How can you resolve to change in 2013? With a community. The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online, and to highlight some of the great resources, we’ve excerpted Prathibha Varkey, MD, MPH, MHPE’s Mayo Clinic Preventive Medicine and Public Health Board Review below.
Community and population health can be enhanced by recognizing the different levels of influence, namely intrapersonal, interpersonal, and organizational influences. More recently, attention is being paid to the importance of interpersonal influences through the study of social networks. Smoking cessation rates of individuals increase as more contacts in their social network quit smoking, and individuals gain weight as more contacts in their social network gain weight. Another example of social influence is an after-school program for teenagers that may not change attitudes but may reduce the opportunity to engage in risky behaviors. Organizational support for behavior change can be in the form of higher taxes on tobacco or alcohol, building recreational centers to enhance physical activity, cleaning up the environment (in one study, neighborhood deterioration was a better predictor of sexually transmitted disease than low education attainment), and using or regulating message delivery by the media.
Bringing about change at the population level may follow the principles of diffusion of innovation, as described by Everett Rogers. In this model, the social system comprises five adopter categories: (1) innovators, (2) early adopters, (3) early majority, (4) late majority, and (5) laggards. Innovators are important for change because they get the process started, but they are not very influential because too much uncertainty about the changed behavior still exists when they adopt the change. The early adopters are key to diffusing an innovation; this group tends to include the opinion leaders, and others usually solicit their advice about new innovations. This model of diffusion of innovation predicts whether innovations and change will be successful on a large scale.
How rapidly an innovation will be diffused depends on the characteristics of the innovation, how it is communicated, and the social system. The characteristics of innovation that determine its speed of adoption include its perceived relative advantage over current practice, compatibility with current practices and needs of the adopters, ease of use (simple vs complex), “trialability” (testable on a small scale), and observability (visibility of results).
The principles of this model can be useful for predicting behavior change or diffusion of best practices at the community or population level. For example, screening mammography has been widely adopted by physicians because it is perceived to detect early stage breast cancer, the test is easy for physicians to order, patient compliance is not burdensome, and results are visible in a short time. In contrast, smoking cessation counseling has been slower to diffuse because the results are not as visible (most people will not quit when advised to do so), the intervention is more complex than just ordering a test, and physician practices are not geared toward counseling.
- Intrapersonal, interpersonal, and organizational influences affect community and population health.
- Health changes at the population level may propagate in a manner predicted by the principles of diffusion of innovation.
A comprehensive and concise review of relevant preventive medicine and public health topics, the Mayo Clinic Preventive Medicine and Public Health Board Review is an ideal study guide for residents preparing to take the examination of the American Board of Preventive Medicine for the first time, as well as for physicians preparing for recertification. Its emphasis on evidence-based information and recommendations makes Mayo Clinic Preventive Medicine and Public Health Board Review a credible, practical resource that can be used in clinical, public health, and academic settings
The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.
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It’s that time again: time to set resolutions and goals for ourselves as we enter the New Year. In this excerpt from Pursuing the Good Life, the late Christopher Peterson puts the spotlight on Benjamin Franklin, encouraging us to take the statesman a little more seriously… not for his political or scientific achievements, but for the way he set and cultivated his personal goals. Peterson shows that whether our resolutions are set in the beginning of January or halfway through the year, Franklin’s approach is one that we can all take some notes from.
Net worth to the world is usually determined by what remains after your bad habits are subtracted from your good ones. —Benjamin Franklin
I am writing this reflection on the last day of the year. Have you made any New Year’s resolutions? I just read an article on the most typical resolutions made by adults in the United States, and I was struck by how many of them embody the strengths of character that have been the subject of my research: spending more time with friends and family (love), saying no to cigarettes and alcohol (self-regulation), getting organized (prudence), learning something new (love of learning), helping others (kindness), getting fi t and losing weight (perseverance), and so on. Another common resolution is climbing out of debt, which in today’s world probably requires creativity coupled with good judgment.
If you want to make your resolutions happen, I suggest one more: taking Benjamin Franklin seriously.
Benjamin Franklin (1706–1790) is of course widely acclaimed as a statesman and scientist, but he may also deserve credit as America’s fi rst positive psychologist. Not only did he enumerate 13 praiseworthy character strengths (virtues), but he also took on the challenge of cultivating each of them, using himself as a research subject (Franklin, 1791/1962).
