “I’d see myself wearing pretty clothes.”  Now we getting somewhere.  “What would you hear that you don’t hear now?” Responding faster now, she said, “I hear compliments from my husband.”  Another motivation. “What would do that you don’t do now?”  Gail said with a hint of a smile, “Oh, I’d run and play with my kids and I’d carry the laundry up the stairs without huffing and puffing.”  
This bit of reflective conversation has enabled Gail to articulate her reasons for managing her weight, to envision the rewards for doing what it takes, to define what she wants and how she will know she’s got it. Now we can focus on that picture of her in pretty clothes enjoying the attention of her husband and playing with her children. To keep her motivated and in action, we agreed to mark progress by her jeans size and how many times she rests on the way up the stairs, rather than by the scale that she says always makes her feel like a failure. As Robert Fritz writes, “The difference in motivation makes all the difference in effectiveness, experience, and orientation.”
Next time you’re having trouble “getting her to lose weight”, (or to take some other action for health) notice that’s what you want and that efforts to get her to do something are manipulation, not motivation. Then ask her what she wants. Just see what happens. ss
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072-2078
Emerald, D. (2006). The power of TED: The Empowerment Dynamic. Bainbridge Island, WA: Polaris Press.
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