Leveraging Customer Psychology for Powerful Communications – Part 1: Communicating to Strengthen Self-Determination

Table of Contents

• Introduction
• Self-Determination is Central to Motivation
• Is Belief in Yourself Linked to Improved Health Behavior?
• Communicating to Increase Peoples’ Self-Determination
• Take-Home Points

Introduction

In a prior post, we showed evidence for just how enormous the difference in persuasive power can be when we are communicating to a motivated audience of customers.  But of course, we all understand that not all customers are equally motivated to change their behavior.  For example, some physicians are content with the therapeutic tools they have for a given condition, while others may be on the lookout for the newest mechanism to drive better outcomes.  One patient might be motivated to keep her condition fully controlled in every way possible, while another might barely find the energy to do the bare minimum to keep the condition from being substantially disruptive.  However we define it, we all understand the power that motivation exerts in human life.  But can we influence it through our communications to customers?  We’ll use this post to share evidence that we can, in fact, do just that.  

Self-Determination is Central to Motivation

A great deal of research and accumulated evidence around human motivation centers on the question of whether individuals internalize a belief in their own capacity to make change.  As usual, the terminology around this concept is variable and includes expressions like self-efficacy (Bigsby & Albarracin, 2022) and perceived control (Fishbein & Ajzen, 2011).  I prefer to use the term self-determination because it fits comfortably with various theories and streams of supporting research in motivational psychology.   

Today, we know quite a bit about self-determination.  I find it helpful to distill this into three levels of analysis. 

• Durable Individual Difference:
  • From one person to another, humans differ systematically on the extent to which they see themselves as having direct personal control over the outcomes in their lives. We each have a fairly consistent tendency to either see ourselves as the author of our lives (intrinsic control) or as the passive recipients of what the outside world has to offer (extrinsic control).  Locus of control was first conceptualized in the 1960s but has proven to be one of the more durable and robust phenomena in motivation research.
  • Not surprisingly, people who have high intrinsic sense of control will tend to be more easily activated by communications about health behavior change.  Accumulated evidence also suggests that people with an internal locus of control deliberately engage in more healthy behavior and avoid less healthy behavior (see research summaries by Cheng et al (2016) and Dogonchi et al (2022)). 
• Learned Self-Determination:
  • It is also clear that a sense of agency can be learned or shaped (Ryan & Deci, 2000).  Across various types of behavior change, psychologists have demonstrated that self-determination can be scaffolded by reinforcing (1) personal salience (as in, I see the value in making this change), (2) personal competence (as in, I have the skills/abilities to make this change), and (3) personal autonomy (as in, I am in control of the decision to make this change). 
  • Communications and other interventions can substantially reinforce these components of self-determination, and thus increase motivation to change or engage in specific behaviors (Gillison et al, 2019).   
• Differences by Activity:
  • By dint of experience, peoples’ sense of self-determination varies across activities, with higher fluency being associated with a stronger sense of self-determination.  To put this plainly, if you have repeatedly done something, your belief in the ability to replicate the behavior is, of course, higher.  This is not a trite statement. For many behaviors, it does not take much repetition for people to begin to feel competent and self-determining. 

The visual below underscores the intersection of these different views on self-determination.  A simple way to think about the psychology of self-determination is that the closer you are to the intersection of these three areas (Point A), the less external support will be needed to get people to engage in productive behaviors.  Conversely, the farther you are from this intersection (Point B), the more external support is likely to be required to see behavior change. 

Figure 1.  Intersection of Views on Self-Determination

With these ideas in place, let’s turn to the practical matter of marketing.  In order for these ideas about self-determination to be useful, it seems to me that we need to answer two nested questions.

1. Is self-determination reliably linked to behavior change in healthcare settings?
2. IF YES:  Can self-determination be influenced by persuasive communication?

Is Belief in Yourself Linked to Improved Health Behavior?

As we have discussed in other posts, the general community of public health and clinical medicine practitioners continue to pay more attention to patient mentality as a driver of health outcomes.  With this increased attention, we have seen a huge surge in the study of how to help patients develop effective mental skills to support healthy behaviors.  Self-determination is one key aspect of this ongoing exploration, and the accumulated evidence suggests that it has strong links to productive health behavior.  A 2010 meta-analysis by Carpenter looked at the relationship between patients’ perceived barriers to behavior change and observed health-related behaviors.  The included studies featured a wide range of endpoints, including drug adherence, smoking cessation, increased exercise and various types of cancer screening.  Among the set of key predictors for health behavior engagement they analyzed, the largest effect by far was for the patient’s perception of whether or not they had the power to make the change.  In other words did they believe they had the self-efficacy to overcome obstacles and change themselves?  The finding is clear:  The more patients see themselves as having the capacity to make change in their lives, the greater the effect on downstream positive changes in health behavior.  They also demonstrated the effect for both prevention-related behaviors and treatment-related behaviors, which is consistent with the data we presented in our post entitled “Are Some Health Behaviors Harder to Shape With Marketing?”.  The data from Carpenter et al’s analysis that bear on the current question are presented in Table 1 below. 