Franklin characterized each of the virtues of interest to him in terms of what he called their precepts . In modern psychological language, these precepts were behavioral markers of the virtue in question. For example, the precepts for industry were “lose no time; be always employ’d in something useful; cut off all unnecessary actions” and for temperance were “eat not to dullness; drink not to elevation” (p. 67).
From my perspective, too many of Franklin’s precepts are phrased in terms of what a person should not do, refl ecting his concern with what contemporary virtue ethicists call corrective virtues , those that protect against human inclinations to act in bad ways. But good character is not simply the absence of bad character. Just because people refrain from mean-spirited actions does not make them kind, any more than being free from anxiety or depression necessarily makes people happy.
Nonetheless, the value of his precepts is that they are behavioral, observable, and countable. The goals they represent are hard and specifi c, which modern psychologists know are more effective in motivating change than the vague “do your best” (DYB) goals that many of us have.
Franklin’s own program of character cultivation was prescient. He recognized that exhortation would not suffi ce to change anyone, including himself, which is a point still not fully grasped by some proponents of today’s character education. Merely hanging a character-relevant poster on a classroom wall (or for that matter, the Ten Commandments) will not lead to change.
I spent my elementary school years staring daily at the periodic table of elements, and that did not make me into a chemist or even into a passable student of chemistry. What is needed is a concrete strategy of changing behavior. Franklin believed, as do I, that most people want to be good and decent. The problem is that we may not know how to do it. One does not tell a depressed patient simply to cheer up or a person prone to procrastination to just do it. If they knew how to be cheerful or how to get things done, then they would do so. What is more helpful is to tell them how to do these things. The same point applies to the cultivation of strengths of character.
Franklin also recognized that it would be too daunting to attempt to strengthen all virtues at the same time, so he prioritized them and tackled them in order. He further observed that the strengthening of one virtue might help with the subsequent cultivation of other virtues. For example, Franklin reasoned that the virtue of moderation should facilitate the virtue of silence, given that the latter requires the skills involved in the former.
Anticipating the modern behavior change strategy of “objectively” monitoring progress, Franklin made a book, with one page for each of the virtues he wished to strengthen. He organized each page by the day of the week. At the end of each day, he would think back over his actions and make “a black mark” if he had failed in following the precept. Again, I gently criticize Franklin for emphasizing his transgressions rather than his positive accomplishments, but that followed from the way he defined the precepts for each virtue.
He resolved to address one virtue per week, in the order he had prioritized, so that in 13 weeks he would have addressed all of them in succession. Then he would do it again, and in a year he would have completed four courses. Again, this is very modern, because Franklin anticipated the need for the maintenance of change.
His goal was to have a clean book, and to help him along the way, he included in his log relevant maxims and prayers, much as people today use Post-Its on their refrigerator to keep their goals front and center. For example, my own refrigerator door has a Post-It asking “Are you really that hungry?”
Franklin judged his program a success, in that he accorded himself fewer black marks as time passed. Still, some virtues were harder for him to strengthen than others. In particular, the strength of order gave him great trouble, as he was wont to scatter about his things and could typically rely on his good memory to know where things were amidst chaos. (Does this sound familiar to any of you readers?) In any event, he decided he was incorrigible with respect to this virtue and decided to accept the fault as part of who he was. From a positive psychology perspective, this is okay. No one can have it all, although to Franklin’s credit, he tried to change before he accepted the less than desirable conclusion.
Franklin did fret that his “success” with respect to some of the virtues refl ected changes in the appearance of the character strength rather than in its reality, but from my vantage point, this is a diffi cult distinction to maintain if we regard character strengths as habits. “Fake it until you can make it” is one of the slogans of Alcoholics Anonymous, and it means that if we behave in a sober way, no matter how deliberate or stilted our initial attempts, then eventually we will be sober. We are what we do.
Appreciate that Franklin did all of this when he was 79 years of age!
In Pursuing the Good Life, one of the founders of positive psychology, Christopher Peterson, offers one hundred bite-sized reflections exploring the many sides of this exciting new field. With the humor, warmth, and wisdom that has made him an award-winning teacher, Peterson takes readers on a lively tour of the sunny side of the psychological street. Christopher Peterson was Professor of Psychology at the University of Michigan. One of the world’s most highly cited research psychologists and a founder of the field of positive psychology, Peterson was best-known for his studies of optimism and character strengths and their relationship to psychological and physical well-being. He was a frequent blogger for Psychology Today, where many of these short essays, including this one, first appeared.
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The post I resolve to take Benjamin Franklin seriously appeared first on OUPblog.