Table 1.  Meta-Analytic Relationship between Perceived Self-Efficacy (Ability to Overcome Barriers) and Subsequent Health Behaviors

For most of us, these effects directionally align with our intuitions; however, the size of the effects is a bit startling.  Perception of one’s capacity to overcome obstacles related to health behavior is obviously a huge driver of whether the behavior actually comes about. 

Now we can turn to the second question:  Can we increase peoples’ feelings of self-determination through our communications? 

Communicating to Increase Peoples’ Self-Determination

I want to take a second to note that, for some readers, this topic might feel cringe-worthy.  Are we seriously talking about affirming peoples’ sense of agency or belief in their power to change themselves, as if we were attending a Tony Robbins workshop?  If you are feeling this way, it might surprise you to learn that this subject is taken very seriously by experts in health communication.  In fact, the range of controlled experiments and trials published on this topic is now so large that we need comprehensive meta-analyses to keep the findings organized.  With that in mind, let’s see what the data suggest. 

A 2019 meta-analysis by Gillison et al formally explored the potency of health-related interventions that were intended to reinforce various aspects of self-determination and motivation.  The researchers took an expansive view of different ways in which self-determination could be supported, which included techniques that fall outside bounds of what we could feasibly do in the context of marketing.  However, many were perfectly appropriate for our style of promotional campaigns.  These studies were generally controlled trials that involved actual in-clinic engagement with patients.  Table 2 summarizes the results of the synthesis and shows that communication interventions designed to support elements of self-determination have fairly strong effects on perceptions of the individual’s capacity to engage in or sustain the targeted health behaviors.  In many cases, the interventions involve simple messages that are focused on providing information about the disease or the behavior, the underlying reason why the behavior change is effective, or reinforcing the idea that the patient has the power to succeed at the behavioral goal.  Thinking back to our introduction to the psychology of self-determination, these findings underscore the point that even if you are not born with that intrinsic locus of control, we can move the needle by helping people to perceive themselves as capable and effective. 

Table 2.  Effects of Interventions Designed to Support Self-Determination

Another meta-analysis (Dorgeat et al, 2022) followed a similar vein by looking at the effects of messaging to children living with a range of long-term (largely congenital) conditions.  The authors looked at a range of communication styles and media channels (including Web-based platforms, text-based approaches and video games) all intended to help children improve on various condition-related outcomes.  Among these were their health-related locus of control and their perception of self-efficacy.  The meta-analysis revealed that, on average, the interventions resulted in a substantial and significant increase in the children’s self-evaluated sense of control.  The mean effect size (r_ES) was .25, which is on the higher end of the types of communication effects we have examined in this series of posts.  Interestingly, the authors found similar effects for accumulated knowledge, which suggests that increased understanding of the condition may be related to feelings of empowerment and self-efficacy. 

So, if we know that high internal agency is related to better health behaviors, and we know that we can use persuasive messaging to increase an individual’s sense of self-determination, can we pull that idea all the way through and change behaviors by communicating to bolster self-determination?  A 2015 meta-analysis by Sweeney and Moyer examined how both intended and observable health behaviors responded to communications that emphasized (or affirmed) self-efficacy in various ways.  They looked at a diverse range of behaviors from cessation-related topics like smoking, alcohol and caffeine, to prevention-related behaviors such as exercise, diet, the use of sunscreen and condom use.  They found that communications that involved reinforcement of self-efficacy had incremental potency on behavior change compared with generic health messages.

Table 3.  Incremental Effects of Communications Targeting Self-Efficacy

If you refer to some of our previous posts on healthcare communication effects on behavior, it will help you to grasp the magnitude of these effects.  Communicating to reinforce a sense of self-determination has effects that are roughly double that of normal tailored communications in healthcare (e.g., those tuned to demographics).  Pretty solid. 

Take-Home Points 

Looking at all these results collectively, I’m struck by the consistency and potency of the effects.  For many of us, the idea of “self-determination” might be regarded as falling on the “softer” side of behavioral science.  But the effects we observe on executed health behavior when comparing those who have it versus those who don’t are substantive.

• People who see themselves as capable of overcoming barriers and executing health-related behaviors are 2 to 3 times more likely to actually respond favorably to persuasive communication.
  • Understanding where customers fall on this continuum may provide helpful context in several types of market research
• Persuasive communications that reinforce this characteristic of self-determination actually work.  Evoking self-determination can have significant downstream effects in terms of behavior change – roughly doubling the effect of ordinary tailored communications. 
• The data on self-determination effects represent good news for marketers who want to use persuasive communication to create positive effects in the lives of their customers. 

Relevant Topic:  If this post felt a bit too upbeat and aspirational for you, don’t worry.  We also explain the potency of another major aspect of motivation that represents a powerful lever for marketers: the power of fear in the post “Leveraging Customer Psychology for Powerful Communications – Part 2: Fear as a Lever for Behavior Change“.    

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